Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis. (+info)
Frame dislocation of body middle rings in endovascular stent tube grafts.
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OBJECTIVES: To understand the cause, and propose a mechanism for frame dislocation in endovascular grafts. MATERIALS AND METHODS: Five tube grafts were explanted due to secondary distal leakage 15-21 months after operation. One bifurcated graft was removed during emergency operation after aortic rupture caused by secondary leakage. A second bifurcated graft was harvested from a patient with thrombotic occlusion of one limb, who died after transurethral prostatic resection. The inside of the grafts were examined endoscopically. The stent was inspected after removal of the fabric, broken ligatures were counted and examined by scanning electron microscopy. The fabric strength was tested by probe puncture. RESULTS: We found 17-44% of the stent ligatures of the body middle rings to be loose. The knots were intact. Degradation of the polyester textile was not observed. CONCLUSIONS: Continuous movements in the grafted aorta and blood pressure impose permanent stress to the stent frame and the polyester fabric resulting in morphological changes in the body middle ring of grafts. The clinical implications of the suture breakages are unknown although they may be related to distal secondary leakage in tube grafts. (+info)
Fibroin allergy. IgE mediated hypersensitivity to silk suture materials.
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Delayed-type hypersensitivity with granulomatous lesions to silk sutures is rather rare. Yet, braided silk sutures often act as a non-immunologic foreign-body and cause a granulomatous inflammatory reaction years after surgery. We report here a case of recurrent granulomas with remarkable infiltration of eosinophils that may have resulted from an IgE-mediated hypersensitivity reaction to silk fibroin, a component of the braided silk suture. Under normal circumstances exposure to fibroin is rather rare. Therefore, the present patient may have developed this reaction to the silk sutures used in a previous surgery. (+info)
Corneal wound healing in tenascin knockout mouse.
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PURPOSE: Tenascin (TN) is a large hexameric extracellular matrix glycoprotein that is expressed in developing organs and tumors. It has also been reported that TN is expressed in the embryonic cornea and during corneal wound healing. However, the role of TN in the cornea is not fully known. In this study, the role of TN in corneal wound healing was examined using the TN knockout (KO) mouse. METHODS: Two different injuries (a linear perforation wound and two 10-0 nylon suture wounds) were made separately on the corneas of both TNKO and congenic wild-type mice. The corneal wound healing was compared histologically, and the expression of TN and fibronectin (FN) on the injured cornea was examined immunohistochemically and by immunoblot analysis. RESULTS: Based on histologic analysis, there was no significant difference in the wound healing process between wild-type and TNKO mice in the linear incision experiment. However, the corneal stromata of TNKO mice were compressed prominently and devoid of migrating keratocytes in suture injury, which induced a more significant amount of TN than perforation wounds. Although FN expression on the sutured corneas of TNKO mice was upregulated during suture injury, the amount of FN protein was smaller than that of wild-type mice at the same time points after injury. CONCLUSIONS: In suture wounds, TN appears to enhance the amount of FN expression, and a lack of TN may impair stromal cell migration. TN plays a significant role in corneal wound healing, especially for wounds with mechanical stress. (+info)
Outcomes of irradiated polyglactin 910 Vicryl Rapide fast-absorbing suture in oral and scalp wounds.
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BACKGROUND: This study evaluated the outcome of wounds closed with irradiated polyglactin 910 (IRPG) Vicryl Rapide (Ethicon, Somerville, N.J.). METHOD: Seventy-one patients with 80 oral wounds and 42 patients with 42 scalp wounds closed with IRPG were evaluated on the day of surgery, then one, seven, 14, 28 and 90 days following surgery. The incidence of inflammation, suppuration and hypertrophic scarring was recorded, along with the timing of spontaneous suture disappearance. This suture material was compared with polytetrafluoroethylene (PTFE) sutures used in dental implant patients, traditional polyglycolic acid (PGLA) sutures used in osteotomy patients and skin staples used in patients with scalp wounds. RESULTS: In the group with intraoral wounds, there were two cases of suppuration with no inflammatory reactions or hypertrophic scarring when IRPG sutures were used, compared to three cases of suppuration with the traditional PGLA sutures. In the group with scalp wounds, there was no suppuration or hypertrophic scarring with IRPG sutures and one inflammatory reaction with skin staples. IRPG sutures never required removal, while all staples, PGLA and PTFE sutures eventually required separate removal. CONCLUSION: Irradiated polyglactin 910 Vicryl Rapide is a useful suture material with both intra- and extraoral applications in the pediatric and adult populations. (+info)
Video-assisted replacement or bypass grafting of the descending thoracic aorta with a new sutureless vascular prosthesis: an experimental study.
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PURPOSE: The feasibility of the video-assisted insertion of a new sutureless vascular prosthesis was studied. METHODS: Seven sheep, weighing 25 to 35 kg, were operated on under general anesthesia. The animals were intubated with a single-lumen endotracheal tube and placed in the right lateral decubitus position. A thoracoscope was introduced in the 11th intercostal space, and a minithoracotomy (4 to 5 cm) was performed in the seventh intercostal space. After retraction of the lung, a short segment (10 cm) of the descending thoracic aorta was exposed. Our prosthesis was made of Dacron and was specifically designed to be inserted without a suture. After systemic heparinization, the aorta was cross-clamped with two vascular clamps introduced into the thoracic cavity through two 5-mm thoracic incisions. The aorta was either replaced (five cases) or bypass grafted (two cases). At the completion of the procedure, blood pressure was pharmacologically increased (5 mg intravenous bolus of epinephrine), and each anastomosis was checked for bleeding. All animals were killed, and the prosthesis was retrieved for macroscopic examination. RESULTS: The procedure was completed in each case without extension of the minithoracotomy. Insertion of the prosthesis was easy and fast, and completion of each anastomosis required 10 to 15 minutes. A 3- to 4-mm space between each clip was sufficient for proper attachment. All procedures were performed in less than 120 minutes. No bleeding was observed at the level of each anastomosis, even when a sustained high blood pressure was induced. The proper insertion of the prosthesis and the absence of any anastomotic stenosis was confirmed by means of macroscopic examination. CONCLUSION: Video-thoracoscopic replacement or bypass grafting of the descending thoracic aorta was easy with this new sutureless vascular prosthesis. Minimally invasive vascular surgery might be facilitated with such a prosthesis. However, long-term animal studies are required before human implantation can be undertaken. (+info)
Anastomotic tissue response associated with expanded polytetrafluoroethylene access grafts constructed by using nonpenetrating clips.
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PURPOSE: The gross, light microscopic, and scanning microscopic appearance of arterial and venous anastomoses in expanded polytetrafluoroethylene (ePTFE) access grafts constructed with nonpenetrating clips were compared with that of those constructed with polypropylene suture. We hypothesized that clip-constructed anastomoses would provide controlled approximation of native vessel intimal and medial components with the ePTFE grafts. We further hypothesized that anastomotic healing with clips would involve primarily an intimal cellular response, as compared with suture-constructed anastomoses in which cells within the media and adventitia walls participate. METHODS: Femoral artery to femoral vein arteriovenous (AV) grafts were constructed in five dogs using 4-mm internal diameter ePTFE graft material. Each animal received one AV graft with anastomoses constructed by using polypropylene sutures in one leg and one AV graft with anastomoses constructed with Vascular Closure System clips in the contralateral leg. Animals were given aspirin for the duration of the study, and grafts were explanted at 5 weeks. At the time of explantation, graft segments were grossly evaluated and then underwent light and scanning electron microscopic analysis. RESULTS: At the time of explantation, all access grafts were patent. Joining the ePTFE grafts to the native vessels with clips resulted in minimal vessel wall damage. The lumenal contours of the discontinuous approximation were smooth and without gross endothelial disruption. These observations are in contrast to the lumenal compromise and endothelial disturbance associated with the sutured anastomoses. Furthermore, hemostasis was achieved immediately in the clipped grafts, decreasing the incidence of perianastomic hematoma. Finally, cellular reconstitution occurred at the anastomotic cleft in both the sutured and the clipped junctions. The neointima exhibited an endothelial cell lining on the lumenal surface and the presence of alpha-smooth muscle cell actin positive cells within the subendothelial layer. CONCLUSION: Vascular Closure System clips are a viable alternative to suture for the approximation of ePTFE AV access grafts to native blood vessels. The use of the clips resulted in a more streamlined anastomosis, with decreased vessel wall damage, immediate hemostasis, and a trend toward shorter procedure times. (+info)
Tissue plasminogen activator (tPA) deficiency exacerbates cerebrovascular fibrin deposition and brain injury in a murine stroke model: studies in tPA-deficient mice and wild-type mice on a matched genetic background.
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Although the serine protease, tissue plasminogen activator (tPA), is approved by the US Food and Drug Administration for therapy to combat focal cerebral infarction, the basic concept of thrombolytic tPA therapy for stroke was challenged by recent studies that used genetically manipulated tPA-deficient (tPA-/-) mice, which suggested that tPA mediates ischemic neuronal damage. However, those studies were potentially flawed because the genotypes of tPA-/- and wild-type control mice were not entirely clear, and ischemic neuronal injury was evaluated in isolation of tPA effects on brain thrombosis. Using mice with appropriate genetic backgrounds and a middle cerebral artery occlusion stroke model with nonsiliconized thread, which does lead to microvascular thrombus formation, in the present study we determined the risk for cerebrovascular thrombosis and neuronal injury in tPA-/- and genetically matched tPA+/+ mice subjected to transient focal ischemia. Cerebrovascular fibrin deposition and the infarction volume were increased by 8.2- and 6. 7-fold in tPA-/- versus tPA+/+ mice, respectively, and these variables were correlated with reduced cerebral blood flow up to 58% (P<0.05) and impaired motor neurological score by 70% (P<0.05). Our findings indicate that tPA deficiency exacerbates ischemia-induced cerebrovascular thrombosis and that endogenous tPA protects the brain from an ischemic insult, presumably through its thrombolytic action. In addition, our study emphasizes the importance of appropriate genetic controls in murine stroke research. (+info)