Bekler, Halil İbrahim | Rosenwasser, Melvin P. | Akılına, Yelena | Bulut, Güven

Other | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 2 ) , pp.157 - 161

Amaç: Otolog ven greftleri periferik arter köprüleme (bypass) işlemlerinde kullanılmaktadır. Greftin aniden arteryel kan basıncına maruz kalması, ven duvar basıncında artışa yol açarak greftte aşırı gerilmeye ve akımda değişikliklere neden olur. Vendeki aşırı gerilmeye sıklıkla anastomozda sızıntı, trombüs oluşumu ve akım kaybı eşlik eder. Bu çalışmada, sıçan modelinde arter köprülemede kullanılan ven greftlerine eriyebilir kolajen örtü uygulamasının grefti koruyucu etkisi araştırıldı. Çalışma planı: Çalışmada, ağırlıkları 250-350 gr arasında değişen, Sprague-Dawley cinsi 22 dişi sıçan kullanıldı. Sıçanlar çalışma (n15) ve kontrol ( . . .n7) grupları olarak rastgele iki gruba ayrıldı. Tüm sıçanlarda, sol femoral venden 10 mm’lik bir segment greft olarak alınarak sağ femoral arter kesisi ven greftiyle onarıldı. Kontrol grubunda başka bir işlem uygulanmadı. Çalışma grubunda onarım tamamlandıktan sonra, ven grefti uygun uzunlukta bir kolajen örtü (Neurawrap Nerve Protector) ile sarıldı ve ven grefti etrafında bir tüp oluşturacak şekilde dikildi. İşlem sonunda kanama yoğunluğu ve süresi ile damar açıklığı kaydedildi. Proksimal ve distal arter segmentleri Doppler ultrasonografi ile incelendi. Tüm gözlem ve ölçümler ameliyattan 1 ve 2 saat sonra tekrarlandı. İkinci saatin sonunda tüm sıçanlar kurban edilerek, arteryel bölümleri ile birlikte ven greftleri histolojik çalışma için çıkarıldı. Sonuçlar: Kontrol grubunda, damar klemplerinin çıkarılmasından sonra tüm ven greftlerinde ani şişme gözlendi. Bu gruptaki tüm deneklerde, anastomoz hattında 1-3 dakika süren kanamayı greftlerin balonlaşması izledi. Çalışma grubunda ise hiçbir ven greftinde şişme ve balonlaşma görülmedi. Bu grupta 11 örnekte herhangi bir kanama görülmezken, diğer dördünde kanama zamanı 1 dakikanın altındaydı. Kontrol grubunda, iki saat sonra yedi greftin sadece biri açıktı, biri daha 3. dakikada tıkandı. Çalışma grubunda ise greftlerin tümü açıktı, hiç tromboz gelişmedi. Doppler incelemede ortalama kan akım hızı kontrol grubunda 0. saatte proksimal arterde 0.930.33 cm/sn, distal arterde 0.730.44 cm/sn ölçüldü. Çalışma grubunda, proksimal ve distal arter kan akımı hızları 0, 1 ve 2 saat sonunda sırasıyla 0.450.27 ve 0.460.22 cm/sn, 0.400.22 ve 0.620.40 cm/sn, 0.550.22 ve 0.640.37 cm/sn idi. Çıkarımlar: Ven greftlerinde aşırı gerilmenin dışarıdan örtü desteğiyle önlenmesi, anastomoz sızıntısını azaltır, intimal mediayı korur, akımın devamını sağlar, tromboz oluşumunu azaltır ve greftin açık kalmasını sağlar. Objectives: Autologous interpositional vein grafts are used in peripheral arterial bypass procedures. Sudden exposure of vein grafts to arterial blood pressure is associated with increased wall tension leading to overdistension of the graft and changes in flow patterns. Overdistension of vein grafts often results in anastomotic leaks, thrombosis, and loss of patency. This study was designed to evaluate the use of a biodegradable collagen cover as a means of preventing overdistension of venous bypass grafts in a rat model. Methods: Twenty-two Sprague-Dawley female rats weighing 250-350 g were randomly assigned to two groups: study group (n 15) and control group (n7). In all the rats, a 10-mm segment of the left femoral vein was harvested and used as a graft in repair of a right femoral artery injury. Following this procedure, control rats remained untreated. After completion of the femoral artery repair in the study group, the graft was wrapped with a collagen cover of appropriate length (NeuraWrap Nerve Protector) and sutured to form a tube around the vein graft. At the end of the procedure, the intensity and duration of bleeding, and vessel patency were recorded and the proximal and distal arterial segments were examined by Doppler ultrasonography. All observations and measurements were repeated at 1 and 2 hours after surgery. After the second hour, all the rats were sacrificed and vein graft samples with the arterial portions were removed for histological study. Results: After removal of the vascular clamps of the control group, a sudden distension was observed in all the vein grafts. In this group, bleeding at the anastomosis site lasted for 1 to 3 minutes and was followed by ballooning of the grafts. In the study group, however, none of the samples exhibited distension and ballooning. There was no bleeding in 11 samples at all, and bleeding time was less than one minute in the remaining four samples. In the control group, only one graft was patent at two hours, one of the grafts was occluded after only three minutes. In the study group, all the grafts were patent and no thrombosis was noted. The mean blood flow velocity of the control group measured at 0 hour by Doppler ultrasonography was 0.93±0.33 cm/sec in the proximal artery, and 0.73±0.44 cm/sec in the distal artery. The mean blood flow velocities in the proximal and distal arteries of the study group were as follows, respectively: at 0 hour: 0.45±0.27 and 0.46±0.22 cm/sec; at 1 hour: 0.40±0.22 and 0.62±0.40 cm/sec; and at 2 hours: 0.55±0.22 and 0.64±0.37 cm/sec. Conclusion: Prevention of overdistension of vein grafts with the use of an external cover decreases anastomotic leaks, protects the intimal media, maintains blood flow, reduces the incidence of thrombosis, and thus provides a higher patency rate Daha fazlası Daha az

Servet, Erkan | Bekler, Halil | Kılınçoğlu, Volkan | Özler, Turhan | Özkut, Afşar

Other | 2016 | Acta Orthopaedica et Traumatologica Turcica50 ( 2 ) , pp.234 - 241

Objective: Epineural scar formation is one of the most significant negative factors affecting surgical repair after peripheral nerve injury. The scar tissue mechanically hinders axonal regeneration and causes adhesions between nerves and surrounding tissues. A hemostatic agent Ankaferd Blood Stopper (ABS; İmmun Gıda İlaç Kozmetik San. ve Tic. Ltd. Şti., Istanbul, Turkey) has not been previously used. Decreasing the postoperative bleeding and adhesions between nerve and surrounding tissues will prevent the formation of scar tissue, as well as corresponding compressive neuropathy and/or deceleration of axonal regeneration. The . . .purpose of this experimental study was to investigate the effects of bleeding on nerve healing and scar tissue after repair of peripheral nerve injuries.Methods: The right sciatic nerve of 30 Sprague-Dawley male rats (weighing 260-330 g) was cut 1.5 cm proximal to the trifurcation and repaired primarily with 8/0 sutures using epineural technique. The rats were then divided into 3 groups. Saline was applied in Group 1 (n10), ABS in Group 2 (n10), and heparin in Group 3 (n10) for 5 minutes to the repair site and surrounding tissues. In each group, electrophysiological measurements were performed with electromyography (EMG) at postoperative week 12. Magnetic resonance diffusion tensor imaging was used at week 12. Macroscopical and histopathological evaluations were conducted after sacrificing the rats at week 24 with total excision of the repaired sciatic nerves and surrounding tissues.Results: The ABS and saline groups showed better healing than the heparin group. The ABS and saline groups were better in the histopathologic evaluations, but there was no statistically significant difference between the 2 groups.Conclusion: Statistically significant differences were not found between the 3 groups. Significant results may be obtained with larger studie Daha fazlası Daha az

Sever, Celalettin | Uygur, Fatih | Külahçı, Yalçın | Torun, Gamze Köse | Urhan, Muammer | Küçükodacı, Zafer | Çaycı, Tuncer

Other | 2010 | Acta Orthopaedica et Traumatologica Turcica44 ( 5 ) , pp.403 - 409

Amac: Bu deneysel calışmanın amacı hidroksiapatit (HA) seramik bloklarına mezenkimal kok hucre, vaskuler pedikul ve hiperbarik oksijen tedavisi (HBOT) uygulanarak, sıcanlarda vaskularize kemik prefabrikasyonunun gercekleştirilmesidir. Calışma planı: Calışmada 45 adet erkek Sprague-Dawley sıcan, her birinde 15 sıcan olan uc gruba ayrıldı. Tum gruplarda HA seramikleri yuzeyel inferior epigastrik arter ve ven ile pedikulize edildi. Grup 2’de HA seramiklerinin icine mezenkimal kok hucre implantasyonu yapıldı. Grup 3’te ise hem mezenkimal kok hucre hem de HBOT uygulandı. Yeni kemik oluşumu ve neovaskularizasyon varlı.ı ve derecesi radyol . . .ojik, mikroanjiografik, sintigrafik, biyokimyasal ve histomorfometrik yontemler ile de.erlendirildi. Sonuclar: Neovaskularizasyon ve yeni kemik oluşumu en fazla, mezenkimal kok hucre implantasyonu yapılan ve takiben HBOT uygulanan Grup 3’te goruldu. Cıkarımlar: HBOT, neovaskularizasyon ve yeni kemik oluşumunu artırır, bu nedenle vaskulerize kemik greftlerinin optimal ve hızlı kemik prefabrikasyonunu sa.layabilir. using the interconnected porous coralline hydroxyapatite ceramic by combining vascular bundle implantation, mesenchymal stem cells, and hyperbaric oxygen therapy (HBOT) administration in a rat model. Methods: Forty-five male Sprague-Dawley rats were divided into three groups, each containing 15 rats. The hydroxyapatite ceramics were vascularized by the superficial inferior epigastric artery and vein in all groups. These vessels passed through the hole of the hydroxyapatite blocks. In Group 2, mesenchymal stem cells were administered into the hydroxyapatite. In Group 3, both mesenchymal stem cells and HBOT were administered. The presence and density of any new bone formation and neovascularization were evaluated by radiography, microangiography, scintigraphy, biochemical analysis, and histomorphometry. Results: Neovascularization and bone formation were significantly greater in Group 3, in which both mesenchymal stem cells and HBOT were applied, than the other groups. Conclusion: HBOT enhances neovascularization and osteogenesis, thus HBOT can provide optimal and faster prefabrication of a vascularized bone graft Daha fazlası Daha az

Uluçay, Çağatay

Other | 2009 | Acta Orthopaedica et Traumatologica Turcica43 ( 3 ) , pp.284 - 285

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Özler, Turhan | Uluçay, Çağatay | Önal, Ayberk | Altıntaş, Faik

Other | 2015 | Acta Orthopaedica et Traumatologica Turcica49 ( 3 ) , pp.255 - 259

Objective: Prevention of deep venous thrombosis (DVT) and associated pulmonary embolism following major orthopedic surgeries is challenging, and there is an increased interest in developing new treatment strategies. We compared 2 switch-therapy modalitiesenoxaparin to rivaroxaban and enoxaparin to dabigatranand enoxaparin monotherapy for preventing DVT after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods: This was a prospective, non-blinded, randomized controlled study. We selected 180 eligible patients out of 247 patients undergoing TKA or THA. During the preoperative checkup, patients were randomized to re . . .ceive either enoxaparin (enoxaparin group) or switch-therapy regimens, comprising enoxaparin during hospitalization and rivaroxaban (rivaroxaban group) or dabigatran (dabigatran group) during the outpatient period. All patients were evaluated for DVT using Doppler ultrasonography (USG) 6 weeks postoperatively. The primary efficacy outcome was the prevention of symptomatic or Doppler ultrasonography (USG)-proven DVT, whereas the primary safety outcome was the incidence of bleeding during the DVT-prophylaxis period. Results: Doppler USG at 6 weeks after surgery revealed no signs of DVT in any patient. During the hospitalization period, only 2 major bleeding events were reported (1 [1.6%] in the enoxaparin group and 1 [1.6%] in the dabigatran group). No major bleeding events were reported during the outpatient follow-up period in any group. Differences among the 3 groups regarding bleeding events were not statistically significant (p>0.05). Conclusion: When using switch-therapy modalities, clinicians can take advantage of the safety of enoxaparin during the hospitalization period and ease of use of new oral anticoagulant drugs during the outpatient period Daha fazlası Daha az