Journal articles on the topic 'Injury repair'
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Stenberg, Lena, Derya Burcu Hazer Rosberg, Sho Kohyama, Seigo Suganuma, and Lars B. Dahlin. "Injury-Induced HSP27 Expression in Peripheral Nervous Tissue Is Not Associated with Any Alteration in Axonal Outgrowth after Immediate or Delayed Nerve Repair." International Journal of Molecular Sciences 22, no. 16 (August 11, 2021): 8624. http://dx.doi.org/10.3390/ijms22168624.
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We investigated injury-induced heat shock protein 27 (HSP27) expression and its association to axonal outgrowth after injury and different nerve repair models in healthy Wistar and diabetic Goto-Kakizaki rats. By immunohistochemistry, expression of HSP27 in sciatic nerves and DRG and axonal outgrowth (neurofilaments) in sciatic nerves were analyzed after no, immediate, and delayed (7-day delay) nerve repairs (7- or 14-day follow-up). An increased HSP27 expression in nerves and in DRG at the uninjured side was associated with diabetes. HSP27 expression in nerves and in DRG increased substantially after the nerve injuries, being higher at the site where axons and Schwann cells interacted. Regression analysis indicated a positive influence of immediate nerve repair compared to an unrepaired injury, but a shortly delayed nerve repair had no impact on axonal outgrowth. Diabetes was associated with a decreased axonal outgrowth. The increased expression of HSP27 in sciatic nerve and DRG did not influence axonal outgrowth. Injured sciatic nerves should appropriately be repaired in healthy and diabetic rats, but a short delay does not influence axonal outgrowth. HSP27 expression in sciatic nerve or DRG, despite an increase after nerve injury with or without a repair, is not associated with any alteration in axonal outgrowth.
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Sánchez Piedra, Genaro Miguel, José Adrián Sánchez León, Juan Sebastián Sánchez León, and Marcela Nataly Parra Álvarez. "Lesión y reparación de la vía biliar: Serie de casos desde 1989 hasta 2020." Revista Médica del Hospital José Carrasco Arteaga 14, no. 1 (April 30, 2022): 33–38. http://dx.doi.org/10.14410/2022.14.1.ao.05.
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BACKGROUND: The benign lesion of the bile duct is a complication of difficult diagnosis and treatment; which has increased due to the use of laparoscopic cholecystectomy (LC) in the management of cholecystolithiasis. Rates of 0.2 to 0.4% of bile duct injuries have been reported, becoming a significant cause of mortality at the time of repair. METHODS: This is an observational, descriptive study, a retrospective case series, based on primary sources of information. The universe of the study are the patients who underwent surgery for bile duct injury from 1989 to 2020, in a private clinic in the city of Cuenca-Ecuador. RESULTS: In more than 30 years, 24 bile duct injury repairs were performed, which occurred: 6 during conventional surgery and 18 during laparoscopic surgery. 54.2% of the lesions occurred less than two centimeters from the confluence of the hepatic ducts. 58.4% of lesions were repaired with Roux-en-Y anastomosis. Antibiotic therapy and drainage were administered to 100% of the patients; 45.83% of the drains placed were tubular drains. 70.8% of the patients didn´t have complications after the repair procedure; the complications that occurred are: bilioma, fistulas, stenosis, cholangitis. CONCLUSION: In most patients who had bile duct injury, the injury occurred during laparoscopic surgery. The injury was most often located less than two centimeters from the confluence of the hepatic ducts. The most frequently performed repair procedure was the Roux-en-Y anastomosis. The most frequent complication after repair was cholangitis.
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Sharma, Shobhit, Vishwanath Pratap Singh, and Sudipta Bera. "Brachial artery injury in pediatric patients: review of management and outcome in 29 patients." International Surgery Journal 6, no. 12 (November 26, 2019): 4419. http://dx.doi.org/10.18203/2349-2902.isj20195405.
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Background: The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability and commonly it is associated with road traffic accidents and occupational injuries. But brachial artery injury in pediatric age group is not very frequent as in adults and commonly associated with supracondylar fracture of humerus. They may present with or without features of ischemia. Prompt diagnosis and treatment is essential for salvage of limb in established ischemia. Obscure presentation of arterial injury poses challenge in early diagnosis and treatment. Repair of the injured artery in these cases is not clearly recommended. We are presenting a series of 29 pediatric brachial artery injuries and their outcome in our institute over the last 5 years.Methods: Twenty nine pediatric patients with brachial artery injury managed in our institute between 2014 to 2018 are assessed retrospectively for operative procedure and outcome.Results: Supracondylar fracture was the most common cause (55.17%). Ischemic and non-ischemic presentation was noted in 41.37% and 69.63% cases respectively. Artery repair was done in 17 (58.62%) cases. Primary repair and interposition vein graft repair was done 8 and 9 cases respectively. Among the 17 repaired artery good functional outcome with Grade 5/5 muscle power noted in 14cases. Amputation was done in two cases.Conclusions: Good functional recovery may be achieved in segmental injury repair with a vein graft. Though in closed injury without ischemic features artery may not be repaired, full functional recovery is possible due to collateral circulations. Obscure presentation detected and repaired early also has a satisfactory result.
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Colantonio, Donald, Anthony Le, Richard Lee, Andres Piscoya, Tobin Eckel, and Alexander Lundy. "Paper 93: Biomechanical Comparison of Tibiotalar Contact Pressures After Syndesmosis Injury With or Without Deltoid Ligament Repair." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0065. http://dx.doi.org/10.1177/2325967121s00656.
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Objectives: Recent studies have stressed the important role of the deltoid ligament in maintaining global ankle stability. However, controversy remains around whether deltoid ligament repair is necessary in addition to syndesmotic repair when addressing injuries that disrupt both the syndesmosis and deltoid ligament. The purpose of this study was to measure differences in tibiotalar joint contact pressures and tibio-talar torsional stability in the presence of deltoid ligament injury, syndesmotic injury, and after their respective repairs using a cadaveric model. Our hypotheseis were 1) injury to the syndesmoosis and deltoid would increase contact pressures and decrease torsional stability, 2) repaired injuries would restore biomechanics to near native state, and 3)that there would be similar tibiotalar contact pressures and torsional stability with syndesmosis repair alone compared to syndesmosis and deltoid ligament repair. Methods: Twelve fresh-frozen human cadaveric lower extremity specimens with intact ankle joints were randomized and tested under a series of conditions: 1) intact syndesmosis and deltoid, 2) sectioning of syndesmosis or deltoid, 3) sectioning of both the syndesmosis and deltoid, 4) repair of syndesmosis or deltoid, 5) repair of both the syndesmosis and deltoid. In one group, the syndesmosis was sectioned and repaired first and in the other the deltoid was sectioned and repaired first. The syndesmosis was repaired with a single high-tensile strength suture mechanism (TightRope, Arthrex), and deltoid ligament repairs were performed with a single suture anchor (FiberTak, Arthrex). Specimens were tested under each condition with 800 N axial compression load, followed by cyclic torsional preconditioning of 5 Nm internal tibial torque (i.e., external foot rotation) at a rate of 2.5 Nm/s, and then a single rotation test of 7.5 Nm internal tibial torque at 1 Nm/s under 800 N axial compression load on a servohydraulic mechanical testing system. Contact pressures within the tibiotalar joint were measured with a digitized pressure sensor film (Tekscan, Boston MA), and coronal plane motion about the tibia was measured in angular displacement. Results: There was no significant difference in peak contact pressures between conditions except when the comparing an isolated deltoid ligament injury to a combined deltoid and syndesmosis injury (4.43±1.33MPa vs 2.67±0.45MPa, p=0.038). Total contact area was less following syndesmosis repair in isolation (609.55±312.37mm2) and combined syndesmosis and deltoid repair (598.28±181.47mm2) compared to all other conditions (p<0.001). There was also a decrease in total contact area compared to native state when the deltoid was repaired in isolation (951.51±72.79mm2 vs 888.72±105.74mm2, p=0.027). The mean external rotation angle was greater when the syndesmosis (15.67±5.39°), deltoid (13.21±3.28°), and both injuries combined (16.59±4.01°) compared to native state (8.55±2.02°), however these values did not achieve statistical significance. Additionally, There was no statistically significant difference in external rotation angle between isolated syndesmosis, isolated deltoid, or combined repairs. Conclusions: These findings demonstrate that ankle contact pressures and torsional stability do not differ significantly when a deltoid ligament repair is performed in conjunction with a syndesmosis repair for a purely ligamentous injury. However, the change in contact area following syndesmosis repair may play a role in the development of post-traumatic arthritis. This finding reinforces the importance of striving for an anatomic syndesmotic reduction, and care should be taken not to over-reduce the syndesmosis during repair.
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RAYAN, G. M., S. I. SAID, S. L. CAHILL, and J. DUKE. "Vasoactive Intestinal Peptide and Nerve Regeneration." Journal of Hand Surgery 16, no. 5 (October 1991): 515–18. http://dx.doi.org/10.1016/0266-7681(91)90106-x.
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The role of vasoactive intestinal peptide (V.I.P.) in nerve regeneration was investigated by assessing the changes in immunoreactive V.I.P. levels in rat sciatic nerves following injury and repair. 60 rats were divided into three surgical groups and one control group: In group I (primary repair), sciatic nerves were divided and immediately repaired; in group II (secondary repair), sciatic nerves were divided and repaired two weeks later; in group III (no repair), sciatic nerves were divided and not repaired; and in group IV (controls), sciatic nerves were exposed but not divided. Animals were sacrificed at three days and at weekly intervals. Their sciatic nerves were extracted and assayed for V.I.P. concentrations by a specific radioimmunoassay. The mean V.I.P. concentration varied between 22 and 46 pg./mg. protein in the control nerves and between 60 and 529 pg./mg. protein in all other groups. In the three surgical groups the levels were significantly higher in proximal than in distal stumps. Following nerve injury, there was an increase in V.I.P. concentration in the injured and repaired areas. This increase was greater in injured non-repaired areas and was highest in the first 48 hours, but continued during regeneration. The accumulation of V.I.P. in divided nerves occurred in response to nerve injury.
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Haney, Lauren J., Esther Bae, Mary Jo V. Pugh, Laurel A. Copeland, Chen-Pin Wang, Daniel J. MacCarthy, Megan E. Amuan, and Paula K. Shireman. "Patency of arterial repairs from wartime extremity vascular injuries." Trauma Surgery & Acute Care Open 5, no. 1 (December 2020): e000616. http://dx.doi.org/10.1136/tsaco-2020-000616.
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BackgroundExtremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.MethodsService members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.ResultsThe cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1–Q3: 3–58; range: 1–175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24–32). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency.ConclusionsArterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries.Level of evidenceTherapeutic/care management, level IV.
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Rayhan, Md Ferdous, Mazharul Rezwan, and Md Mohoshin Sarker. "Evaluation of the result of early repair of open tendo achilles injury." MOJ Orthopedics & Rheumatology 14, no. 1 (February 28, 2022): 24–27. http://dx.doi.org/10.15406/mojor.2022.14.00572.
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Introduction: Toilet pan injury or accidental cut injury which causes open tendo achilles injury is very much common in our country. The Achilles tendon injury is very difficult to treat, sometimes it creates a disabling condition due to calf muscle contracture, wound infection or skin necrosis. Therefore even in immediate repair of fresh injury will need reconstruction. So early repair of Tendo-Achilles injury after meticulous surgical toileting give best result. Objective: Assessments of result in primary repair of open Tendo-Achilles injury and evaluate the outcomes. To calculate the percentage of results of early repair of open TendoAchilles injury. Assess the rate of infections, skin necrosis, and failure of healing in primary repair. Material & methods: Thirty patients who had acute open Tendo-Achilles injury were studied. Variable level of open acute Tendo-Achilles injury were treated at Sher-E-Bangla Medical College Hospital, Barishl in the period from July 2018 to June 2020. After thorough surgical toileting cut tendon was repaired end to end by modified Kessler method. Plaster cast was given for immobilization & broad spectrum antibiotic given for two to three weeks. Result: Final outcome measured according to Juhana Leppilahti modified scoring scale. Thirty patients with Tendo-Achilles injury were studied. Fifteen cases result were excellent, eleven cases good, two case fair and two cases poor. Conclusion: In early repair of open Tendo-Achilles injury need short period of post operative inactivity. It will help to return a Tendo-Achilles injured patient to his normal work early as well as reduce burden of hospital cost and his family. Early repair of open Tendo-Achilles injury within 12 hours is effective procedure for patients as for surgeon
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Lundy, Alexander, Donald Colantonio, Anthony Le, Richard C. Lee, Andres S. Piscoya, Erik Holm, and Tobin T. Eckel. "Biomechanical Changes in the Ankle Joint after Syndesmosis and Deltoid Injury and Subsequent Repair in a Cadaveric Model." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0076. http://dx.doi.org/10.1177/2473011421s00760.
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Category: Ankle; Trauma Introduction/Purpose: Recent studies have stressed the important role of the deltoid ligament in maintaining global ankle stability. However, controversy remains around whether deltoid ligament repair is necessary in addition to syndesmotic repair when addressing injuries to both. The purpose of this study was to measure differences in tibiotalar joint contact pressures and tibiotalar contact area in the presence of deltoid ligament injury, syndesmotic injury, and after their respective repairs using a cadaveric model. Our hypotheses were 1) injury to the syndesmosis and deltoid would increase contact pressures and decrease contact area, 2) repaired injuries would restore biomechanics to near native state, and 3) that there would be similar tibiotalar contact pressures and contact area with syndesmosis repair alone compared to syndesmosis and deltoid ligament repair. Methods: Twelve human cadaveric lower extremities were randomized and tested under a series of conditions: 1) native, 2) sectioning of syndesmosis or deltoid, 3) sectioning of both the syndesmosis and deltoid, 4) repair of syndesmosis or deltoid, 5) repair of both. In one group, the syndesmosis was sectioned and repaired first and in the other the deltoid was sectioned and repaired first. The syndesmosis was repaired with a single high-tensile strength suture mechanism and deltoid ligament repairs were performed with a single suture anchor. Specimens were tested under each condition with an axial compressive and torsional load. Contact pressures and area within the ankle were measured with a digitized pressure sensor (Tekscan, Boston MA). Changes in contact pressure and area were compared with two-way repeated measure analysis of variance and significant findings were tested with post-hoc pairwise comparisons of estimated marginal means with Bonferroni-adjusted p-values for multiple comparisons (α = 0.05). Results: The highest mean contact pressure was seen when the deltoid was injured, but the syndesmosis was still intact (4.43 +/- 1.328 mPa) compared to mean contact pressure of 3.142 +/-0.511 mPa in the native condition. The lowest mean contact pressure was seen when the deltoid was repaired, but the syndesmosis was still disrupted (3.068 +/- 0.477). However, these differences in mean contact pressures did not differ significantly with pairwise comparison. Total contact area was significantly less following syndesmosis repair in isolation when compared to the native condition (609.55+-312.37mm2 vs 903.854mm2 p=0.0183). When the syndesmosis was repaired, irrespective of the state of the deltoid, the distribution of contact pressures shifted from the medial half of the joint to the lateral half of the joint in all but one specimen. Conversely, after deltoid ligament repair the distribution of pressure remain concentrated in the medial half of the joint, like the native state. Conclusion: We did not find a significant difference in overall mean ankle contact pressures between the various tested conditions. However, there can be a significant decrease in the joint contact area and a shift in the distribution of contact pressures within the joint after syndesmosis repair that was not seen after deltoid repair. In fact, with a deltoid repair alone, the distribution of contact pressures and the joint contact area did not differ significantly from the native state. These changes in contact area and distribution of pressures may affect long-term clinical and radiographic outcomes.
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Eriksson, Karl, Erik Rönnblad, Bjorn Barenius, and Bjorn Engstrom. "Meniscal Sutures are Superior to Bioabsorbable Arrows: Results After 918 Consecutive Meniscal Repairs in a Dual Center Analysis." Orthopaedic Journal of Sports Medicine 5, no. 5_suppl5 (May 1, 2017): 2325967117S0019. http://dx.doi.org/10.1177/2325967117s00197.
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Objectives: It has been long known that removal of the meniscus can lead to degenerative changes, and preserving surgery rather than meniscal resection is likely to have better long-term outcomes. Success rates after meniscal repair ranges from 60- 95%, but with most studies having small number of patients. The purpose of this study was to review all meniscal repairs, and potential predictors for failure, during a 12-year period. Methods: A dual center retrospective analysis was performed on two consecutive cohorts of meniscal repairs, during the period 1999-2011 and 1999-2010 respectively. Data from surgical protocols and follow up charts were reviewed including type of tear, location, associated injury to the knee, and surgery. Study endpoint was failure of repair, which was defined as a need for reoperation and secondary partial or total meniscal resection, within 3 years. Kaplan-Meier was used to assess repair device survival. Results were expressed as hazard ratios (HR) with 95% confidence intervals (CI) and were adjusted for confounding factors using cox regression. results: 954 meniscal repairs were performed on 918 patients (n = 536 males [58%] and 382 females [42%]) with a mean age of 23 years (12-60). 64% underwent medial meniscal repair and 36% underwent lateral meniscal repair. 4% were repaired both medially and laterally. 75% of the repairs were performed using meniscal sutures (predominantly Fast-Fix), and 25% of the meniscal tears were repaired using bioabsorbable arrows (Biofix). The median time from injury to surgery was 23 days (0-360). The reoperation rate in the whole cohort was 29%. 35% of the medial meniscal repairs failed and 17% failures were noted on the lateral side. Repair with bioabsorbable arrows on the medial meniscus resulted in reoperation in 44% of the cases, whereas the reoperation rate for meniscal sutures was 32% on the medial side. On the lateral side 18% failures were noticed when using arrows, and 17% when sutures were used. 62% of the patients had a simultaneous anterior cruciate ligament (ACL) injury. When medial meniscal repair was preformed with simultaneous ACL-reconstruction 26% of the meniscal repairs failed, when no simultaneous ACL- reconstruction was performed 37% of the meniscal repairs failed and with no associated ACL-injury 41% of the meniscal repairs failed. Analyzing failure in a multivariate cox regression, adjusted according to age, gender, meniscus, ACL-pathology and days- to-surgery, revealed a higher failure rate for medial meniscal repairs (HR 3.006 [2.074-4.355; p = 0.000). Bioabsorbable arrows had significantly more failures than meniscal sutures (HR 1.656 [1.207-2.273]; p = 0.002). With reference to no ACL injury, meniscal repairs performed with a simultaneous ACL-reconstruction resulted in less failure than when no simultaneous ACL-reconstruction was performed (HR 0.605 [0.413-0.885]; p = 0.010). Conclusion: The failure rate was significantly higher on the medial side, especially when using Biofix-arrows. Patients who underwent a simultaneous ACL-reconstruction had a significantly better healing than conservatively treated ACL-ruptures, and patients with no ACL-injury. Age and days-to-surgery were not significant factors for failure.
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Roman, William, Helena Pinheiro, Mafalda R. Pimentel, Jessica Segalés, Luis M. Oliveira, Esther García-Domínguez, Mari Carmen Gómez-Cabrera, Antonio L. Serrano, Edgar R. Gomes, and Pura Muñoz-Cánoves. "Muscle repair after physiological damage relies on nuclear migration for cellular reconstruction." Science 374, no. 6565 (October 15, 2021): 355–59. http://dx.doi.org/10.1126/science.abe5620.
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Muscle repair without stem cells Skeletal muscle is a mechanical organ that endures cellular damage after contraction. Lesions caused by external injury can be repaired by muscle stem cells, which fuse with injured cells or create entirely new myofibers. Roman et al . describe a cell-autonomous repair process that is independent of muscle stem cells (see the Perspective by McNally and Demonbreun). After localized damage, myonuclei migrate to injury sites and locally deliver messenger RNA for cellular reconstruction. This myofiber self-repair represents a model for understanding the restoration of muscle architecture in health and disease. —BAP
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BUNDUKI, M. M. C., K. J. FLANDERS, and C. W. DONNELLY. "Metabolic and Structural Sites of Damage in Heat- and Sanitizer-Injured Populations of Listeria monocytogenes." Journal of Food Protection 58, no. 4 (April 1, 1995): 410–15. http://dx.doi.org/10.4315/0362-028x-58.4.410.
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Two food isolates of Listeria monocytogenes (strains ATCC 51414 and F5027) were sublethally injured by exposure to heat (56°C for 20 min) or to a chlorine sanitizer (Antibac, 100 ppm for 2 min). Percent injury following treatment ranged from 84% to 99%. Injured Listeria were repaired in Listeria repair broth (LRB) at 37°C. Comparison of the repair curves generated by each method indicated that the time for repair was greater for sanitizer-injured cells (14 h) than for heat-injured cells (5 h). Sites of injury were determined by repairing heat- and sanitizer-treated Listeria in LRB supplemented with one of the following inhibitors: rifampicin (10 and 20 μg/ml), chloramphenicol (5 μg/ml), cycloserine D (10 and 20 μg/ml), and carbonyl cyanide m-chlorophenyl-hydrazone(CCCP) (2.5 μg/ml). In both heat- and sanitizer-injured populations, a total inhibition of repair was seen following incubation with rifampicin, chloramphenicol and CCCP. These results clearly indicate a requirement for mRNA, protein synthesis, and oxidative phosphorylation for repair to occur. The cell wall is not a site of damage since cycloserine D had no effect on repair of heat- or sanitizer-injured Listeria. Investigation of damage to the cell membrane showed that stress caused by sublethal heat or sanitizer did not allow proteins or nucleotides to leak into the medium. The recognition of injury and repair in Listeria will lead to improved methods of detection and ultimately to control strategies which prevent outgrowth of this organism in foods.
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Liu, Yi, Jinlong Zhang, Yuyu Sun, Xiaogang Zhou, Kun Yuan, and Zhiming Cui. "Study on the function of self-polymerizing peptide nanofiber material combined with nerve growth factor-mediated RNA repair for nerve injury treatment in rabbits with the osteofascial compartment syndrome." Materials Express 10, no. 7 (October 1, 2020): 1149–54. http://dx.doi.org/10.1166/mex.2020.1713.
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The present study aimed to establish an animal model of the osteofascial compartment syndrome (OFCS) in hind legs of rabbits, and to repair an early nerve injury using the self-polymerized peptide nanofiber material that was laced with nerve growth factors (NGFs). An animal model of the compartment syndrome was established using the tourniquet method. The intrafascial pressure of rabbit legs at different time points was measured after successful modeling. Western blotting was used to assess the proliferation of nerve cells after injury. After incision and decompression, the repair group was implanted with the self-polymerized peptide nanofiber material in combination with NGFs at the nerve injury sites for repair of the injured nerves. Rabbit hind leg nerve specimens were collected from experimental rabbits (control group), rabbits 5 days after injury (unrepaired group), and rabbits 5 days after injury (repaired group), and hematoxylin-eosin (HE) staining analysis and immunofluorescence experiments were also performed. After loosening the tourniquet, the intra-fascial pressure peaked on the 1st day after injury and then gradually decreased. A western blot showed low expression of the proliferating cell nuclear antigens (PCNAs) in the control group, as it began to increase 4 h after injury, peaked 5 days after injury (P < 0.05), and then gradually decreased. Meanwhile, the tissue morphology of the repair group was better than that of the non-repair group. Fluorescence double labeling results showed that the proliferation of nerve cells in the repair group increased significantly, and S100 and DAPI co-labeling intensities increased significantly. The early application of the self-polymerizing peptide nanofiber material combined with NGF exhibited evident effects on the nerve injury treatment in the osteofascial compartment syndrome.
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Kirita, Yuhei, Haojia Wu, Kohei Uchimura, Parker C. Wilson, and Benjamin D. Humphreys. "Cell profiling of mouse acute kidney injury reveals conserved cellular responses to injury." Proceedings of the National Academy of Sciences 117, no. 27 (June 22, 2020): 15874–83. http://dx.doi.org/10.1073/pnas.2005477117.
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After acute kidney injury (AKI), patients either recover or alternatively develop fibrosis and chronic kidney disease. Interactions between injured epithelia, stroma, and inflammatory cells determine whether kidneys repair or undergo fibrosis, but the molecular events that drive these processes are poorly understood. Here, we use single nucleus RNA sequencing of a mouse model of AKI to characterize cell states during repair from acute injury. We identify a distinct proinflammatory and profibrotic proximal tubule cell state that fails to repair. Deconvolution of bulk RNA-seq datasets indicates that this failed-repair proximal tubule cell (FR-PTC) state can be detected in other models of kidney injury, increasing during aging in rat kidney and over time in human kidney allografts. We also describe dynamic intercellular communication networks and discern transcriptional pathways driving successful vs. failed repair. Our study provides a detailed description of cellular responses after injury and suggests that the FR-PTC state may represent a therapeutic target to improve repair.
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Dhanaraju, S., and N. Kannan. "Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair." International Surgery Journal 5, no. 11 (October 26, 2018): 3672. http://dx.doi.org/10.18203/2349-2902.isj20184642.
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Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor.
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Wang, X. H., L. Hu, J. D. Klein, H. Minakuchi, S. Wakino, K. Hosoya, A. Yoshifuji, et al. "TISSUE INJURY AND REPAIR." Nephrology Dialysis Transplantation 29, suppl 3 (May 1, 2014): iii23—iii24. http://dx.doi.org/10.1093/ndt/gfu118.
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Li, Yong, James Cummins, and Johnny Huard. "Muscle injury and repair." Current Opinion in Orthopaedics 12, no. 5 (October 2001): 409–15. http://dx.doi.org/10.1097/00001433-200110000-00008.
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LeBrasseur, Nicole. "APP for injury repair." Journal of Cell Biology 170, no. 5 (August 22, 2005): 699. http://dx.doi.org/10.1083/jcb1705rr3.
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Koski, John A., Clemente Ibarra, Scott A. Rodeo, and Russell F. Warren. "MENISCAL INJURY AND REPAIR." Orthopedic Clinics of North America 31, no. 3 (July 2000): 419–35. http://dx.doi.org/10.1016/s0030-5898(05)70161-9.
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Schmid, Daniel B., and A. Neil Salyapongse. "Nerve injury and repair." Current Orthopaedic Practice 19, no. 5 (September 2008): 475–80. http://dx.doi.org/10.1097/bco.0b013e3283021495.
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Best, Thomas M., and Kam D. Hunter. "Muscle Injury and Repair." Physical Medicine and Rehabilitation Clinics of North America 11, no. 2 (May 2000): 251–66. http://dx.doi.org/10.1016/s1047-9651(18)30128-1.
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Ghivizzani, Steven C., Thomas J. Oligino, Paul D. Robbins, and Christopher H. Evans. "Cartilage Injury and Repair." Physical Medicine and Rehabilitation Clinics of North America 11, no. 2 (May 2000): 289–307. http://dx.doi.org/10.1016/s1047-9651(18)30130-x.
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Harrison, D. H. "Nerve injury and repair." British Journal of Plastic Surgery 43, no. 6 (November 1990): 747. http://dx.doi.org/10.1016/0007-1226(90)90209-i.
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Plewes, J. "Nerve injury and repair." Injury 20, no. 4 (July 1989): 247. http://dx.doi.org/10.1016/0020-1383(89)90135-6.
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Saito, Hidetomo, Yoichi Shimada, Toshiaki Yamamura, Shin Yamada, Takahiro Sato, Koji Nozaka, Hiroaki Kijima, and Kimio Saito. "Arthroscopic Quadriceps Tendon Repair: Two Case Reports." Case Reports in Orthopedics 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/937581.
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Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.
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Silva, MA, C. Coldham, AD Mayer, SR Bramhall, JAC Buckels, and DF Mirza. "Specialist Outreach Service for On-Table Repair of Iatrogenic Bile Duct Injuries – A New Kind of ‘Travelling Surgeon’." Annals of The Royal College of Surgeons of England 90, no. 3 (April 2008): 243–46. http://dx.doi.org/10.1308/003588408x261663.
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INTRODUCTION The objective of this study was to determine the outcome of on table repair of iatrogenic bile duct injuries (IBDIs) following laparoscopic cholecystectomy, by specialist hepatobiliary surgeons as an outreach service. PATIENTS AND METHODS Prospectively collected data on IBDI managed as an outreach service, was analysed retrospectively. The Strasberg classification was used to define types of injury. RESULTS There were 22 patients. Twenty (91%) had type E ‘classical’ excision injuries, two had types B and D. Two type E cases had co-existent vascular injury both with right hepatic artery injuries; one also had a co-existent portal vein injury. A Roux-en-Y hepaticojejunostomy was used to repair the IBDI in 21 (95%) patients. One type D injury had duct repair over a T-tube. No attempt was made to reconstruct the injured hepatic arteries, while the portal vein injury was primarily repaired. The median follow-up was 210 days (range, 47–1088 days). Two patients developed bile leak and cholangitis while another developed transient jaundice. There were no postoperative mortalities. All patients were followed up at our centre. CONCLUSIONS Repair of IBDI as an outreach service by specialist surgeons is feasible and safe, with minimal disruption to the patient pathway. Prompt recognition and definitive management may help reduce complaints and medicolegal litigation.
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GROBBELAAR, A. O., and D. A. HUDSON. "Flexor Tendon Injuries in Children." Journal of Hand Surgery 19, no. 6 (December 1994): 696–98. http://dx.doi.org/10.1016/0266-7681(94)90237-2.
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Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister’s criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.
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Kim, Jin K., Anand Desai, Anastasia Kunac, Aziz M. Merchant, and Constantinos Lovoulos. "Robotic Transthoracic Repair of a Right-Sided Traumatic Diaphragmatic Rupture." Surgery Journal 06, no. 03 (July 2020): e164-e166. http://dx.doi.org/10.1055/s-0040-1716330.
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Abstract Introduction Traumatic diaphragm rupture injury repairs are predominately performed through thoracotomy, laparotomy, or a combination of the two approaches. While open surgery is often necessary to follow the fundamentals of damage-control operations in unstable or polytrauma patients, minimally invasive surgery may be an alternative for those with a low injury burden to reduce the postoperative morbidities associated with open operations. Case Description We describe the first case of a right-sided diaphragm rupture from blunt trauma that was repaired by a robotic transthoracic approach in the index admission. Conclusion Minimally invasive repair of an acute traumatic diaphragm rupture is feasible in selected trauma patients.
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Jain, Abhilash, Rebecca Dunlop, Tim Hems, and Jin Bo Tang. "Outcomes of surgical repair of a single digital nerve in adults." Journal of Hand Surgery (European Volume) 44, no. 6 (May 12, 2019): 560–65. http://dx.doi.org/10.1177/1753193419846761.
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Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.
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Zemans, Rachel L., Jazalle McClendon, Yael Aschner, Natalie Briones, Scott K. Young, Lester F. Lau, Michael Kahn, and Gregory P. Downey. "Role of β-catenin-regulated CCN matricellular proteins in epithelial repair after inflammatory lung injury." American Journal of Physiology-Lung Cellular and Molecular Physiology 304, no. 6 (March 15, 2013): L415—L427. http://dx.doi.org/10.1152/ajplung.00180.2012.
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Repair of the lung epithelium after injury is integral to the pathogenesis and outcomes of diverse inflammatory lung diseases. We previously reported that β-catenin signaling promotes epithelial repair after inflammatory injury, but the β-catenin target genes that mediate this effect are unknown. Herein, we examined which β-catenin transcriptional coactivators and target genes promote epithelial repair after inflammatory injury. Transmigration of human neutrophils across cultured monolayers of human lung epithelial cells resulted in a fall in transepithelial resistance and the formation of discrete areas of epithelial denudation (“microinjury”), which repaired via cell spreading by 96 h. In mice treated with intratracheal (i.t.) LPS or keratinocyte chemokine, neutrophil emigration was associated with increased permeability of the lung epithelium, as determined by increased bronchoalveolar lavage (BAL) fluid albumin concentration, which decreased over 3–6 days. Activation of β-catenin/p300-dependent gene expression using the compound ICG-001 accelerated epithelial repair in vitro and in murine models. Neutrophil transmigration induced epithelial expression of the β-catenin/p300 target genes Wnt-induced secreted protein (WISP) 1 and cysteine-rich (Cyr) 61, as determined by real-time PCR (qPCR) and immunostaining. Purified neutrophil elastase induced WISP1 upregulation in lung epithelial cells, as determined by qPCR. WISP1 expression increased in murine lungs after i.t. LPS, as determined by ELISA of the BAL fluid and qPCR of whole lung extracts. Finally, recombinant WISP1 and Cyr61 accelerated repair, and Cyr61-neutralizing antibodies delayed repair of the injured epithelium in vitro. We conclude that β-catenin/p300-dependent expression of WISP1 and Cyr61 is critical for epithelial repair and represents a potential therapeutic target to promote epithelial repair after inflammatory injury.
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Blanch, Richard J., Jonathan Bishop, Hedayat Javidi, and Philip Ian Murray. "Effect of time to primary repair on final visual outcome after open globe injury." British Journal of Ophthalmology 103, no. 10 (January 12, 2019): 1491–94. http://dx.doi.org/10.1136/bjophthalmol-2017-311559.
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Background/AimHistoric data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.MethodsThis is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6–12 months and demographic data were examined.Results56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6–12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).DiscussionOpen globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.
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Roganovic, Zoran. "Missile-caused Ulnar Nerve Injuries: Outcomes of 128 Repairs." Neurosurgery 55, no. 5 (November 1, 2004): 1120–29. http://dx.doi.org/10.1227/01.neu.0000142353.92119.fe.
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Abstract OBJECTIVE: This prospective study presents repair results after missile-caused ulnar nerve ruptures as well as factors influencing the outcomes. METHODS: Between 1991 and 1994, 128 casualties with missile-caused complete ulnar nerve injury were managed surgically in the Neurosurgical Department of the Belgrade Military Medical Academy. At least 4 years after surgery, we scored sensorimotor recovery, neurophysiological recovery, and patient judgment of the outcome. On the basis of the total score, we defined the final outcome as poor, insufficient, good, or excellent. The last two outcomes were considered to be successful. RESULTS: A successful outcome was obtained in 0% of high-level, 33.8% of intermediate-level, and 77.3% of low-level repairs (P< 0.001). On average, the nerve defect, preoperative interval, and patient age were lower for patients with a successful outcome than for those with an unsuccessful outcome (P= 0.004, P= 0.032, and P= 0.003, respectively). Worsening of the outcome was related to nerve defect longer than 4.5 cm, preoperative interval longer than 5.5 months, and age older than 23 years (P= 0.002, P= 0.034, and P= 0.023, respectively). A successful outcome occurred in 48.8% of patients repaired with direct suture and in 41.2% of patients repaired with a nerve graft (P> 0.05). A successful outcome also occurred 22.2% of combined ulnar-median nerve repairs and in 49.5% of isolated ulnar nerve repairs (P= 0.011). Repair level (P< 0.001), preoperative interval (P= 0.001), length of the nerve defect (P< 0.001), and associated median nerve rupture (P= 0.028) were independent predictors of a successful outcome. CONCLUSION: The outcome of ulnar nerve repair depends significantly on the repair level, preoperative interval, associated median nerve injury, length of the nerve defect, and age of the patient. High-level ulnar nerve repair is probably useless if performed in the classic manner.
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Bourke, Gráinne, Aleksandra M. McGrath, Mikael Wiberg, and Lev N. Novikov. "Effects of early nerve repair on experimental brachial plexus injury in neonatal rats." Journal of Hand Surgery (European Volume) 43, no. 3 (September 26, 2017): 275–81. http://dx.doi.org/10.1177/1753193417732696.
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Obstetrical brachial plexus injury refers to injury observed at the time of delivery, which may lead to major functional impairment in the upper limb. In this study, the neuroprotective effect of early nerve repair following complete brachial plexus injury in neonatal rats was examined. Brachial plexus injury induced 90% loss of spinal motoneurons and 70% decrease in biceps muscle weight at 28 days after injury. Retrograde degeneration in spinal cord was associated with decreased density of dendritic branches and presynaptic boutons and increased density of astrocytes and macrophages/microglial cells. Early repair of the injured brachial plexus significantly delayed retrograde degeneration of spinal motoneurons and reduced the degree of macrophage/microglial reaction but had no effect on muscle atrophy. The results demonstrate that early nerve repair of neonatal brachial plexus injury could promote survival of injured motoneurons and attenuate neuroinflammation in spinal cord.
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Wang, Jing, Mokarram Hossain, Ajitha Thanabalasuriar, Matthias Gunzer, Cynthia Meininger, and Paul Kubes. "Visualizing the function and fate of neutrophils in sterile injury and repair." Science 358, no. 6359 (October 5, 2017): 111–16. http://dx.doi.org/10.1126/science.aam9690.
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Neutrophils have been implicated as harmful cells in a variety of inappropriate inflammatory conditions where they injure the host, leading to the death of the neutrophils and their subsequent phagocytosis by monocytes and macrophages. Here we show that in a fully repairing sterile thermal hepatic injury, neutrophils also penetrate the injury site and perform the critical tasks of dismantling injured vessels and creating channels for new vascular regrowth. Upon completion of these tasks, they neither die at the injury site nor are phagocytosed. Instead, many of these neutrophils reenter the vasculature and have a preprogrammed journey that entails a sojourn in the lungs to up-regulate CXCR4 (C-X-C motif chemokine receptor 4) before entering the bone marrow, where they undergo apoptosis.
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Pereira, David S., Ronald S. Kvitne, Michael Liang, Frank B. Giacobetti, and Edward Ebramzadeh. "Surgical Repair of Distal Biceps Tendon Ruptures." American Journal of Sports Medicine 30, no. 3 (May 2002): 432–36. http://dx.doi.org/10.1177/03635465020300032101.
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Background Rupture of the distal biceps brachii tendon has most commonly been repaired by anatomic reattachment of the tendon to the radial tuberosity by a single- or two-incision approach. Researchers have studied suture anchor attachment through a single incision, but the tendon-suture interface and bone quality have not previously been analyzed. Hypothesis Suture anchor repair results in stiffness and tensile strength equal to that of bone-tunnel repair for biceps tendon rupture. Study Design Controlled laboratory study. Methods Twelve matched pairs of fresh-frozen cadaveric elbow specimens were used. Suture anchor and bone-tunnel tendon repairs were performed in a randomized fashion. Each specimen was loaded to tensile failure. Load-displacement graphs were generated to calculate repair stiffness, yield strength, and ultimate strength. Computed tomography bone density measurements and additional statistical analyses were then performed after grouping the specimens by mode of failure. Results The bone-tunnel repair was found to be significantly stiffer in all cases and to have significantly greater tensile strength than the suture anchor repair in the younger, nonosteoporotic elbows. Conclusions Suture anchor repairs were not as stiff or strong as bone-tunnel repairs. Clinical Relevance Biceps tendon surgery using the traditional two-incision technique yields a stronger and stiffer repair in the typical patient with this injury.
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Hung, LK, KW Pang, PLC Yeung, L. Cheung, JMW Wong, and P. Chan. "Active Mobilisation after Flexor Tendon Repair: Comparison of Results following Injuries in Zone 2 and other Zones." Journal of Orthopaedic Surgery 13, no. 2 (August 2005): 158–63. http://dx.doi.org/10.1177/230949900501300209.
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Purpose. To prospectively study the role of active mobilisation after flexor tendon repair. Methods. The standard modified Kessler's technique was used to repair 46 digits in 32 patients with flexor tendon injuries. Early active mobilisation of the repaired digit was commenced on the third postoperative day. Range of movement was monitored and recovery from injury in zone 2 was compared with injury in other zones. Results. There were 24 and 22 injuries in zone 2 and other zones respectively. The total active motion score of the American Society for Surgery of the Hand was measured. Patients with zone-2 injuries achieved similar results to those with other-zone injuries apart from a 3-week delay in recovery. The final results were good to excellent in 71% and 77% of zone-2 and other-zone cases respectively (p<0.05). There were 2 ruptures in zone-2 and one rupture in zone-3 repairs (6.5%). Conclusion. Preliminary results of this study showed that active mobilisation following flexor tendon repair provides comparable clinical results and is as safe as conventional mobilisation programmes although recovery in patients with zone-2 injury was delayed.
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Bittel, Daniel C., Goutam Chandra, Laxmi M. S. Tirunagri, Arun B. Deora, Sushma Medikayala, Luana Scheffer, Aurelia Defour, and Jyoti K. Jaiswal. "Annexin A2 Mediates Dysferlin Accumulation and Muscle Cell Membrane Repair." Cells 9, no. 9 (August 19, 2020): 1919. http://dx.doi.org/10.3390/cells9091919.
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Muscle cell plasma membrane is frequently damaged by mechanical activity, and its repair requires the membrane protein dysferlin. We previously identified that, similar to dysferlin deficit, lack of annexin A2 (AnxA2) also impairs repair of skeletal myofibers. Here, we have studied the mechanism of AnxA2-mediated muscle cell membrane repair in cultured muscle cells. We find that injury-triggered increase in cytosolic calcium causes AnxA2 to bind dysferlin and accumulate on dysferlin-containing vesicles as well as with dysferlin at the site of membrane injury. AnxA2 accumulates on the injured plasma membrane in cholesterol-rich lipid microdomains and requires Src kinase activity and the presence of cholesterol. Lack of AnxA2 and its failure to translocate to the plasma membrane, both prevent calcium-triggered dysferlin translocation to the plasma membrane and compromise repair of the injured plasma membrane. Our studies identify that Anx2 senses calcium increase and injury-triggered change in plasma membrane cholesterol to facilitate dysferlin delivery and repair of the injured plasma membrane.
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Chung, Rosa, Bruce K. Foster, and Cory J. Xian. "The potential role of VEGF-induced vascularisation in the bony repair of injured growth plate cartilage." Journal of Endocrinology 221, no. 1 (January 24, 2014): 63–75. http://dx.doi.org/10.1530/joe-13-0539.
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Growth plate injuries often result in undesirable bony repair causing bone growth defects, for which the underlying mechanisms are unclear. Whilst the key importance of pro-angiogenic vascular endothelial growth factor (VEGF) is well-known in bone development and fracture repair, its role during growth plate bony repair remains unexplored. Using a rat tibial growth plate injury repair model with anti-VEGF antibody, Bevacizumab, as a single i.p. injection (2.5 mg/kg) after injury, this study examined the roles of VEGF-driven angiogenesis during growth plate bony repair. Histology analyses observed isolectin-B4-positive endothelial cells and blood vessel-like structures within the injury site on days 6 and 14, with anti-VEGF treatment significantly decreasing blood-vessel-like structures within the injury site (P<0.05). Compared with untreated controls, anti-VEGF treatment resulted in an increase in undifferentiated mesenchymal repair tissue, but decreased bony tissue at the injury site at day 14 (P<0.01). Consistently, microcomputed tomography analysis of the injury site showed significantly decreased bony repair tissue after treatment (P<0.01). RT-PCR analyses revealed a significant decrease in osteocalcin (P<0.01) and a decreasing trend in Runx2 expression at the injury site following treatment. Furthermore, growth plate injury-induced reduced tibial lengthening was more pronounced in anti-VEGF-treated injured rats on day 60, consistent with the observation of a significantly increased height of the hypertrophic zone adjacent to the growth plate injury site (P<0.05). These results indicate that VEGF is important for angiogenesis and formation of bony repair tissue at the growth plate injury site as well as for endochondral bone lengthening function of the uninjured growth plate.
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GLASBY, M. A., A. C. FULLERTON, and G. M. LAWSON. "Immediate and Delayed Nerve Repair Using Freeze-Thawed Muscle Autografts in Complex Nerve Injuries." Journal of Hand Surgery 23, no. 3 (June 1998): 354–59. http://dx.doi.org/10.1016/s0266-7681(98)80057-0.
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Five sheep underwent repair of the median nerve along with the establishment and repair of a brachial artery defect adjacent to the site of nerve injury. The defect in the brachial artery was of similar length to the nerve defect and lay in parallel with it. It was repaired using a reversed vein autograft harvested from one of the superficial veins of the arm. A further five sheep underwent similar treatment with the repair of the nerve delayed for 30 days after the establishment of the complicating vascular injury. Six months after the nerve repair, each group of sheep was assessed using electrophysiological and morphometric methods in order to establish objective indices of nerve recovery and regeneration. These results were compared with those from other sheep which had undergone nerve repair both immediate and delayed with no complicating injury and groups in which the complicating injury consisted of a cavity, fibrosis and haematoma. It was found that delay in the nerve repair and the presence of a complicating arterial injury, both separately and additively, contributed to a poorer outcome in recovery of nerve function and maturation. The effect of an arterial injury, in both of these respects, was to produce a worse outcome than the presence of a cavity with fibrosis and haematoma.
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FULLARTON, A. C., D. V. LENIHAN, L. M. MYLES, and M. A. GLASBY. "Assessment of the Method and Timing of Repair of a Brachial Plexus Traction Injury in an Animal Model for Obstetric Brachial Plexus Palsy." Journal of Hand Surgery 27, no. 1 (February 2002): 13–19. http://dx.doi.org/10.1054/jhsb.2001.0657.
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A Sunderland type IV traction injury to the C6 root of adult sheep or newborn lamb brachial plexus was used as a model for obstetric traction injury to the C5 root in humans. In one experimental cohort the injury was created and repaired using interfascicular nerve autografts or coaxially aligned freeze-thawed skeletal muscle autografts in a group of adult sheep and in a group of newborn lambs. In a second cohort a similar injury was created and repaired either immediately or after a delay of 30 days, using either interfascicular nerve autografts or coaxially aligned freeze-thawed skeletal muscle autografts in four groups of six newborn lambs. In all cases both functional and morphometric indices of nerve regeneration were poorer in the injured and repaired nerves than in normal nerves. In lambs the method of repair made no difference and no significant differences were found for any of the indices of nerve function or morphology. In sheep the use of muscle grafts was associated with a poorer outcome than the use of nerve autografts. Where a delay of 30 days had elapsed between injury and repair, the results using nerve autografts were not significantly different. Where freeze-thawed muscle autografts had been used, the maturation of the regenerated nerve fibres after delay was significantly poorer than after immediate repair. The electrophysiological variables CVmax and jitter, which may be applied clinically, were found to be good discriminators of recovery in all of the animals and in respect of all procedures.
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Cho, Dosang, Kriangsak Saetia, Sangkook Lee, David G. Kline, and Daniel H. Kim. "Peroneal nerve injury associated with sports-related knee injury." Neurosurgical Focus 31, no. 5 (November 2011): E11. http://dx.doi.org/10.3171/2011.9.focus11187.
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Object This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management. Methods The authors retrospectively reviewed the cases of peroneal nerve injury associated with sports between the years 1970 and 2010. Each patient was evaluated for injury mechanism, preoperative neurological status, electrophysiological studies, lesion type, and operative technique (neurolysis and graft repair). Preoperative status of injury was evaluated by using a grading system published by the senior authors. All lesions in continuity had intraoperative nerve action potential recordings. Results Eighty-four (approximately 18%) of 448 cases of peroneal nerve injury were found to be sports related, which included skiing (42 cases), football (23 cases), soccer (8 cases), basketball (6 cases), ice hockey (2 cases), track (2 cases) and volleyball (1 case). Of these 84 cases, 48 were identified as not having fracture/dislocation and 36 cases were identified with fracture/dislocation for surgical interventions. Good functional outcomes from graft repair of graft length < 6 cm (70%) and neurolysis (85%) in low-intensity peroneal nerve injuries associated with sports were obtained. Recovery from graft repair of graft length between 6 and 12 cm (43%) was good and measured between Grades 3 and 4. However, recovery from graft repair of graft length between 13 and 24 cm was obtained in only 25% of patients. Conclusions Traumatic knee-level peroneal nerve injury due to sports is usually associated with stretch/contusion, which more often requires graft repair. Graft length is the factor to be considered for the prognosis of nerve repair.
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Shichiri, Keiko, Kiyotaka Imamura, Minoru Takada, and Yoshiyasu Anbo. "Minimally invasive repair of right-sided blunt traumatic diaphragmatic injury." BMJ Case Reports 13, no. 11 (November 2020): e235870. http://dx.doi.org/10.1136/bcr-2020-235870.
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Right-sided blunt traumatic diaphragmatic injury (TDI) is a rare injury that is rarely repaired by the minimally invasive approach in the acute setting. Laparoscopic repair of right-sided TDI is challenging because the liver often obstructs access to the injury site. Herein, we report a case wherein acute right-sided blunt TDI was successfully repaired using a combined laparoscopic and thoracoscopic approach. A 30-year-old man presented with shortness of breath after falling on his back while jumping on a snowboard. CT revealed a right-sided TDI. As the patient was haemodynamically stable, laparoscopic repair was planned. Laparoscopy revealed a right-sided diaphragmatic rupture. As the posterior portion was covered by the liver and difficult to access, we added trocars in the chest cavity and closed the diaphragmatic defect with a thoracic approach. A combined laparoscopic and thoracoscopic approach can repair right-sided diaphragmatic injury by a minimally invasive approach even in the acute setting.
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Shambaugh, Braidy C., Suzanne Laura Miller, and Thomas H. Wuerz. "Does Time from Injury to Surgery Affect Outcomes Following Surgical Repair of Partial and Complete Proximal Hamstring Ruptures?" Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0011. http://dx.doi.org/10.1177/2325967118s00110.
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Objectives: The purpose of this study was to determine if time from injury to surgery affected postoperative outcomes after primary repair of partial and complete proximal hamstring ruptures. The secondary aim of the study was to assess patients’ experiences from initial evaluation to finding a treating surgeon to help increase awareness of the injury. Methods: Office records from 2008 to 2016 were reviewed from one orthopedic surgeon’s practice. A total of 124 partial and complete proximal hamstring repairs in 121 patients were identified. Ninety-two patients completed questionnaires including a custom survey in addition to validated outcome measures: Lower Extremity Outcome Score (LEFS), custom LEFS, Marx Activity Scale, custom Marx scale, and University of California at Los Angeles (UCLA) Activity Score. A chart review was performed to collect demographic, encounter, and operative information. Results were analyzed and compared for both partial and complete proximal hamstring repairs performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks following injury. Results: Mean follow-up of study respondents was 43 months (range, 6-116 months). Of the 93 proximal hamstring repairs reviewed, 50.5% (9/28 partial, 38/65 complete), 78.5% (16/28 partial, 57/65 complete) and 21.5% (12/28 partial, 8/65 complete) were performed ≤ 3 weeks, ≤ 6 weeks, and > 6 weeks, respectively. At various injury-to-surgery time intervals, no statistical difference was found in the LEFS, custom LEFS, Marx Activity Scale, custom Marx Scale, and UCLA Activity Scores. Overall, partial proximal hamstring repairs had better outcome scores compared to complete tears although this was not statistically significant with the exception of leg pain at rest, which was higher after repair of complete tears (P = 0.021). Additionally, female gender and age were negative predictors of outcome scores. Increasing time from injury-to-surgery was associated with lower perceived strength of operative side compared to contralateral leg, most notable with surgery > 6 weeks after injury (% patients with perceived near or full strength of the contralateral limb: partial tears ≤ 6 weeks 93.8% versus > 6 weeks 75%; complete tears ≤ 6 weeks 75.4% versus > 6 weeks 50%). Patients who underwent repair > 6 weeks following injury for both partial and complete tears exhibited a greater sitting intolerance after one hour compared to those repaired ≤ 6 weeks (0% partial, 7.1% complete ≤ 6 weeks; 12.5% partial, 25% complete > 6 weeks). The majority of patients with complete ruptures (42%) were initially evaluated at a local emergency room while most partial tears were evaluated by their primary care physician (35.7%). Patients with repairs performed > 6 weeks following injury visited, on average, 2.6 practitioners prior to evaluation by the treating surgeon compared to 1.6 for those surgically treated ≤ 6 weeks following injury. Conclusion: Proximal hamstring ruptures performed in both the acute and chronic setting can expect overall successful outcomes but may experience lower perceived strength and difficulty with prolonged sitting with repair > 6 weeks following injury. Patients also faced challenges in correct diagnosis of the injury and referral to an appropriate treating surgeon. These findings emphasize the need for increased awareness of the injury not only within the orthopedic community, but also the emergency room and primary care settings.
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Zhang, Chaoqi, Lifeng Li, Kexin Feng, Daoyang Fan, Wenhua Xue, and Jingli Lu. "‘Repair’ Treg Cells in Tissue Injury." Cellular Physiology and Biochemistry 43, no. 6 (2017): 2155–69. http://dx.doi.org/10.1159/000484295.
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Studies in mice and humans have elucidated an important role for Tregs in promoting tissue repair and restoring tissue integrity. Emerging evidence has revealed that Tregs promoted wound healing and repair processes at multiple tissue sites, such as the heart, liver, kidney, muscle, lung, bone and central nervous system. The localization of repair Tregs in the lung, muscle and liver exhibited unique phenotypes and functions. Epidermal growth factor receptor, amphiregulin, CD73/CD39 and keratinocyte growth factor are important repair factors that are produced or expressed by repair Tregs; these factors coordinate with parenchymal cells to limit injury and promote repair. In addition, repair Tregs can be modulated by IL-33/ST2, TCR signals and other cytokines in the context of injured microenvironment cues. In this review, we provide an overview of the emerging knowledge about Treg-mediated repair in damaged tissues and organs.
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CHIANG, HONGSEN, YI-YOU HUANG, and CHING-CHUAN JIANG. "REPAIR OF ARTICULAR CARTILAGE INJURY." Biomedical Engineering: Applications, Basis and Communications 17, no. 05 (October 25, 2005): 243–51. http://dx.doi.org/10.4015/s1016237205000366.
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Articular cartilage defects heal poorly and lead to consequences as osteoarthritis. Clinical experience has indicated that no existing medication would substantially promote the healing process, and the cartilage defect requires surgical replacement. Allograft decays quickly for multiple reasons including the preparation process and immune reaction, and the outcome is disappointing. The extreme shortage of sparing in articular cartilage has much discouraged the use of autograft, which requires modification. The concept that constructs a chondral or osteochondral construct for the replacement of injured native tissue introduces that of tissue engineering. Limited number of cells are expanded either in vitro or in vivo, and resided temporally on a scaffold of biomaterial, which also acts as a vehicle to transfer the cells to the recipient site. Three core elements constitute this technique: the cell, a biodegradable scaffold, and an environment suitable for cells to present their proposed activity. Modern researches have kept updating those elements for a better performance of such cultivation of living tissue.
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Lee, Steve K., and Scott W. Wolfe. "Peripheral Nerve Injury and Repair." Journal of the American Academy of Orthopaedic Surgeons 8, no. 4 (July 2000): 243–52. http://dx.doi.org/10.5435/00124635-200007000-00005.
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