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Articles by Caroline A. Hundepool in JoVE
Other articles by Caroline A. Hundepool on PubMed
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The Learning Rate in Three Dimensional High Definition Video Assisted Microvascular Anastomosis in a Rat Model
Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS.
Nov, 2016 |
Pubmed ID: 27650118 Three-dimensional (3D) high definition (HD) video systems are changing microsurgical practice by providing stereoscopic imaging not only for the surgeon and first assistant using the binocular microscope, but also for others involved in the surgery. The purpose of this study was to evaluate the potential to replace the binocular microscope for microarterial anastomoses and assess the rate of learning based on surgeons' experience. Two experienced and two novice microsurgeons performed a total of 88 rat femoral arterial anastomoses: 44 using a 3D HD video device ('Trenion', Carl Zeiss Meditech) and 44, a binocular microscope. We evaluated anastomosis time and modified OSATS scores as well as the subjects' preference for comfort, image adequacy and technical ease. Experienced microsurgeons showed a steep learning curve for anastomosis times with equivalent OSATS scores for both systems. However, prolonged anastomosis times were required when using the novel 3D-HD system rather than direct binocular vision. Comparable learning rates for anastomosis time were demonstrated for novice microsurgeons and modified OSATS scores did not differ between the different viewing technologies. All microsurgeons reported improved comfort for the 3D HD video system but found the image quality of the conventional microscope superior, facilitating technical ease. The present study demonstrates the potential of 3D HD video systems to replace current binocular microscopes, offering qualitatively-equivalent microvascular anastomosis with improved comfort for experienced microsurgeons. However, image quality was rated inferior with the 3D HD system resulting in prolonged anastomosis times. Microsurgical skill acquisition in novice microsurgeons was not influenced by the viewing system used.
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Safety and Suitability of Finger Replantations As a Residency Training Procedure: A Retrospective Cohort Study With Analysis of the Initial Postoperative Outcomes
Annals of Plastic Surgery.
Apr, 2017 |
Pubmed ID: 27893542 Finger replantations demand technical excellence in microsurgery and hand trauma care. The objective of this study was to determine whether finger replantations constitute an appropriate and safe procedure for residency training. Additionally, the prognostic risk factors for the need to take a replanted finger back to the operation room and replant failure were analyzed.All patients who underwent finger replantation after complete amputation between 2007 and 2015 were included in a retrospective comparative study. These patients were either treated by an attending plastic surgeon (cohort 1) or by a postgraduate year 5 or 6 resident under supervision (cohort 2). Logistic regression analysis was used to identify the prognostic risk factors for emergent take backs and replant failures.A total of 109 completely amputated fingers were replanted in 89 patients. Fifty-seven digits were replanted in cohort 1, and 52 digits were replanted in cohort 2. Patient demographic data revealed an equal distribution between the two cohorts with an overall finger-replantation success rate of 67.0%. The prognostic risk factors related to increased take back and replant failure rates were fewer than two venous anastomoses (take back odds ratio [AOR], 0.27; confidence interval (CI), 0.12-0.63; and replant failure AOR, 0.21; 95% CI, 0.08-0.55) and intraoperative noticeable problems regarding the vascular anastomoses (take back AOR, 2.26; 95% CI, 0.96-5.33 and replant failure AOR, 2.45; 95% CI, 1.00-6.00). The type of surgeon did not exhibit an influence on the risk of take back (OR, 1.14; 95% CI, 0.53-2.41) or replant failure (OR, 1.03; 95% CI, 0.46-2.30). Similarly, after adjusting for all risk factors, the risks for take backs (AOR, 1.04; 95% CI, 0.46-2.36) and replant failures (AOR, 0.91; 95% CI, 0.38-2.19) did not differ between the 2 cohorts.Finger replantations can be applied as a safe procedure in residency training under standardized conditions and do not negatively affect quality of care. Technical proficiency in microsurgery and elective and trauma hand care as well as supervision by an experienced plastic or hand surgeon are mandatory. Regardless of the surgeons' experience, fewer than 2 venous anastomoses and the presence of intraoperative vascular anomalies represent significant prognostic risk factors for postoperative complications.
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Optimizing Decellularization Techniques to Create a New Nerve Allograft: an in Vitro Study Using Rodent Nerve Segments
Neurosurgical Focus.
Mar, 2017 |
Pubmed ID: 28245670 OBJECTIVE Commercially available processed nerve allografts have been shown to be inferior to autografts in previous animal studies. The authors hypothesized that combining different processing and storage techniques will result in improved nerve ultrastructure preservation, lower immunogenicity, and minimized cellular debris. Different processing protocols were evaluated using chemical detergents, enzymes, and irradiation, with the addition the of enzyme elastase, were used. Additionally, the difference between cold and frozen storage was investigated. The goal of this study was to create an optimized nerve allograft. METHODS Fifty rat nerves were decellularized with modifications of previous protocols and the addition of elastase. Subsequently, the nerve segments were stored at either 4°C or -80°C. Both processed and fresh control nerves were analyzed with confocal microscopy using immunohistochemical staining on the basal lamina (laminin γ-1), Schwann cells (S100 protein), and immunogenicity using major histocompatibility complex-I (MHCI) staining. Morphology of the ultrastructure and amount of cellular debris were analyzed on cross-sections of the nerves stained with toluidine blue and H & E, and by using electron microscopy. RESULTS Nerve ultrastructure was preserved with all decellularization protocols. Storage at -80°C severely altered nerve ultrastructure after any decellularization method. Elastase was found to significantly reduce the immunogenicity and amount of Schwann cells, while maintaining good structural properties. CONCLUSIONS Reduced immunogenicity, diminished cellular debris, and the elimination of Schwann cells was observed when elastase was added to the nerve processing while maintaining ultrastructure. Storage at -80°C after the decellularization process heavily damaged the nerve ultrastructure as compared with cold storage. Further in vivo studies are needed to prove the nerve regenerative capacity of these optimized allografts.
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