Collagen Plug Research Articles

Comparison of Three Biphasic Calcium Phosphate Block Substitutes: A Histologic and Histomorphometric Analysis in the Dog Mandible.

The purpose of this animal study was to determine which ratio of hydroxyapatite (HA) and tricalcium phosphate (TCP) is the most appropriate in the composition of alloplastic biphasic block grafts, in terms of bone density and bone formation, for the regeneration of alveolar defects. Different concentrations of HA/TCP were used for the alloplastic block grafts: 100/0 (HA100 group), 79/21 (HA75 group), and 57/43 (HA50 group); the control treatment filled the defect with a collagen plug. All control and test sites were covered with a resorbable collagen membrane. Sacrifices were performed at 4, 12, and 24 weeks after grafting. Microcomputed tomography and histologic and histomorphometric analyses were performed to determine bone density and the characteristics of the regenerated bone as well as the percentages of newly formed bone (NB), residual material (RM), and connective tissue (CT). Bone density increased significantly over time (P < .001), with stabilization between 12 and 24 weeks (P = 1.000). No differences in density were observed between the different test blocks (P = .813). The percentage of NB increases over time, independent of the concentration (P < .001). At 12 weeks, the control group exhibited more NB than the HA100 group (P < .001). At 24 weeks, the HA50 group exhibited more NB than the HA100 (P < .001) and control (P = .066) groups. At 24 weeks, the HA100 and HA75 groups showed high RM percentages. The HA50 group exhibited an increased tendency of less RM percentage compared with the HA100 and HA75 groups. Although slight differences were found, the HA50 group's HA/TCP ratio seems the appropriate concentration when taking into account the bone density and percentage of NB and RM at 12 and 24 weeks of healing.

Effectiveness of Collagen Membrane in the Treatment of Schneiderian Membrane Perforation

Schneiderian membrane perforation (SMP) is the most common complication encountered during sinus lift procedures. SMPs should be managed to prevent loss of the valuable bone graft and bone substitute materials. A fast-resorbing collagen membrane (CM) is a soft, white, pliable, and nonfriable sponge used in dental surgery. The purpose of this study was to evaluate the clinical outcomes of SMP repair using CMs when an SMP had occurred during a sinus lifting procedure. The patients were divided into three groups according to the size of the SMPs during the sinus lift procedure. (A) Group 1: there was no perforation of the Schneiderian membrane but the membrane was weakened (or thinned) and repaired using CMs. (B) Group 2: the SMP was small to medium in size (&lt; 10 mm) and repaired using CMs and fibrin adhesive (FA). (C) Group 3: the SMP was large in size (&gt; 10 mm) and repaired using a collagen plug. The negative control group consisted of patients who did not have any SMP (Control) and these patients were randomly selected. Orthopantomographic X-rays taken before surgery, 2–3 days following surgery, and over 6 months after surgery (follow-up) were used to evaluate the acquired bone height according to groups. Bone heights were measured from the crestal bone at the planned implant placement sites. Clinical outcomes, including implant success and complications according to repair method, were also investigated. There was no significant difference in bone heights between the groups with the exception of group 3. The overall implant survival rate was 100% for implants placed in sinuses with frank SMPs or weakened sinus membranes. The CM is applicable for small-to-moderate perforations or sinus membranes which have been weakened or thinned during sinus lift procedures.

Efficacy of PRF vs PRF + Biodegradable Collagen Plug in Post-extraction Preservation of Socket

To compare the clinical sequelae of the efficacy of PRF vs PRF + collagen plug in soft tissue healing and preservation of the socket width, height, and bone density in patients reporting for extractions of maxillary or mandibular anterior or posterior teeth and patients who desired replacement of teeth with dental implants in future. The study included 54 patients who were divided randomly into 3 groups consisting of 18 patients in each group: in group I, no preservation of extraction socket; in group II, PRF was used; and in group III, PRF + collagen plug was used for preservation of extraction socket. Assessment of the soft tissue healing, bone density, bone height, and width was done on 1st, 8th, 12th, and 16th weeks, postoperatively. Both PRF and PRF + Collaplug are comparable to each other in preserving the bone height, bone density, and also similar soft tissue healing; however PRF + Collaplug is better than PRF alone in preserving the bone width 4th month postoperatively, indicating that the resorbable Collaplug® does play an additional role in preserving the socket width. PRF + Collaplug® has better clinical outcome in socket preservation in comparison to PRF alone. However, as results were not statistically significant, subjecting a larger sample size with PRF + Collaplug® for socket preservation may result in statistical critical values to substantiate our observations. PRF and Collaplug® can help in ridge preservation after extraction and also avoid additional bone grafting procedures in future implant placement for the patients. How to cite this article: Ahmed N, Gopalakrishna V, Shetty A, et al. Efficacy of PRF vs PRF + Biodegradable Collagen Plug in Post-extraction Preservation of Socket. J Contemp Dent Pract 2019;20(11):1323-1328.

Effectiveness of naturally derived bovine hydroxyapatite (Cerabone™) combined with platelet-rich fibrin matrix in socket preservation: A randomized controlled clinical trial.

Background and Objectives:Socket preservation is the procedure which is carried out at the time of extraction to enhance the esthetic predictability of prosthesis and to reduce the number of surgical interventions by minimizing the crestal bone loss. The aim of the present study was to compare the efficacy of natural bovine hydroxyapatite and platelet-rich fibrin (PRF) matrix along with collagen plug to unassisted natural healing in extraction sites.Materials and Methods:A sample of 25 patients of age 17–50 years who require extraction of at least two teeth which were not adjacent to each other were included in the study. One site in each patient was subjected to ridge preservation procedure using Cerabone™ PRF along with collagen plug and the other site was subjected to atraumatic extraction alone. Parameters such as loss of ridge width and loss of ridge height were measured clinically and radiographically at baseline and after 6 months.Results:The mean loss of width was found to be 2.75 mm (2.75 ± 1.49) at the control site compared to 1.47 mm (1.47 ± 1.44) at the test site. The test site showed 2.31 mm bone fill, (8.7%) compared to the control site.Conclusion:Within the limitations of the study, the results suggest that socket preservation procedure is a reliable method that minimizes the alveolar bone loss.

Transaxillary transcatheter aortic valve implantation utilizing a novel vascular closure device with resorbable collagen material: a feasibility study.

We herein aimed to evaluate technical feasibility of transaxillary (Tax) transcatheter aortic valve implantation (TAVI) utilizing a novel vascular closure device with a resorbable collagen plug and absence of suture material. Between 05/2018 and 8/2018, eight patients (76.0 ± 5.9 years, 62.5% male, logEuroSCORE I 23.6 ± 4.7) received Tax-TAVI using the MANTA™ vascular closure device. Implanted transcatheter heart valves consisted of Edwards Sapien 3, NVT Allegra, Medtronic CoreValve EvolutR and SJM Portico. Puncture location depth was variable (3.5-7.5cm). The left subclavian artery was used in five cases, the right subclavian artery in three cases. Low-pressure balloon-angioplasty for vessel closure was performed in 5/8 patients. VARC-2 defined device success was met in all patients. Major access site complication occurred in one patient with aneurysma spurium of the subclavian artery and consecutive stent implantation on postoperative day 5. The MANTA™ device is applicable in Tax-TAVI, with potential particular advantages regarding easiness of use and marked access for subsequent interventions in case of vascular complications. Before conclusions regarding clinical efficacy and safety can be made, the device has to be evaluated in larger patient cohorts.

Access site complications after transfemoral aortic valve implantation - a comparison of Manta and ProGlide

BackgroundDespite decreasing sheath diameter, access site bleeding and vascular complications are still a major concern in transfemoral aortic valve implantation (TAVI), and may increase morbidity and even increase mortality. The aim was to compare safety of arterial closure in transfemoral TAVI with two different principles, pre-suture with ProGlide and collagen plug closure with Manta.ResultsSeventy-six patients treated with ProGlide and 75 with Manta were analysed. The endpoints were 1: access site vascular complications and 2: non-planned vascular or endovascular surgery at the puncture site. Complications occurred in 2 (2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the learning phase there were no significant differences. In the established phase there was one event (2%) in the ProGlide group, compared to 6 endpoints (12.0%), p = 0.047, in the Manta group.Unplanned surgery or intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta patients, p = ns. There were no significant differences during the learning phase. In established use, endpoints occurred more frequently in patients treated with the Manta device (12%), than in patients treated with the ProGlide (2%), p = 0.047.ConclusionThe ProGlide presuture closure device was associated with significantly lower rates of vascular complications and lower rates of surgery and interventions compared to the collagen plug Manta system.Trial registrationThe data were collected from Internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280, Oslo University Hospital, Ullevål.

IP077. Two-Device Closure Method for Large-Diameter Arteriotomies in Percutaneous Endovascular Aortic Repair

Percutaneous endovascular aortic repairs are associated with access site complications. As endovascular devices become more sophisticated and frequently require large-bore arteriotomies, several devices and techniques have been described to aid in the percutaneous closure of arteriotomies, including collagen plug devices (Angio-Seal; Terumo Interventional Systems, Somerset, NJ) and percutaneous suture-mediated closure devices (Perclose; Abbott Vascular, Santa Clara, Calif). Two-device preclose technique using two Perclose devices has been well established. Combined Perclose and Angio-Seal technique has been described for arteriotomies up to 14F because of instances of only a single Perclose device successfully predeployed during the preclose technique. We sought to determine whether a hybrid Perclose and Angio-Seal closure technique would safely and effectively establish hemostasis in large-bore arteriotomies up to 20F. Before sheath insertion, one Perclose device was predeployed. At the end of percutaneous endovascular aortic repair, device sheath and introducer were withdrawn over a 0.035-inch wire, and partially deployed Perclose was fully deployed. The sheath and introducer were fully withdrawn, and the arteriotomy was closed with a 6F Angio-Seal vascular closure device. Patients were observed at day 1 and day 30 and at least 1 year after intervention. A composite end point of complications was defined as an access site-related bleed or hematoma or retroperitoneal hematoma that required blood transfusion, pseudoaneurysm, arteriovenous fistula, or dissection. The combined technique was initially successful in 44 of 46 arteriotomies (95.6%) in 24 of 26 patients (92.3%) with no conversions to cutdown. Sheath sizes ranged from 10F to 20F outer diameter (OD), with an average of 15.85F OD. In the two instances in which satisfactory hemostasis using this method was not initially achieved, Perclose failure and Angio-Seal failure each accounted for a singled episode and required manual compression. Both instances occurred in a 20F arteriotomy. The only late complication of this method was a subcentimeter pseudoaneurysm in the arteriotomy where the perclose device did not deploy. There were no other early or late complications in this series. Large-bore arteriotomies can be safely and effectively closed using a hybrid percutaneous closure technique for sheaths up to 19F OD. Further investigation is needed to assess the value of this closure in 20F OD sheaths and above.

PERİANAL SİNÜS TEDAVİSİNDE PRESS-FİT® (DOĞAL KOLLAJEN PLUG) UYGULAMASI

Objective: Although the pilonidal sinus is most commonly seen in the sacrococcygeal region, it may emerge in any region of the body, where the hairs may penetrate. The pilonidal sinus that develops in the perianal area is called 'endoanal' or 'perianal pilonidal sinus' and it is in the close neighborhood with the anal verge. In this study, our objective was to present the patients with "perianal pilonidal sinus", whom we treated with the "Natural Collagen Plug", which is mainly used for the perianal fistulae.Materials and methods: The data of four patients, who applied to our clinic due to the perianal pilonidal sinus between June and December 2015 and treated with “natural collagen plug” after curettage, were included in the study. The characteristics of patients such as age, gender, treatment duration, complications and recurrence rates were investigated. Findings: The mean age of the patients was 25.75 ± 3.5 years and all patients were males. The treatment was administered twice to one patient and just once to the remaining 3 patients. Only one patient developed abscess as a complication. Average recovery time was 27.5 ± 3.3 days. During the follow-up (average: 5.75 ± 1.7 months) period, the disease recurred in one patient and one patient did not recover. The success rate of the procedure was 50% even though the number of patients was very limited. Conclusion: Although the perianal pilonidal sinus disease is a rare condition, it is difficult to treat due to the close neighborhood to the anal verge. Even the duration of healing is long and the success rate is relatively low in these patients, “natural collagen plug” application after a thorough local removal of the hairs and debridement can be taken into consideration. This method can be used safely around the anal region.

Decellularized Muscle Supports New Muscle Fibers and Improves Function Following Volumetric Injury.

Current strategies to treat volumetric muscle loss use primarily pedicle or free muscle transfers, but these grafts fail to adequately regenerate functional tissue. Decellularized soft tissue grafts possess physical and chemical cues to promote muscle regeneration, suggesting their potential for use in large muscle defects. In this study, we developed a decellularized muscle matrix (DMM) graft using rat gastrocnemius. Anisotropy and chemical components of the extracellular matrix were retained, including laminin, fibronectin, and collagen. We compared the ability of DMM, autologous muscle grafts (clinical standard), and type I collagen plugs (negative control) to support muscle regeneration. DMM supported regeneration over a 56-day period in 1 × 1 cm and 1.5 × 1 cm gastrocnemius defects in rats. Muscle function tests demonstrated improved muscle recovery in rats with DMM grafts when compared to collagen. Histological sections were assessed using morphometrics and immunostaining. DMM supported muscle regeneration with less fibrosis and more de novo neuromuscular receptors than either autograft or collagen. Overall, our results indicate that DMM may be used as a muscle replacement graft based on its ability to improve muscle function recovery, promote muscle regeneration, and support new neuromuscular junctions.

Tissuepatch is biocompatible and seals iatrogenic membrane defects in a rabbit model.

To evaluate novel sealing techniques for their biocompatibility and sealing capacity of iatrogenic fetal membrane defects in a pregnant rabbit model. At day 23 of gestation (term=d31), a standardized fetoscopy was performed through a 14G cannula. The resulting fetal membrane defect was closed with condensed collagen, collagen with fibrinogen, Tissuepatch, Duraseal, or a conventional collagen plug (Lyostypt) as reference. At d30, the fetuses were harvested and full thickness fetal membrane samples were analyzed. The study consisted of 2 consecutive parts: (1) biocompatibility testing by fetal survival, apoptosis, and infiltration of polymorphonuclear cells in the membranes and (2) the efficacy to seal fetal membrane defects. Three sealants (collagen with fibrinogen, Duraseal, or Lyostypt) were associated with a higher fetal mortality compared to control unmanipulated littermates and hence were excluded from further analysis. Tissuepatch was biocompatible, and amniotic fluid levels were comparable to those of control untouched littermates. Compared to the condensed collagen, Tissuepatch was also easier in surgical handling and induced limited cell proliferation. Tissuepatch had the best biocompatibility and efficacy in sealing an iatrogenic fetal membrane defect in the pregnant rabbit compared to other readily available sealants.

Validity of Collagen Plugs for Ridge Preservation in a Canine Model.

The purpose of the present study was to evaluate healing outcomes after collagen plug insertion in extraction-related defects. The third and fourth mandibular premolars in canines were extracted, and the septal bone was removed. The following treatments were performed for the defects: porcine atelo-collagen plug, bovine atelo-collagen plug, and no intervention (control). The experimental animals were killed after 6, 12, or 24 weeks (n = 4, respectively). Histologic and histomorphometric analyses were performed. Clinical healing was uneventful, and no difference was detected among the 3 groups. Histologically, similar healing patterns were observed in all groups. Gingival healing was complete at 6 weeks, but discontinuity in the buccal crestal bone was observed. At 12 weeks, various degrees of buccal bone depression and increase in bone marrow were observed. At 24 weeks, no further healing was observed. Histomorphometrically, the ridge width at 1, 3 and 5 mm levels below the crest and the ridge dimensions 1, 3, and 5 mm above the level were not statistically different among groups or healing periods. The healing following the use of collagen plug in the extraction socket may correspond to the natural healing after extraction.

Transfemoral Approach for Coronary Angiography and Intervention: A Collaboration of International Cardiovascular Societies

ObjectivesThe aim of this study was to examine the current practice and use of transfemoral approach (TFA) for coronary angiography and intervention. BackgroundWide variability exists in TFA techniques for coronary procedures. MethodsThe authors developed a survey instrument that was distributed via e-mail lists from professional societies to interventional cardiologists from 88 countries between March and December 2016. ResultsOf 987 operators, 18% were femoralists, 38% radialists, 42% both, and 2% neither. Access using femoral pulse palpation alone was preferred by 60% of operators, fluoroscopy guidance by 11%, and a combination of palpation, fluoroscopy, or ultrasound by 27%. Only 11% used micropuncture in >90% of their cases. Performing femoral angiography immediately after access was preferred by 23% and at the end of the procedure by 47%, and not done at all by 31% of operators. Hemostasis by manual compression was preferred by 50%, collagen plug vascular closure device by 31%, and suture-based vascular closure device by 11% of operators. Judkins left and right catheters were preferred for diagnostic angiography of the left (99%) and right (94%) coronary arteries. Extra backup curves (XB or EBU) were most commonly preferred for percutaneous coronary intervention of the left anterior descending (80%) and left circumflex (80%), whereas the Judkins right catheter was preferred for percutaneous coronary intervention of the right coronary artery (86%). ConclusionsThere is significant variability in preferences for femoral access technique. Even though recommended best practices advocate for fluoroscopic and ultrasound guidance, most operators use palpation alone. Femoral angiography is also not consistently used despite guideline recommendations. The lack of adoption of imaging guidance for vascular access deserves further investigation.

Alveolar Ridge Preservation as a Way to Reduce the Need for Bone Augmentation: Implementation of a New, Non-invasive Method of Measuring Bone Preservation: Study Protocol of a Randomized Controlled Clinical Trial and Feasibility Testing Results

Introduction: The efficacy of alveolar ridge preservation (ARP) in preserving the bone after tooth extractions and before rehabilitation with an implant-supported restoration is examined. A new, non-invasive measurement method to determine the extent of bone preservation is presented. This measurement method is based on a 3D comparison of the condition immediately after extraction with the data of a cone-beam computed tomography (CBCT) eight weeks after extraction. Method: The study is a single-center, randomized, controlled parallel-group clinical investigation. 88 patients who required extraction of a maxillary tooth participated in the study. In 44 patients (intervention group), the socket is filled with a combination of a collagen plug and a collagen membrane introduced in the empty socket immediately after tooth removal (ARP). The 44 patients (control group) experience unassisted socket healing the hyporeflective space. Primary endpoints are (1) bone loss after tooth extraction; (2) the preservation of the alveolar ridge (soft tissue and bone); (3) the need for augmentation during the subsequent implant treatment; and (4) the question whether ARP is more costeffective than the therapy with unassisted socket healing. Patients will be followed for 5 years. Discussion: The extent of bone resorption after tooth extraction significantly influences the subsequent implant placement. Preserving the bone as well as possible is of great importance for the stability, prosthetically correct position and long-term functional success of the implantological treatment. A new, non-invasive method, without additional, study-related X-ray exposure, presented here for the first time, the change in volume of the bone bed can be analyzed. The preliminary results of this feasibility test report a median value of buccal and palatal bone loss of 6.2 mm (control)/4.4 mm (test) and 2.5 mm (control)/2.8 mm (test), respectively. These values are comparable to studies that also determined bone resorption by CBCT.

Porcine Collagen Transconjunctival Wound Closure System for Microincisional Vitrectomy Surgery.

Microincisional vitrectomy surgery has improved outcomes for vitrectomies; however, wound closure complications remain an important concern. The authors introduce a technique to improve transconjunctival wound closure in vitrectomy surgery. The authors evaluated the efficacy of porcine collagen plugs on stopping leakage from sclerotomy test sites in vitro and in vivo and assessed wound site healing with histology samples. The porcine collagen plugs successfully prevented leakage of trypan blue dye in enucleated rabbit eyes and of fluid flow in the rabbit model. Histology showed excellent wound reconstruction and healing, with essentially no inflammation for either angled or straight incisions with a 23-gauge system. The authors describe a simple and effective novel approach to wound closure in any-gauge vitrectomy surgery using porcine collagen plugs. This method can help reduce complications related to wound leakage. The authors plan to conduct human studies to demonstrate the safety of the approach in the future. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:576-579.].

Punctal occlusion for dry eye syndrome.

Dry eye syndrome is a disorder of the tear film and is associated with symptoms of ocular discomfort. Punctal occlusion is a mechanical treatment in which the tear drainage system is blocked in order to aid in the preservation of natural tears on the ocular surface.The objective of this review was to assess the safety and efficacy of punctal plugs for the management of dry eye.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 6), MEDLINE (January 1950 to June 2010), EMBASE (January 1980 to June 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). We also searched the Science Citation Index-Expanded database and reference lists of included studies. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 21 June 2010.We included randomized and quasi-randomized controlled trials of collagen or silicone punctal plugs in symptomatic participants diagnosed with aqueous tear deficiency or dry eye syndrome.Two review authors independently assessed trial quality and extracted data. We contacted study investigators for additional information.Seven randomized controlled trials including 305 participants (601 eyes) met the inclusion criteria and are summarized in this review. We did not perform meta-analysis due to appreciable variability in interventions and follow-up intervals. Although punctal plugs provided symptomatic improvement and clinical outcomes also improved from baseline measures, few studies demonstrated a benefit of punctal plugs over the comparison intervention. Reported adverse effects included epiphora (overflow of tears), foreign body sensation, eye irritation, and spontaneous plug loss.This systematic review shows a relative scarcity of controlled clinical trials assessing the efficacy of punctal occlusion therapy in dry eye. Although the evidence is very limited, the data suggest that silicone plugs can provide symptomatic relief in severe dry eye. Moreover, temporary collagen plugs appear similarly effective to silicone plugs on a short-term basis.

Effects of the bilayer nano-hydroxyapatite/mineralized collagen-guided bone regeneration membrane on site preservation in dogs.

This study was aimed at assessing the effects of the porous mineralized collagen plug with or without the bilayer mineralized collagen-guided bone regeneration membrane on alveolar ridge preservation in dogs. The third premolars in the bilateral maxilla of mongrel dogs ( N = 12) were extracted. Twenty-four alveolar sockets were thus randomly divided into three groups: membrane + collagen plug (MP, n = 8), nonmembrane + collagen plug (NP, n = 8) and blank group without any implantation (BG, n = 8). Radiographic assessment was carried out immediately and in the 2nd, 6th, and 12th week after surgery. The bone-repairing effects of the two grafts were respectively evaluated by clinical observation, X-ray micro-computed tomography examination, and histological analysis in the 8th and 12th week after surgery. Three groups presented excellent osseointegration without any inflammation or dehiscence. X-ray micro-computed tomography and histological assessment indicated that the ratios of new bone formation of MP group were significantly higher than those of NP group and BG group in the 8th and 12th week after surgery ( P < 0.05). As a result, the porous mineralized collagen plug with or without the bilayer mineralized collagen-guided bone regeneration membrane could reduce the absorption of alveolar ridge compared to BG group, and the combined use of porous mineralized collagen plug and bilayer mineralized collagen-guided bone regeneration could further improve the activity of bone regeneration.

Femoral Arterial Haemostasis Using an Anchored Collagen Plug after Percutaneous EVAR with an Ultra-Low Profile Device: Prospective Audit of an Evolving “Post-Close” Technique

To present an audit of a successful "post-close" haemostatic technique using the Angio-Seal VIP vascular closure device (VCD) after percutaneous endovascular aneurysm repair (p-EVAR) using an ultra-low profile (ULP) device. Thirty patients underwent EVAR using the Ovation device, of which 26 procedures were totally percutaneous. Data including patient habitus, procedural details, number of VCDs deployed including use of the double wire approach, and technical success/complications were prospectively recorded. Numerical/statistical analyses were undertaken using Microsoft Excel 2007 and Minitab for Windows. Thirty consecutive patients (27 male, 3 female; age range 70-85 years [mean 76.1, SD 6.5]) underwent EVAR for an infrarenal AAA (mean size 61mm, SD 9.7) between March 2014 and August 2016 using the Ovation endograft system. In a few patients open ipsilateral femoral access was used (n=4); the remainder underwent p-EVAR (n=26), and these results are presented hereafter. Ipsilateral sheath sizes used varied between 14F (n=22), 15F (n=3), and 16F (n=1), and were closed using a single 8F Angio-Seal (n=7), a combination of 8F/6F Angio-Seal VCDs (n=18), or two 8F Angio-Seal VCDs (n=1) with prior double wire set up. Contralateral punctures were closed mostly with a single 8F Angio-Seal (n=24) or combination of 8F/6F Angio-Seal VCDs (n=2) to seal defects downsized to 12F. The overall immediate haemostasis success rate was 100%. Mean length of stay in the p-EVAR cohort was 2 days (SD 1.5). All patients had a post-EVAR computed tomography angiogram (n=24) or duplex ultrasound (n=2) which did not reveal any stenoses or seromas; two patients developed an ipsilateral femoral pseudoaneurysm successfully treated by thrombin injection. A "post-close" technique can be employed successfully for haemostasis after p-EVAR using an ULP device. An 8F Angio-Seal is usually effective in closing a 12F femoral arterial defect. This represents a viable option for femoral arterial closure in this scenario.

Comparison of Bio-degradation for Ridge Preservation Using Silk Fibroin-based Grafts and a Collagen Plug.

A material for ridge preservation should have dimensional stability to resist bio-degradation. This study was designed to compare bio-degradation of ridge preservation materials. Collagen plug was used as a positive control. Untreated, ethanol-treated, and 4-hexylresorcinol (4HR)-treated silk plugs were used for the experimental group. Each material underwent a scanning electron microscopic exam and a Fourier transform infrared (FT-IR) spectroscopic exam. Bio-degradation was evaluated by analyzing cylindrical bony defects in rabbit tibias. There were no prominent differences in microstructure among the silk plug groups. FT-IR exam demonstrated that the ethanol- and 4HR-treated silk plug groups had enhanced β-sheet structure. All silk plug groups exhibited significantly higher residual graft than the collagen plug group 4weeks postoperative (p<0.05). In conclusion, silk fibroin-based ridge preservation material was less bio-degradable than a collagen plug until at least 4weeks after grafting.

Preterm prelabor rupture of membranes after fetoscopic laser surgery for twin-twin transfusion syndrome.

To assess the incidence, clinical course, risk factors and outcomes of preterm prelabor rupture of membranes (PPROM) after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). This was a prospective observational cohort study of 154 consecutive cases of TTTS. PPROM was defined as rupture of membranes before 34 weeks' gestation. Procedure-to-PPROM and PPROM-to-delivery intervals were determined. Relevant preoperative and intraoperative variables were analyzed by univariate and multivariate logistic regression to determine their impact on PPROM after FLS. The incidence of PPROM was 39% (n = 60), occurring at a mean gestational age of 27.2 ± 4.6 weeks. Median procedure-to-PPROM interval was 46 (range, 1-105; interquartile range (IQR), 13-66) days and median PPROM-to-delivery interval was 1 (range, 0-93; IQR, 0-13) day. Mean gestational age at delivery in cases with PPROM was 29.0 ± 4.5 weeks compared with 32.6 ± 3.9 weeks in cases without PPROM (P < 0.0001). Insertion of a collagen plug was the only significant factor found on both univariate and multivariate analysis to be associated with an increased rate of PPROM (odds ratio, 3.1 (95% CI, 1.2-8.0); P = 0.006). There was no statistically significant difference in fetal (P = 0.07) or neonatal (P = 0.08) survival between those with and those without PPROM. PPROM after FLS increases prematurity by 3.6 weeks. The latency period after PPROM was 2 weeks; 50% of patients delivered within 24 h. No variable thought to be associated with PPROM after FLS was found to be significantly associated with this complication. Other etiologies and mechanisms for PPROM after FLS should be explored. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Estudio de factibilidad y seguridad del plug de colágeno (PICS-AF™) en el tratamiento de la fístula anal criptoglandular

IntroductionThe PICS-AF™ (Curaseal Inc.) device is a new plug made of collagen that has a retention system in the internal orifice. This pilot study was designed to assess both the feasibility and safety of this plug in the treatment of trans-sphincteric anal fístulas. MethodsA total of 44 patients (34 men), with a mean age of 54.68±7.3, with trans-sphincteric anal fístulas were included in the study; 34 of them were analyzed. All patients were examined according to a strict preoperative protocol and until 6 months after surgery. The feasibility of the procedure and the adverse events were analyzed. ResultsFinally, 34 patients were operated on, and in 30 of them the plug was used. Therefore, the feasibility was calculated at 88%. There was a total of 16 adverse events, 4recorded as not related (3 mild and one moderate) and 12 related to the procedure or to the device implanted. Of these, 5were mild, 5moderate and 2severe. The majority of the events reported were related to proctalgia (4 patients) or infection at the implant site (4 patients). ConclusionsThe present study indicates that the new collagen plug can be placed effectively and with an acceptable complication rate.