Excision Of Granulation Tissue Research Articles

Management of Tracheal Stent Granulations: A Novel Approach

This is a case of a 29 year old female, diagnosed with adenoid cystic carcinoma of trachea who had previously undergone bronchoscopy, de-bulking of the tumour, stenting of trachea with a metallic stent followed by a course of chemo-radiotherapy. She then presented to our hospital with complaints of breathing difficulty. On rigid telescopy of larynx, a metallic stent was visualised below the level of the vocal cords with a mass lesion over it narrowing the airway. Contrast enhanced CT scan of neck and thorax showed a tracheal stent with soft tissue thickening at proximal and distal ends. By using VV-ECMO, in this patient we were able to perform satisfactory airway evaluation, biopsy of mass at upper and lower end of tracheal stent using a rigid bronchoscope with Hopkins telescope and optical forceps and KTP laser assisted excision of granulation tissue with full endoscopic visualisation and without any complications.

Prevalence of Airway Abnormality after Tracheotomy at a Tertiary Safety Net Children’s Hospital

Introduction: Over 4500 pediatric tracheotomies are performed an-nually in the United States. However, there is no consensus on the appropriate time for surveillance endoscopy. The St. Christopher’s Hospital for Children implemented the Trach Safe Initiative to improve airway safety in tracheotomy-dependent children. A major component of this initiative is surveillance endoscopy. The objectives of this study are to describe the prevalence of abnormal airway changes in trach dependent patients, to identify and describe the frequency of airway interventions, and to ultimately minimize morbidity in this population. Method: A report consisting of a list of patients meeting our inclusion criteria was generated using CPT codes for tracheotomy and direct bronchoscopy and laryngoscopy at SCHC. A retrospective chart review of patients under the age of 18 who has had a tracheotomy from 2010 to 2020 was conducted in order to describe airway abnormalities after tracheotomy quantitatively andqualitatively. Result: 55 patients met inclusion criteria and were included in our study. Our study found the overall rate of abnormal findings onen-doscopy after tracheotomy is 72.7 % (p < 0.05). The average time from tracheotomy to the time of initial surveillance endoscopy at SCHC was 884 days (95%CI 684 -1084). The most common abnormal finding was granulation tissue (29.1%), followed by supra-stomal collapse (12.7%), and subglottic stenosis (12.7%). 58.2% of patients undergoing endoscopy had an intervention. The most common intervention during endoscopy was excision of granulation tissue (25.4%) and trach change (23.6%) followed by tracheoplasty/stomoplasty (7.2%). Conclusion:Our study found a high rate of airway abnormality on surveillance endoscopy with a significant percentage of our patients requiring airway intervention. Our findings necessitate a guideline for routine surveillance endoscopy for our tracheotomy patients and the development of a database tracking airway abnormalities of patients in order to prepare a safe airway plan.

Complicated Paediatric Bronchial Foreign Body: A Novel Extraction Technique

A paediatric bronchoscopy procedure for foreign body inhalation is indeed a highly challenging procedure due to multiple risk factors such as lower physiological functional residual capacity and adverse pulmonary function effects by anaesthetic agents in addition to concurrent active lungs infection. Here we elucidate a novel technique of foreign body removal located at the distal airway in a paediatric patient and in a situation where a paediatric flexible bronchoscopy with built-in working channel is not available. A 1-year 7-months-old boy presented with acute respiratory distress syndrome following a one-week history of active respiratory infection. On examination, he was tachypnoeic with audible soft inspiratory stridor and intermittent barking cough despite being supplemented with 3 liters /minute oxygen mask. Chest x-ray showed right upper lobe collapse. He was referred to the otorhinolaryngology team after a suspicious history of foreign body aspiration obtained from his mother. Bedside flexible nasopharyngolaryngoscopy showed granulation tissue at the junction of laryngeal surface of epiglottis and anterior commissure. He underwent emergency direct laryngoscopy, tracheoscopy, bronchoscopy, excision of granulation tissue and removal of foreign body under general anaesthesia. Herein, some of complicated bronchoscopy demand critical thinking of alternative or modified techniques to achieve a successful and safe surgery. Bangladesh J Otorhinolaryngol 2021; 27(2): 177-183

Transplantation of Cultivated Fibroblasts on a Backing of Xenogenic Tissue in the Treatment of Wounds.

IntroductionTrophic ulcers are a common health problem, and there are numerous treatment methods. Irreversible damage in the skin, subcutaneous tissue, and fascia with long-term ulcer existence make standard autotransplantation inneffective. Skin grafts are often complicated by partial or complete rejection of skin flaps. The aim of this study was to examine the feasibility of using transplanted cultivated allogenic fibroblasts on the backing of a cellularless xenogenic fabric for wound healing.MethodsTransplantation of cultured embryonic fibroblasts on a backing of xenogenic tissue was used in the complex treatment of trophic ulcers for stimulation of regenerative processes. Decellularization xenogenic film was previously held. Then allogenic fibroblasts were cultivated on the surface of collagen-elastin matrix. Since 2013, we treated 12 patients with giant ulcers caused by the following: lymphedema (2 patients), vascular disease (3 patients), diabetes (2 patients), after injury (4 patients), and radiation ulcer (1 patient). Dimensions of ulcers were from 150 to 600 cm2. Duration of the lower limb ulcers ranged from 8 months to 10 years. For a number of years, all patients were on a complex therapy, which had not resulted in healing wounds. During the operation when excision of granulation tissue was performed, plastic wounds perforated with the ratio 1:2 autoskin. Xenogenic fabric with cultured fibroblasts was applied on top. In this case, xenogenic film protected the skin from drying, created optimal microclimate, and cultured fibroblasts stimulating regeneration and improving engraftment.ResultsThe first redress was held on the fifth day. In all cases, the results of engraftment skin grafts achieved maximum possible (100%) and optimal (90%). Complete epithelialization of the cell perforation was seen in five patients on the fifth day and three on seventh day after skin plastics. Average period of inpatient treatment was 20.7 days. All patients were discharged with healed wounds.ConclusionThus, the treatment of trophic ulcers can be successfully solved using advances in biotechnology. Transplantation of cultivated allogenic fibroblasts on a backing of cellularless xenogenic fabric shows good clinical results due to the stimulation of regenerative processes and creates the optimum environment for autotransplants.

Outcome of postoperative intubation and mechanical ventilation in neonates with surgical pathologies

Background and aims: With rising survival of neonates, the need for surgical intervention and mechanical ventilation are also increasing. Neonates with mechanical ventilation may have problems related to the intubation. In this study, we aimed to evaluate the factors leading to complications among the intubated neonates after surgery. Materials and Methods: Twenty three newborns with surgical pathologies, who required endotracheal intubation and mechanical ventilation after surgery, were enrolled in the study between January 2008 and December 2008. The gestational age, diagnosis, duration of intubation, associated congenital abnormalities, intubation difficulties and respiratory problems after the extubation were recorded. Results: The mean gestation age was 34 weeks. Congenital diaphragmatic hernia was present in four neonates. There were 5 patients with esophageal atresia and tracheoesophageal fistula, 3 patients with intestinal perforation due to necrotizing enterocolitis and 2 patients with omphalocele. Three patients (with diagnosis of bladder exstrophy, neonatal cholestasis, cystic adenomatoid malformation) having pneumothorax were also included into the study. The mean length of intubation was 8.8 days. Intubation difficulty was encountered in two patients. One patient had extubation failure due to laryngeal stenosis, laryngomalacia and laryngeal granulation. In four patients (17.3%) subglottic stenosis, laryngeal granulation, stridor and laryngomalacia developed. Endoscopic dilatation and excision of granulation tissue were performed in two of them. The other two patients were managed conservatively. All four patients were extubated successfully. Two patients -without extubation problems- died due to multiple organ failure. Conclusion: Endotracheal intubation, extubation and mechanical ventilation are safe procedures in neonates with surgical pathologies if they are performed by the stuff with experience. Follow up of these patients must be achieved in NICU. Complications may occur due to intubation and mechanical ventilation and these problems may require a surgical repair.

Excision of Granulation Tissue and Free Conjunctival Autograft in the Management of Necrotizing Scleritis

To describe a novel use of conjunctival autograft in the management of surgically induced scleral necrosis that occurred after squint surgery. Interventional case report. A 22-year-old man underwent bilateral adjustable squint surgery. Two weeks postoperatively, he developed conjunctival retraction and an area of scleral necrosis/melting with 80% thinning. The surrounding conjunctiva was markedly inflamed with raised edges. Screening for autoimmune and vasculitic conditions did not provide any positive results. The conjunctiva surrounding the area of scleral melt was excised and the area covered by a conjunctival autograft resulting in complete healing of the scleral melt within 1 month of surgery. The pathogenesis of surgically induced scleral necrosis not associated with autoimmune conditions may be the result of the products of inflammation and lytic enzymes released by the surrounding conjunctival tissue initiating the scleral melting process. This type of surgically induced scleral necrosis may be successfully managed by excision of the surrounding inflamed conjunctiva, thus removing a potential source of collagenases, and covering the exposed sclera by a conjunctival transplant obviating the need for prolonged high-dose immunosuppression.

Postoperative fistula of the abdominal wall after laparascopic cholecystectomy due to lost gallstones

Abdominal fistula caused by cholesterol gallstones, which remained in the abdominal wall after laparascopic cholecystectomy: a laparascopic cholecystectomy was performed in a 60-years-old man who was diagnosed as acute necrosing cholecystitis due to cholecystolithiasis. After removal of the gallbladder using an Endocath some gallstones remained in the excision channel of the abdominal wall. Therefore, a fistula developed in the excision channel postoperatively. As the wound healing was disturbed an investigation of the abdominal wall was performed by ultrasound. In the former excision channel several small, oval, formations with high echogenicity and faint ultrasound shadows were detected, corresponding to additional gallstones. After excision of granulation tissue and removal of the cholesterol stones, complete healing of the fistula in the abdominal wall was achieved.

Conservative surgical management of Mersilene* mesh suburethral sling erosion

Objective: The aim of this study was to describe conservative surgical management of polyethylene terephthalate (Mersilene, Ethicon, Inc, Somerville, NJ) mesh suburethral sling erosion as an alternative to sling removal. Study Design: Seven women who had undergone suburethral sling procedures with Mersilene mesh were found to have varying degrees of mesh visible in the vagina at 4 to 12 weeks after the operation. Three women with erosions <5 mm were treated in the office and 4 women who had 6 to 30 mm erosions underwent inpatient surgical revision, which consisted of trimming of mesh when needed, excision of granulation tissue, and re-covering of the erosion in 2 layers. Results: All 7 patients have been followed up for 6 to 37 months. Only 1 woman who underwent inpatient surgical revision had a recurrence (4 mm); this was treated successfully in the office. Conclusion: Vaginal erosions in suburethral sling procedures with Mersilene mesh can be managed initially with our conservative surgical technique. (Am J Obstet Gynecol 1998;179:1424-9.)

Pathogenesis and treatment of growing skull fractures

BACKGROUNDGrowing skull fractures are poorly understood complications of pediatric skull fractures.METHODSA retrospective review of skull fractures at our institution from 1980–1993 revealed 10 patients with growing skull fractures. The age at injury ranged from 1–144 months, with 9 of 10 patients being under one year of age. The etiology of these fractures included falls, motor vehicle accidents, and child abuse. On average, growth of the fracture was diagnosed 14 months after the initial injury.RESULTSSix patients have had magnetic resonance imaging (MRI) with one demonstrating leptomeningeal cyst herniation, two having brain herniation, and three having both brain parenchyma and leptomeningeal cyst herniation. All patients had malacic cortex underlying the fracture, but there was no evidence of intracranial hypertension. Nine patients have undergone craniotomy with excision of granulation tissue and gliotic brain, dural repair, and cranioplasty using surrounding normal skull. There were no surgical complications or recurrences.CONCLUSIONSBrain/leptomeningeal cyst herniation through a dural rent, without MRI evidence of increased intracranial pressure, implicates physiologic growth and brain cerebrospinal fluid (CSF) pulsations as the cause of fracture enlargement.

Fracture of a synthetic fenestrated tracheostomy tube: Case report and review of the literature

Frequently patients require a tracheostomy tube over a prolonged period of time. A number of complications have been reported with the chronic use of tracheostomy tubes including granulation tissue formation, subglottic stenosis, and tracheomalacia. Reports of a tracheostomy tube fracture are rare. Many of these tubes were made of metal such as silver, zinc, and copper.‘.’ It was thought that corrosion of the metal predisposed the tubes to fracture.l With the advent of synthetic tracheostomy tubes in the 196Os, it was hoped that these tubes would be free of the problem of fracture. However, the first report of a synthetic tube fracture was documented in 197X3 Thereafter, several other reports have described synthetic tracheostomy tube fracture. Most of these fractures occurred at the neck plate site. In this article the first case of a fracture in a synthetic fenestrated tracheostomy tube is reported and the literature is reviewed. This case may suggest that the fenestration in the tube may be a weak point and that fracture at that site may occur, particularly after prolonged wear. The patient was subsequently lost to follow-up until his visit to the ear, nose, and throat clinic 4 years later. The patient had not changed his tube during this time period. The patient presented with a foul smell from the tracheostomy tube and a mass under his tube. He had no shortness of breath and no hemoptysis. The patient had a no. 8 fenestrated Shiley tracheostomy tube with a nonfunctional cuff. There was a large amount of peristomal granulation tissue which partially pushed out the tracheostomy neck plate. The patient was brought to the operating room for tracheostomy tube change and excision of peristomal granulation tissue. Under local anesthesia, the tracheostomy tube was inspected. It was noticed that two fractures, approximately 1 to 2 cm in length, were present at the site of the fenestration (Fig 1). The granulation tissue had grown through the fenestration preventing removal of the tube. Excision of the granulation tissue was performed with electrocautery. The tracheostomy tube and fracture site were both grasped and removed with a clamp. A new no. 8 cuffless nonfenestrated Shiley tracheostomy tube was inserted. The patient was discharged with two sets of tracheostomy tubes. He is closely followed up in clinic for tracheostomy tube changes.

Pericardial patch tracheoplasty for severe tracheal stenosis in children: Intermediate results

Between 1982 and 1990, 15 children have undergone pericardial patch tracheoplasty, 13 for complete tracheal rings and 2 for acquired tracheal stenosis. Eleven had complete tracheal rings from the thoracic inlet or the cricoid to the carina. Diagnosis was by bronchoscopy (15), computed tomography (10), and magnetic resenance imaging (3). As first described by Idriss in 1984, the surgical technique uses a median sternotomy approach, extracorporeal circulation, bronchoscopic guidance, and the use of pericardium as a tracheal patch. There was one perioperative death of mediastinitis (operative survival, 93%). There were two late deaths caused by complications of tracheostomy (1) and direct laryngoscopy and bronchoscopy (DLB) (1). Follow-up is complete in 12 intermediate-term survivors and ranges from 0.4 to 8.2 years (mean, 4.2 ± 2.9 years). Five children required multiple DLBs with dilation and excision of granulation tissue; one of these patients underwent tracheoplasty revision 5 months after the initial procedure for residual tracheal rings, and four of these children have had tracheostomies, two temporary and two currently (4 months, 7 years). Seven children had widely patent tracheas observed at follow-up DLB with little or no residual stenosis after tracheoplasty. All survivors are currently asymptomatic, except for the two children with tracheostomies. Pericardial patch tracheoplasty offers effective therapy with relatively low operative mortality for infants and children with severe long segment tracheal stenosis. On intermediate-term follow-up, nearly all survivors are essentially free of symptoms of residual tracheal stenosis.