Removal Of Fibrous Tissue Research Articles

Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents.

Osteochondritis dissecans (OCD) is a joint disorder predominantly affecting the knee, elbow, and ankle of children and adolescents. This comprehensive review delves into the epidemiology, etiology, clinical manifestations, diagnostic approaches, and treatment of OCD. The most common cause of OCD is repetitive microtrauma, typically associated with sports activities, alongside other significant factors such as genetic predisposition, ischemia, and obesity. In early stages or when lesions are small, OCD often presents as non-specific, vaguely localized pain during physical activity. As the condition progresses, patients may experience an escalation in symptoms, including increased stiffness and occasional swelling, either during or following activity. These symptom patterns are crucial for early recognition and timely intervention. Diagnosis in most cases is based on radiographic imaging and magnetic resonance imaging. Nonsurgical treatment of OCD in young patients with open growth plates and mild symptoms involves activity restriction, immobilization methods, and muscle strengthening exercises, with a return to sports only after symptoms are fully resolved and at least six months have passed. Surgical treatment of OCD includes subchondral drilling in mild cases. Unstable lesions involve methods like restoring the joint surface, stabilizing fractures, and enhancing blood flow, using techniques such as screws, anchors, and pins, along with the removal of fibrous tissue and creation of vascular channels. The specifics of OCD treatment largely depend on the affected site. This synthesis of current research and clinical practices provides a nuanced understanding of OCD, guiding future research directions and enhancing therapeutic strategies.

Surgical technologies of sutured iris fixation of the dislocated IOL — fibrosed capsular bag complex

Purpose. To present various techniques of surgical treatment with the dislocation of the IOL — fibrosed capsular bag complex, and to analyze their clinical and functional results.Material and methods. 50 patients (mean age 75.7 ± 1.3 years) who received surgery with IOL-capsular bag complex (ICBC) were divided into 2 groups according to the applied treatment tactics. Tactics 1 consisted in suturing ICBC to the iris on the support needle without manipulations with the capsular bag (26 eyes). Tactic 2 involved IOL suturing to the iris in combination with various manipulations on the capsular bag, aimed at partial or complete removal of fibrous tissue (24 eyes). The follow-up period ranged from 4 to 6 years.Results. The criteria affecting the choice of the treatment technique were determined: integrity of the Zinn ligament, manifestation of capsular bag fibrosis (phimosis of the anterior capsulorhexis, fibrosis of the posterior capsule); impact of changes in the capsular bag structure on the correct position of the IOL (frontal inclination of the IOL, inversion of haptic elements to the optic zone); presence of a prolapse of the vitreous body; Semmering's ring with a high risk of the release of lens masses. A frequency occurrence analysis of the proposed criteria showed their importance in the choice of surgical treatment technique in patients with mixed type ICBC dislocation. Remote functional results of the operations are presented.Conclusion. The proposed low invasive methods of surgical treatment of patients with the dislocation of the IOL — fibrosed capsular bag complex are reliable and technically simple. Relative indications to choosing the treatment method with dislocation of the IOL-fibrosed capsular bag complex have been determined for various combinations of the proposed criteria.

Feasibility of aponeurectomy in combination with perioperative 192Ir high dose rate brachytherapy for Dupuytren’s disease

Partial aponeurectomy (PA) is astandard procedure for Dupuytren's contracture (DC). Here we report anovel approach using surgery combined with perioperative high dose rate (192Ir-HDR) brachytherapy. From March 2018 until February 2020, thirteen rays of 6patients with Dupyutren's contractures underwent PA followed by HDR brachytherapy. After removal of fibrous tissue and mobilization of the tendons, one to three catheters per patient were placed intraoperatively. Immediately after surgery, aplanning computer tomography with 3D-planning was performed. Then 10-12 Gy were given to 0-2 mm from the catheters' surface and the catheters were removed 6-12 h after brachytherapy. No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p < 0.01). One patient showed progressive fibrosis of anontreated ray during follow-up. HDR brachytherapy in combination with surgery is feasible and harbors the potential for combined modality therapy to reduce relapse rates of advanced or relapsing DC. Controlled studies are warranted to investigate the role of bimodal therapy compared with PA alone.

Isolated and Multilevel Spondylolysis (Literature Review)

One of the main causes of lumbar spine pain is spondylolysis. The purpose of this review is to present the current state of the problem of diagnosis and treatment isolated and multilevel spondylolysis.Materials and Methods. The review includes 86 publications on the problem of spondylolysis for 2005–2019, obtained from electronic databases: PubMed, Cochrane Library, eLIBRARY, CYBERLENINKA.Results. There is still the only known classification of spondylolysis by P. Niggemann et al, which includes four severity of this pathology — from mild to very severe: A, BI, BII, BIII. The classification is based on the nature of changes in the area of bone defect of the vertebral arch when the patient performs functional tests. In some cases, the pathology can be regarded as a transition between different degrees of severity of type B. The treatment of spondylolysis can be both conservative and operational. The conservative therapy consists of physical activity restriction, physiotherapy, wearing a corset, massage, and pharmacotherapy. The purpose of surgical treatment is the removal of fibrous tissue from the zone of spondylolysis and the achievement in this area the bone fusion via a bone autoplasty and(or) osteosynthesis with different metal frameworks. Reasoned arguments about the need for a combination of conservative and surgical treatment of patients with spondylolysis are also reflected in the publications. Information on multilevel spondylolysis is represented by a small number of articles. only 15 authors described clinical cases of multilevel spondylolysis in a total of 21 patients. Spondylolysis is a high risk factor for the spondylolisthesis formation. Among the various categories of patients suffering from spondylolysis and lumbar spondylolysis spondylolisthesis, pregnant women are of particular interest. Hormonal restructuring and changes in the biomechanics of the spine in women during the gestational period often leads to the appearance or intensification pain syndrome in lumbar spine complicating the pregnancy, and hence a fetus development.Conclusion. Timely diagnosis of spondylolysis and the subsequent development of individual rehabilitation not only improves the quality of life of patients, but in some cases can prevent such a serious pathology as spondylolisthesis.

Diamond Burr Polishing of Bowman’s Layer in the Treatment of Subepithelial Fibrosis after Radial Keratotomy (Clinical Case)

Radial keratotomy (RK) was widely used at the end of the last century for refractive purposes. However, ophthalmologists are increasingly faced with negative long-term consequences after RK now. A relatively rare complication after RK is subepithelial fibrosis (according to some data, it occurs in 2.7 % of cases), which may be the result of abnormal activation or proliferation of stromal keratocytes (stromal fibroblasts) after surgical or accidental injury of the Bowman membrane. Phototherapeutic keratectomy and manual mechanical removal by the “scraper” are used for the removal of fibrous tissue, as well as a combination of these methods with mitomycin. Since laser energy can provoke a recurrence of fibrosis in the future due to the activation of stromal keratocytes and using “scraper” is not always possible to remove fibrotic tissue and the use of mitomycin is associated with a number of complications, the question of finding new methods for its removal with minimal risk of complications arises. The method of diamond burr polishing of the cornea, which developed by us for treating the syndrome of recurrent cornea erosion, was, in our opinion, the most optimal for this purpose. The method of diamond burr polishing of the cornea in this clinical case made it possible to remove the epithelial fibrosis zone without damaging the Bowman’s layer, thereby avoiding the recurrence of fibrosis in the postoperative period (the follow-up period was 2 years). The depth of the location pathological tissue location was assessed using the OCT of the cornea. The absence of recurrence is also confirmed biomicroscopically and with the OCT of the cornea. So, the method of diamond burr polishing of the Bowman’s layer can be a method of choice for the treatment of subepithelial fibrosis for patients after keratorefractive operations, being highly effective, accessible, easy to perform.

CURRENT TREATMENT OF PATIENTS WITH GIANT TROPHIC ULCERS

The prevalence of venous ulceration in legs among the population is 0.1-1.5%, in 24% of patients and the duration of their treatment is more than a year. As a result, 45% of patients suffer from limited mobility, and many patients move only within the home. Wound healing rate in specialized centers for 6 months is 70% and 45% - in non-specialized hospitals. The aim of the study: Reduce the length of hospital stay and the duration of treatment for patients with giant trophic ulcers. The therapeutic tactics of 13 patients with giant trophic ulcers who were treated during the 2016 in the clinic of the Department of Surgery No. 2 of Danylo Halytsky LNMU were analyzed. Patients had an area of ulcers greater than 150 cm2 without tendency to heal. One-time treatment was carried out, consisting of surgery debridement, removal of fibrous tissue (shave-therapy), autodermoplastics with the use of negative pressure wound therapy (NPWT). The intervention was performed under i.v. or regional nerve blockade. With the use of the NPWT, a patient can be mobilized rather quickly, there is no need for constant bed rest, and with the possibility of adequate and supervision care is transferred to outpatient treatment on the first days. The total term of patients staying in a hospital was from 1 to 6 days. This technique has allowed to achieve a significant improvement in the quality of treatment and reduction of its terms.

Aseptic nonunion of pediatric subtrochanteric fracture: A case report

Nonunion of pediatric fractures related to the extracapsular proximal femur is a rare event if managed appropriately. Varus malposition renders increased stress over the fracture site leading to failure of the sound union. Management of such fractures is difficult owing to limited implant choices and presence of adjacent open physes. Open reduction and freshening of edges, removal of fibrous tissue, internal fixation with intra, or extramedullary implants, and a compliant follow-up are keys to the good functional outcome.

Management of Neglected Elbow Dislocations in a Setting with Low Clinical Resources

To investigate the effect of open reduction operative treatment in neglected elbow dislocation. Between January 2009 and October 2010, 13 patients (mean, 27 years, nine men and four women) with old unreduced posterior dislocation of the elbow were treated by open reduction and removal of fibrous tissue between distal humerus and ulna with Kirschner wire fixation with or without triceps lengthening in our hospital. The patients were followed up for a mean of 18 (range, 14-22) months. The mean operating time was 69.53 (range, 56-90) min. Mean operative blood loss 361.53 mL (range, 300-450 mL), mean tourniquet time 51.92 min (range, 46-70 min). According to the Mayo Elbow Performance Index at the final follow-up, 11 patients had satisfactory outcomes (six excellent, five good) and two patients had unsatisfactory outcomes (one fair and one poor). The mean score was 87. Nine patients had no pain, two had mild pain during repetitive elbow movements or weight lifting, and two had moderate pain. The mean pain score was 38 (range, 15-45). At the final follow-up, two patients had signs of instability; the mean score was 15. Seven achieved a flexion range of 105° to 130°, two achieved 100°, two achieved 95°, one achieved 80°, and one 60°. Operative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable and functional limb.

Periprosthetic Tissue Removal in Minimally Invasive Hip Refix Procedures

An alternative to conventional revision surgery of loosened hip prostheses is a new minimally invasive refixation procedure. This procedure requires the removal of periprosthetic fibrous tissue. The aim of this preliminary study is to evaluate which technique is most suitable for minimally invasive periprosthetic tissue removal: a Ho:YAG laser or a VAPR-2 coblation system. The clinical situation of a loosened prosthesis was simulated by several cadaveric femora, each implanted with a hip prosthesis. Artificially created periprosthetic lesions were filled with a fibrous tissue substitute. Using this fibrous tissue substitute, we measured temperatures in vitro at different distances from the site of removal. Temperatures during removal were recorded both inside the fibrous tissue and in the surrounding bone. This study demonstrated that temperatures generated in the bone do not result in thermal damage. Temperatures inside the fibrous tissue are sufficiently high to remove the fibrous tissue. Using the laser instead of the coblation system for the removal of fibrous tissue resulted in higher temperatures, thus, a faster removal of fibrous tissue. Additionally, the laser takes less effort to be integrated with the new surgical instrument and, therefore, we consider it a promising tool. However, when translating the results to clinical practice, the limitations of this study should be kept in mind. The equipment was set to typical presets; different settings (pulse frequency, pulse energy, and activated time) might affect the procedure’s success and risks. Care must be taken with respect to generated temperatures at larger distances from the place of removal. The use of the Ho:YAG laser, as well as VAPR coblation, might form a small risk for thermal damage to healthy surrounding tissues. Further research on apparatus settings and removal strategy is necessary before this technique can be applied for the removal of fibrous tissue in the clinical setting.

Assessment of a Suction-Assisted Cartilage Shaver Plus Liposuction for the Treatment of Gynecomastia

The development of feminized breasts in men may cause significant emotional distress and embarrassment, particularly in young men and adolescents. Numerous techniques have been described for the correction of gynecomastia, many of which include the removal of fat and glandular tissue. The authors assess the utility of combining vibroliposuction with the use of a power-assisted arthroscopic-endoscopic cartilage shaver to correct gynecomastia and suggest a treatment algorithm for patients with gynecomastia. Forty consecutive patients with a median age of 32 years (range 19-57 years) and with varying degrees of gynecomastia underwent a combined approach that included vibroliposuction (power-assisted tumescent liposuction) for the removal of fatty tissue, followed by the removal of fibrous tissue with the use of a power-assisted cartilage shaver. Follow-up periods ranged in duration from six to 18 months. All patients had satisfactory results. However, expansive hematomas requiring surgical drainage developed in three patients. Other complications included one case of insufficient resection requiring reoperation and three cases of hyperpigmentation and skin irregularities in patients with grade I gynecomastia. Combination treatment using vibroliposuction and a power-assisted arthroscopic-endoscopic cartilage shaver is an effective treatment for gynecomastia, but the technique has a learning curve. This procedure is most appropriate for patients with grades II and III gynecomastia, or as a first-stage treatment for patients with grade IV gynecomastia.

Endoscopy for evaluation and treatment of the ciliary body in hypotony.

To determine the clinical utility of the intraocular videoendoscope for evaluation of the ciliary body in eyes with hypotony and as a visualization tool for surgery of the ciliary body. A gradient index of refraction rod endoscope was used to evaluate the ciliary body in 14 patients. Videotapes and charts were reviewed retrospectively to correlate the appearance of the ciliary body and to analyze the clinical findings and surgical results. Videoendoscopic surgery to remove fibrous tissue from the ciliary processes was performed in nine eyes. The endoscope produced a clear detailed image of the ciliary body in a state that is undisturbed by scleral depression or other forms of mechanical distortion. In eyes without hypotony the normal ciliary processes are uniformly pigmented with a velvet-like surface at high magnification. White surface changes in the peak and crest of individual ciliary processes (white-caps) were seen in 11 of 14 patients with hypotony. At high magnification the white surface changes had a brush-like texture integral to the ciliary processes. Other findings in hypotony were fibrous covering of the ciliary body in 10 patients, loss of pigment epithelium in 5, traction elongation of the ciliary processes in 8, vascular loops in 4, pigmented sheets in 3, and areas of missing ciliary processes in 1. White caps were present in seven of the nine patients who had surgery for fibrous traction of the ciliary processes and hypotony and three patients with hypotony not due to other endoscopically visible abnormalities of the ciliary processes. Endoscopically visualized dissection of ciliary body in 9 patients resulted in normal or elevated tension immediately postoperatively in 7 (78%). At the most recent visit only three of the patients had normal tension, but for these nine patients the pressures were marginally, significantly (P = 0.08) higher compared to the preoperative pressures. The evaluation and management of hypotony is enhanced by the use of intraocular videoendoscopy. Clinical findings of whitecaps and traction elongation of the ciliary processes were associated with ocular hypotony. The endoscope facilitated surgery for dissection and removal of fibrous tissue over the ciliary processes. Further studies are needed to better understand the pathophysiology of ocular hypotony.

Superficialization of hemodialysis access using a video-assisted procedure.

Brachiocephalic fistula is one of the main options to gain blood access for hemodialysis. Although the fistula is easy to establish, puncture becomes increasingly difficult because the cephalic vein runs deep and fibrous tissue is being continually deposited over the cephalic vein. Although superficialization-i.e., the removal of fibrous tissue along the basilic vein-has been performed with conventional surgery, the long incision along the cephalic vein induces the buildup of hard fibrous tissue so that puncture may remain difficult even after the operation. To avoid this problem, we tried superficialization of hemodialysis access using a video-assisted procedure and obtained a good result.