A Quantitative Systematic Review of Clinical Outcome Measure Use in Peripheral Nerve Injury of the Upper Limb.

Background: Peripheral nerve injury (PNI) is common, leading to reduced function, pain, and psychological impact. Treatment has not progressed partly due to inability to compare outcomes between centers managing PNI. Numerous outcome measures exist but there is no consensus on which outcome measures to use nor when.

Engineering a cell-hydrogel-fibre composite to mimic the structure and function of the tendon synovial sheath.

The repair of tendon injuries is often compromised by post-operative peritendinous adhesions. Placing a physical barrier at the interface between the tendon and the surrounding tissue could potentially solve this problem by reducing adhesion formation. At present, no such system is available for routine use in clinical practice.

Aberrant Differentiation of Human Pluripotent Stem Cell-Derived Kidney Precursor Cells inside Mouse Vascularized Bioreactors.

Background: Numerous studies have documented the in vitro differentiation of human pluripotent stem cells (hPSCs) into kidney cells. Fewer studies have followed the fates of such kidney precursor cells (KPCs) inside animals, a more life-like setting. Here, we tested the hypothesis that implanting hPSC-derived KPCs into an in vivo milieu surgically engineered to be highly vascular would enhance their maturation into kidney tissues.

Four-Dimensional Imaging of Soft Tissue and Implanted Biomaterial Mechanics: A Barbed Suture Case Study for Tendon Repair.

Timely, recent developments in X-ray microcomputed tomography (XμCT) imaging such as increased resolution and improved sample preparation enable nondestructive time-lapse imaging of polymeric biomaterials when implanted in soft tissue, which we demonstrate herein. Imaging the full three-dimensional (3D) structure of an implanted biomaterial provides new opportunities to assess the micromechanics of the interface between the implant and tissues and how this changes over time as force is applied in load-bearing musculoskeletal applications. In this paper, we present a case study demonstrating in situ XμCT and finite element analysis, using a dynamically loaded barbed suture repair for its novel use in tendon tissue.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery.

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades.

Distinct Cellular Mechanisms Underlie Smooth Muscle Turnover in Vascular Development and Repair.

Rationale: Vascular smooth muscle turnover has important implications for blood vessel repair and for the development of cardiovascular diseases, yet lack of specific transgenic animal models has prevented it's in vivo analysis.

Objective: The objective of this study was to characterize the dynamics and mechanisms of vascular smooth muscle turnover from the earliest stages of embryonic development to arterial repair in the adult.

Methods And Results: We show that CD146 is transiently expressed in vascular smooth muscle development.

Strategies to Reduce Ischemia Reperfusion Injury in Vascularized Composite Allotransplantation of the Limb.

An important and often underinvestigated contributor to solid organ transplant rejection is ischemia reperfusion injury. This pathophysiological response releases damaging reactive oxygen species and cell stress signals that initiate inflammation, which has a critical role in priming the immune system for allorecognition. In time, this renders graft dysfunction and how this response is mediated in composite tissues remains unknown.

Improving Outcomes in Tendon Repair: A Critical Look at the Evidence for Flexor Tendon Repair and Rehabilitation.

Learning Objectives: After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration.

Versatility and "flap efficiency" of pedicled perforator flaps in lower extremity reconstruction.

Background: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects.

Patients And Methods: Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps.

Improving results of flexor tendon repair and rehabilitation.

Background: The global time and effort attributed to improving outcomes in the management of flexor tendon injury are large, but the degree of advancement made over the past 50 years is relatively small. This review examines the current perceived wisdom in this field and aims to explore the limitations to the authors' understanding of the tendon healing process, examining how this may be a factor that has contributed to the authors' modest progress in the field.

Methods: The authors critically evaluate the sum of laboratory and clinical literature on the topic of zone II flexor tendon management that has guided their practice and provide evidence to support their methods.

Reduction of tendon adhesions following administration of Adaprev, a hypertonic solution of mannose-6-phosphate: mechanism of action studies.

Repaired tendons may be complicated by progressive fibrosis, causing adhesion formation or tendon softening leading to tendon rupture and subsequent reduced range of motion. There are few therapies available which improve the gliding of damaged tendons in the hand. We investigate the role of Mannose 6-phosphate (M6P) in a 600 mM hypertonic solution (Adaprev) on tendon adhesion formation in vivo using a mouse model of severed tendon in conjunction with analysis of collagen synthesis, cellular proliferation and receptors involved in TGF beta signalling.

Sutured tendon repair; a multi-scale finite element model.

Following rupture, tendons are sutured to reapproximate the severed ends and permit healing. Several repair techniques are employed clinically, with recent focus towards high-strength sutures, permitting early active mobilisation thus improving resultant joint mobility. However, the arrangement of suture repairs locally alters the loading environment experienced by the tendon.

Is distal fibular fracture an absolute contraindication to free fibular flap harvesting? A review of evidence in the literature and illustration by a successful case.

Despite the advantages of a fibula flap, many surgeons would often be hesitant in its use in patients with a history of distal fibular fracture. The chief concern is the potential vascular damage sustained during the injury. From our experience, however, we noticed that the blood supply of various components of a fibula flap rarely relies on its distal part alone.

The cellular biology of flexor tendon adhesion formation: an old problem in a new paradigm.

Intrasynovial flexor tendon injuries of the hand can frequently be complicated by tendon adhesions to the surrounding sheath, limiting finger function. We have developed a new tendon injury model in the mouse to investigate the three-dimensional cellular biology of intrasynovial flexor tendon healing and adhesion formation. We investigated the cell biology using markers for inflammation, proliferation, collagen synthesis, apoptosis, and vascularization/myofibroblasts.