Laser soldering of rat skin, using fiberoptic temperature controlled system

Is Transgenic Porcine Skin as Good as Allogeneic Skin for Regenerative Medicine? Comparison of Chosen Properties of Xeno- and Allogeneic Material

BACKGROUND

Burn treatment is associated with the need of dressing large cutaneous defects. There is a need of alternative search for the allogeneic skin as a source of grafting for a clinical use. Such sources include animals. For many years, porcine skin was used as a biological dressing for wounds or donor's fields, or residual fields after skin grafting. Current studies aim to minimize immunogenicity, inter alia, through the decellularization process.

MATERIALS AND METHODS

The decellularization methods and porcine skin resettlement of human keratinocytes and fibroblasts were evaluated. The mechanical properties of the dressings and their influence on the viability, apoptosis, population doubling, and cell cycle of keratinocytes and fibroblasts were examined. The inheritance of cell antigens responsible for histocompatibility on the human keratinocyte and fibroblast surface in the cultures incubated with examined variants of dressings from porcine skin were analyzed.

RESULTS

The most effective acellularization method is trypsinization. Morphology of the cell remained proper and stable during the whole experiment. In both fibroblast and keratinocyte cultures, the highest number of apoptotic cells was observed when samples were incubated with allogeneic skin. In the keratinocyte cultures, the highest number of live cells was observed when incubated with porcine transgenic acellular dermal matrix. The acellular matrices influence the increase of population doubling of keratinocytes in the cultures.

CONCLUSION

For routine acellurization, trypsinization was chosen as the most effective method with preservation of tissue properties.

Influence of laser wavelength and beam profile on the coagulation depth in a soft tissue phantom model

In laser tissue soldering (LTS), a protein solution is thermally denatured and cross-linked to obtain a strong bond between tissues or tissue and a wound dressing. However, if the extension of the heat-affected zone is too large, wound healing is impaired by thermal tissue injuries. Therefore, heat input and coagulation depth have to be limited. We investigate the influence of wavelength and beam profile on coagulation depth using a soft tissue phantom in case of weakly (980 nm) and strong (1540 nm) absorbed laser radiation. The soft tissue phantom is doped with polystyrene (PS) beads to obtain similar scattering properties as natural tissue. The propagation of the laser radiation in the phantom is simulated by Monte-Carlo method and the optical penetration (OPD) depth calculated from isophotes. The simulation results are compared with the experimental determination of the coagulation volume. The results reveal that scattering effect of tissues on laser radiation increases the losses of a Gaussian beam profile laterally leading to a half-sphere coagulation volume. The depth profile of the coagulation follows approximately the intensity distribution of the laser beams as long as scattering effects are weak. As scattering effects become significant, as for 980-nm radiation, the intensity distribution of the laser beam in the tissue deviates from the original one, leading to different profile of the coagulation depth.

Scar management in burn injuries using drug delivery and molecular signaling: Current treatments and future directions

In recent decades, there have been tremendous improvements in burn care that have allowed patients to survive severe burn injuries that were once fatal. However, a major limitation of burn care currently is the development of hypertrophic scars in approximately 70% of patients. This significantly decreases the quality of life for patients due to the physical and psychosocial symptoms associated with scarring. Current approaches to manage scarring include surgical techniques and non-surgical methods such as laser therapy, steroid injections, and compression therapy. These treatments are limited in their effectiveness and regularly fail to manage symptoms. As a result, the development of novel treatments that aim to improve outcomes and quality of life is imperative. Drug delivery that targets the molecular cascades of wound healing to attenuate or prevent hypertrophic scarring is a promising approach that has therapeutic potential. In this review, we discuss current treatments for scar management after burn injury, and how drug delivery targeting molecular signaling can lead to new therapeutic strategies.

Corneal cut closure using temperature-controlled CO2 laser soldering system

We aimed to evaluate the effectiveness of temperature-controlled laser soldering for repair of large perforated corneas in a porcine model. Eight Yorkshire pigs aged 6 months underwent 6-mm-deep 180° crescent-shaped trephination of the central corneas. Right corneal injuries were repaired by placement of 47 % bovine albumin along the cut followed by CO2 laser soldering (power density 16 W/cm(2)) to a target temperature of 65(°). Left corneal injuries were repaired with 10/0 nylon sutures. The groups were compared for operative time, leakage, and histopathological findings. Mean tissue temperature was 63 ± 4 °C. Mean operative time was 31.57 ± 2.8 min in laser-soldered eyes and 41.38 ± 2.3 min in controls (p < 0.0001, unpaired Student's t test). Compared to controls, the soldered corneas had less neovascularization, complete re-epithelization, and mild stromal inflammation. There was no leakage in either group. Combined CO2 laser and radiometer is effective for the in vivo repair of corneal cuts. These results have important implications for modern corneal surgery. Further studies are needed in the clinical setting.

Nerve repair: toward a sutureless approach

Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.

Cutaneous wound closure materials: an overview and update

Introduction:

On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky.

Objectives:

We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds.

Materials and Methods:

The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990.

Conclusion:

Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

Evaluation of dermal substitute in a novel co-transplantation model with autologous epidermal sheet

The development of more and more new dermal substitutes requires a reliable and effective animal model to evaluate their safety and efficacy. In this study we constructed a novel animal model using co-transplantation of autologous epidermal sheets with dermal substitutes to repair full-thickness skin defects. Autologous epidermal sheets were obtained by digesting the basement membrane (BM) and dermal components from rat split-thickness skins in Dispase II solution (1.2 u/ml) at 4 °C for 8, 10 and 12 h. H&E, immunohistochemical and live/dead staining showed that the epidermal sheet preserved an intact epidermis without any BM or dermal components, and a high percentage of viable cells (92.10 ± 4.19%) and P63 positive cells (67.43 ± 4.21%) under an optimized condition. Porcine acellular dermal matrixes were co-transplanted with the autologous epidermal sheets to repair full-thickness skin defects in Sprague-Dawley rats. The epidermal sheets survived and completely re-covered the wounds within 3 weeks. Histological staining showed that the newly formed stratified epidermis attached directly onto the dermal matrix. Inflammatory cell infiltration and vascularization of the dermal matrix were not significantly different from those in the subcutaneous implantation model. Collagen IV and laminin distributed continuously at the epidermis and dermal matrix junction 4 weeks after transplantation. Transmission electron microscopy further confirmed the presence of continuous lamina densa and hemidesmosome structures. This novel animal model can be used not only to observe the biocompatibility of dermal substitutes, but also to evaluate their effects on new epidermis and BM formation. Therefore, it is a simple and reliable model for evaluating the safety and efficacy of dermal substitutes.

Effects of PerClot® on the healing of full-thickness skin wounds in rats

PerClot(®) is a hemostatic material made of polysaccharide from modified starch and has been shown to assist in topical hemostasis. The principal goal in treating surgical and non-surgical wounds is the need for rapid closure of the lesion. This study investigated whether topical application of PerClot(®) could improve impaired wound healing in Sprague-Dawley (SD) rats. Full-thickness skin wounds were created on the back of the rats. Immediately, PerClot(®) was introduced into the wound bed, while wounds receiving starch or nothing served as controls. Wound closure was monitored using well-recognized wound-healing parameters: histological examination for inflammatory cells and fibroblast infiltration, newly formed capillaries, and collagen deposition. Meanwhile, transforming growth factor (TGF-β1) was measured by immunochemistry. Wound closure was significantly accelerated by local application of PerClot(®). Furthermore, PerClot(®)-treated wounds showed significantly increased fibroblast numbers at 5 days post-wounding, and newly formed capillaries at 7 days post-wounding, and collagen regeneration at 7 and 14 days post-wounding. The number of infiltrating fibroblasts expressing TGF-β1 was significantly higher than that in the controls at 7 and 14 days post-wounding. PerClot(®) can improve the wound healing and this effect might involve an increase in the activity of fibroblasts and increased release of TGF-β1.

Enhanced laser tissue soldering using indocyanine green chromophore and gold nanoshells combination

Gold nanoshells (GNs) are new materials that have an optical response dictated by the plasmon resonance. The wavelength at which the resonance occurs depends on the core and shell sizes. The purposes of this study were to use the combination of indocyanine green (ICG) and different concentration of gold nanoshells for skin tissue soldering and also to examine the effect of laser soldering parameters on the properties of repaired skin. Two mixtures of albumin solder and different combinations of ICG and gold nanoshells were prepared. A full thickness incision of 2 × 20 mm(2) was made on the surface and after addition of mixtures it was irradiated by an 810 nm diode laser at different power densities. The changes of tensile strength (σ(t)) due to temperature rise, number of scan (Ns), and scan velocity (Vs) were investigated. The results showed at constant laser power density (I), σ(t) of repaired incisions increases by increasing the concentration of gold nanoshells in solder, Ns, and decreasing Vs. It was demonstrated that laser soldering using combination of ICG + GNs could be practical provided the optothermal properties of the tissue are carefully optimized. Also, the tensile strength of soldered skin is higher than skins that soldered with only ICG or GNs. In our case, this corresponds to σ(t) = 1800 g cm(-2) at I ∼ 47 Wcm(-2), T ∼ 85 [ordinal indicator, masculine]C, Ns = 10, and Vs = 0.3 mms(-1).

CO(2) Laser Fascia to Dura Soldering for Pig Dural Defect Reconstruction

BACKGROUND AND OBJECTIVES

The purposes of this study were to demonstrate that laser soldering is safe and effective for tissue bonding in dural reconstruction and to compare this new reconstruction technique to an established one.

STUDY DESIGN

A temperature-controlled fiberoptic CO(2) laser system or fibrin glue were used for in vitro dural defect reconstruction in two groups of pigs. The CO(2) laser technique was also used for dural reconstruction in live pigs.

RESULTS

The burst pressure of the reconstructed dura by the laser system was significantly higher than that of fibrin glue (mean pressure 258.5 +/- 117.3 cm H(2)O and 76.8 +/- 47.2 cm H(2)O, respectively). There were no postoperative complications and no signs of thermal damage to the dura, fascia, or underlying tissue on histological analysis following the in vivo CO(2) laser experiments.

CONCLUSIONS

Temperature-controlled laser soldering is an effective technique for dural repair. It creates a strong tissue bonding with no thermal damage to the tissue. The burst pressure of the reconstructed dura done with laser soldering is significantly higher than that of fibrin glue.

Collagen-binding peptidoglycans inhibit MMP mediated collagen degradation and reduce dermal scarring

Scarring of the skin is a large unmet clinical problem that is of high patient concern and impact. Wound healing is complex and involves numerous pathways that are highly orchestrated, leaving the skin sealed, but with abnormal organization and composition of tissue components, namely collagen and proteoglycans, that are then remodeled over time. To improve healing and reduce or eliminate scarring, more rapid restoration of healthy tissue composition and organization offers a unique approach for development of new therapeutics. A synthetic collagen-binding peptidoglycan has been developed that inhibits matrix metalloproteinase-1 and 13 (MMP-1 and MMP-13) mediated collagen degradation. We investigated the synthetic peptidoglycan in a rat incisional model in which a single dose was delivered in a hyaluronic acid (HA) vehicle at the time of surgery prior to wound closure. The peptidoglycan treatment resulted in a significant reduction in scar tissue at 21 days as measured by histology and visual analysis. Improved collagen architecture of the treated wounds was demonstrated by increased tensile strength and transmission electron microscopy (TEM) analysis of collagen fibril diameters compared to untreated and HA controls. The peptidoglycan's mechanism of action includes masking existing collagen and inhibiting MMP-mediated collagen degradation while modulating collagen organization. The peptidoglycan can be synthesized at low cost with unique design control, and together with demonstrated preclinical efficacy in reducing scarring, warrants further investigation for dermal wound healing.

Closure of skin incisions by laser-welding with a combination of two near-infrared diode lasers: preliminary study for determination of optimal parameters

Laser welding has the potential to become an effective method for wound closure and healing without sutures. Closure of skin incisions by laser welding with a combination of two near-infrared lasers (980 and 1064 nm), was performed for the first time in this study. One centimeter long, full-thickness incisions were made on the Wistar rat's dorsal skin. The efficiencies of laser-welding with different parameters were investigated. Incision-healing, histology examination, and a tensile strength test of incisions were recorded. Laser welding with the irradiance level of 15.9 W∕cm(2) for both 980 and 1064-nm lasers and exposure time of 5 s per spot in continuous wave mode yielded a more effective closure and healing with minimal thermal damage, faster recovery, and stronger apposition in comparison with a suturing technique. The conclusion is that skin welding with a combination of two near-infrared diode lasers can be a good candidate for incision closure, and further investigations are in progress for clinical use.

In vivo comparison of near infrared lasers for skin welding

The skin closure abilities of near infrared lasers and suturing were compared by histological examination and mechanical tensile tests during a 21-day healing period. One-centimeter incisions on the dorsal skin of Wistar rats were treated by one of the closing techniques: (a) soldering, using an 809 nm diode laser (0.5 W, 5 s) with 25% bovine serum albumin (BSA) and 2.5 mg/ml indocyanine green (ICG); (b) direct welding with a 980 nm diode laser (0.5 W, 5 s); (c) direct welding with a 1,070 nm fiber laser (0.5 W, 5 s); (d) suturing. Six spots (79.61 J/cm(2) for each spot) were applied through the incisions. Healing was inspected on the 1st, 4th, 7th, 14th, and 21st post-operative days. The closure index (CI), thermally altered area (TAA), granulation area (GA) and epidermal thickness (ET) were determined by histological examination. Tensile tests were performed at a 5 mm/min crosshead speed up to the first opening along the incision. Immediate superficial closure with high CI values was found for the laser-irradiated incisions at the early phase of recovery. Clear welds without thermal damage were observed for the group irradiated at 1,070 nm. For the sutured group, the incisions remained unclosed for the first day, and openings through the incision were observed. At the end of the 21-day recovery period, no differences between experimental groups were observed in terms of the CI, GA and ET values. However, the tensile strength of the groups irradiated at 980 nm and 1,070 nm was found to be higher than that of the sutured incisions. The laser welding techniques were found to be reliable in terms of immediate and mechanically strong closure compared with suturing. Of them, 1,070 nm laser welding yielded noticeably stronger bonds, with minimal scarring at the end of the 21-days of recovery.

Enhancement of incisional wound healing by thrombin conjugated iron oxide nanoparticles

Thrombin has been clinically used for topical hemostasis and wound management for more than six decades. The half-life of thrombin in human plasma is shorter than 15s due to close control by inhibitors. In order to stabilize the thrombin, it was bound to maghemite (gamma-Fe(2)O(3)) nanoparticles, as demonstrated in previous work. The aim of the present study was to examine the efficiency of the bound thrombin for wound healing applications compared to the free thrombin. For this purpose incisional wounds on rat skin were treated with a mixture of fibrinogen, CaCl(2) solution and free or bound thrombin. The wounds' edges were then approximated by skin staples. The control incisional wounds were closed with staples only. In the course of 28 days of healing the highest values of skin tensile strength were observed following treatment with the bound thrombin. Significantly lower values of tensile strength were observed following treatment with the free thrombin, and the lowest values were obtained following treatment with staples only. The histological findings correlate with the mechanical strength measurements, which demonstrate the most advanced stages of healing following treatment with the bound thrombin.

The future of lasers in urology

The use of laser applications in urology has undergone significant advances over the past 20 years. Laser technology is now used in a wide variety of procedures, and has become the primary treatment modality or standard of care for many urologic conditions. Despite these advances, a number of challenges still face laser utilization in urologic practice. Recent work has illuminated the potential improvement and further optimization of this field. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, precision of laser application and cost reduction have served to further improve laser technology and extend the potential applications.

Immediate tight sealing of skin incisions using an innovative temperature-controlled laser soldering device: in vivo study in porcine skin

BACKGROUND

A feedback temperature-controlled laser soldering system (TCLS) was used for bonding skin incisions on the backs of pigs. The study was aimed: 1) to characterize the optimal soldering parameters, and 2) to compare the immediate and long-term wound healing outcomes with other wound closure modalities.

MATERIALS AND METHODS

A TCLS was used to bond the approximated wound margins of skin incisions on porcine backs. The reparative outcomes were evaluated macroscopically, microscopically, and immunohistochemically.

RESULTS

The optimal soldering temperature was found to be 65 degrees C and the operating time was significantly shorter than with suturing. The immediate tight sealing of the wound by the TCLS contributed to rapid, high quality wound healing in comparison to Dermabond or Histoacryl cyanoacrylate glues or standard suturing.

CONCLUSIONS

TCLS of incisions in porcine skin has numerous advantages, including rapid procedure and high quality reparative outcomes, over the common standard wound closure procedures. Further studies with a variety of skin lesions are needed before advocating this technique for clinical use.

Closure of skin incisions by 980-nm diode laser welding

A 980-nm diode laser is proposed to be an alternative welding laser in dermatology due to its optimal penetration in tissue. An in vivo predosimetry study was done to estimate the optimal laser energy delivery conditions (6 W, 400 ms). Next, in vivo experiments were comparatively performed to examine healing of wounds closed either with suture or laser welding. One-centimeter-long, full-thickness incisions were done on the dorsal side of Wistar rats. Wounds were surgically removed at 1, 4, 7, 14, and 21 days postoperatively. Macroscopic examinations showed that welding had minimal scarring and a fine quality healing. According to histological (hematoxylin and eosin staining) results, change of epidermal thickness and granulation tissue formation through 21 days of healing period showed similarities in both methods. Epidermal thickness of welded wounds decreased from 62.46+/-6.87 microm (first day) to 36.49+/-0.92 microm (21st day) and that of sutured wounds decreased from 62.94+/-13.53 microm (first day) to 37.88+/-7.41 microm (21st day). At day 14, epidermal thickness of sutured wounds (61.20+/-6.60 microm) were higher than welded wounds (49.69+/-6.31 microm) (p<0.05). Besides, granulation values were greater for the sutured wounds but the difference was statistically significant (p<0.05) only for the seventh day (197,190.29+/-.89,554.96 microm(2) for sutured wounds, 138,433.1+/-51,077.17 microm(2) for welded wounds). Those differences indicate a faster recovery with laser welding. It is concluded that tissue welding with a 980-nm diode laser can be a good candidate for tissue welding applications with accelerated and improved healing, but further investigations are in progress for clinical use.

Near infrared laser-tissue welding using nanoshells as an exogenous absorber

BACKGROUND AND OBJECTIVE

Gold nanoshells are a new class of nanoparticles that can be designed to strongly absorb light in the near infrared (NIR). These particles provide much larger absorption cross-sections and efficiency than can be achieved with currently used chemical chromophores without photobleaching. In these studies, we have investigated the use of gold nanoshells as exogenous NIR absorbers to facilitate NIR laser-tissue welding.

STUDY DESIGN/MATERIALS AND METHODS

Gold nanoshells with peak extinction matching the NIR wavelength of the laser being used were manufactured and suspended in an albumin solder. Optimization work was performed on ex vivo muscle samples and then translated into testing in an in vivo rat skin wound-healing model. Mechanical testing of the muscle samples was immediately performed and compared to intact tissue mechanical properties. In the in vivo study, full thickness incisions in the dorsal skin of rats were welded, and samples of skin were excised at 0, 5, 10, 21, and 32 days for analysis of strength and wound healing response.

RESULTS

Mechanical testing of nanoshell-solder welds in muscle revealed successful fusion of tissues with tensile strengths of the weld site equal to the uncut tissue. No welding was accomplished with this light source when using solder formulations without nanoshells. Mechanical testing of the skin wounds showed sufficient strength for closure and strength increased over time. Histological examination showed good wound-healing response in the soldered skin.

CONCLUSIONS

The use of nanoshells as an exogenous absorber allows the usage of light sources that are minimally absorbed by tissue components, thereby, minimizing damage to surrounding tissue and allowing welding of thicker tissues.

Novel laser tissue-soldering technique for dural reconstruction

OBJECT

The goal of this study was to use a modified version of the CO2 laser-soldering system to develop a simple and reliable technique for the repair of dural defects after excision of brain tumors.

METHODS

The authors used a CO2 fiber optic laser system that they had developed for heating, monitoring, and controlling tissue temperature in situ and in real time, thereby reducing damage to the brain parenchyma. They adapted the system for dural closure by using free fascial grafts in a porcine model. Measures for estimation of reconstruction quality included visual assessment under magnification and direct measurements of adhesive strength and cerebrospinal fluid leak (CSF) pressure. Reliable soldering was achieved in 54 of 57 experiments, providing a 95% success rate. The average peak adhesive strength was 82 +/- 3 mN/cm2. The measured leak pressure of the fascia-dura mater bond was 66 +/- 5 mm Hg. Conventional suturing performed using Prolene stitches resulted in immediate CSF leakage from areas between the stitches and from the area of the needle hole itself.

CONCLUSIONS

Fascia-dura mater soldering using the CO2 laser is feasible and may support CSF pressure up to six times higher than normal intracranial pressure. Findings of this study may provide a basis for the development of new tools for dural reconstruction.

Chitosan adhesive for laser tissue repair: in vitro characterization

BACKGROUND AND OBJECTIVES

Laser tissue repair usually relies on hemoderivate protein solders, based on serum albumin. These solders have intrinsic limitations that impair their widespread use, such as limited tensile strength of repaired tissue, poor solder solubility, and brittleness prior to laser denaturation. Furthermore, the required activation temperature of albumin solders (between 65 and 70 degrees C) can induce significant thermal damage to tissue. In this study, we report on the design of a new polysaccharide adhesive for tissue repair that overcomes some of the shortcomings of traditional solders.

STUDY DESIGN/MATERIALS AND METHODS

Flexible and insoluble strips of chitosan adhesive (elastic modulus approximately 6.8 Mpa, surface area approximately 34 mm2, thickness approximately 20 microm) were bonded onto rectangular sections of sheep intestine using a diode laser (continuous mode, 120 +/- 10 mW, lambda = 808 nm) through a multimode optical fiber with an irradiance of approximately 15 W/cm2. The adhesive was based on chitosan and also included indocyanin green dye (IG). The temperature between tissue and adhesive was measured using a small thermocouple (diameter approximately 0.25 mm) during laser irradiation. The repaired tissue was tested for tensile strength by a calibrated tensiometer. Murine fibroblasts were cultured in extracted media from chitosan adhesive to assess cytotoxicity via cell growth inhibition in a 48 hours period.

RESULTS

Chitosan adhesive successfully repaired intestine tissue, achieving a tensile strength of 14.7 +/- 4.7 kPa (mean +/- SD, n = 30) at a temperature of 60-65 degrees C. Media extracted from chitosan adhesive showed negligible toxicity to fibroblast cells under the culture conditions examined here.

CONCLUSION

A novel chitosan-based adhesive has been developed, which is insoluble, flexible, and adheres firmly to tissue upon infrared laser activation.

A scanning electron microscopy study of CO2 laser-albumin soldering in the rabbit model

OBJECTIVE

We sought to assess the rabbit as an experimental animal in the investigation of laser skin soldering. We studied, using the scanning electron microscope (SEM), the surface appearances of experimental incisions made on the rabbit back skin and soldered by CO(2) laser.

BACKGROUND DATA

Laser soldering of incisions in various tissues is a modality of wound healing of a very promising clinical value. At present, more component studies on animals directed at paving the way towards clinical protocols are needed.

METHODS

Surgical incisions on rabbits back skin were bonded using either albumin-assisted CO(2) laser soldering (experimental) or thread suturing (reference). The incisions closed were excised 2, 3, 4, and 5 days postoperatively, and skin surfaces were studied in the SEM.

RESULTS

Naked eye inspection and SEM analysis showed that full-length sealing of soldered and sutured incisions was discernible as early as day 2. In the SEM, all incisions were found confluently coated by epidermal cells along the former cut streak. Soldering subserved to bond incisions efficiently, with surface smooth and close to normal skin. On the other hand, the surface of sutured incisions appeared convoluted and its aesthetic quality inferior to that of the former. Some of the days two and three soldered incisions suffered dehiscence on excision, which suggests an incomplete regeneration of tensile strength at this early phase of healing. Sutured incisions tolerated excision, very probably due to the microthread still present in the skin tissue rather than because of breaking strength regained during wound healing. Also, hair stumps re-grown on the skin by day 5 postoperative might impair satisfactory microscopy of bonded incisions.

CONCLUSIONS

CO(2) laser soldering of incisions on the rabbit back skin effected rapid wound sealing and resulted in smooth scars indistinguishable from normal skin. The rabbit is well suited for this kind of studies, provided that excision of experimental cuts takes place not later than 5 days post-incision so that hair stumps may not grow large enough to jeopardize the quality of scanning electron microscopy.

Repair of pig dura in vivo using temperature controlled CO2 laser soldering

BACKGROUND AND OBJECTIVES

The purpose of this study was to demonstrate that laser soldering might be successfully used for closing holes or cuts in the dura layer, which encapsulates the brain.

STUDY DESIGN/MATERIALS AND METHODS

A temperature controlled fiberoptic CO(2) laser system and albumin solder were used for spot soldering of fascia patches to holes in the dura of farm pigs, in vitro and in vivo.

RESULTS

The mean burst pressure of the soldered patches in the in vitro experiments was 190 +/- 88 mm Hg-significantly higher than typical maximum CSF pressure of 15 mm Hg. In the in vivo experiments the pigs showed no postoperative complications. Histopathological studies exhibited an accepted level of inflammatory reaction and showed no thermal damage to the underlying brain tissue.

CONCLUSIONS

It has been clearly demonstrated that temperature controlled laser soldering is a very useful technique for the repair of the dura. It provides significant advantages over standard closure techniques: it is easy to apply, the bond is strong and watertight and the procedure is likely to be much faster than suturing. This research work will lead to clinical trials.

Laparoscopic laser soldering for repair of ureteropelvic junction obstruction in the porcine model

BACKGROUND AND PURPOSE

Laparoscopic pyeloplasty is used for the repair of ureteropelvic junction (UPJ) obstruction. Our objective was to introduce laser soldering to this procedure.

MATERIALS AND METHODS

We developed a system based on a CO2 laser, an infrared detector, and two infrared transmitting optical fibers to obtain temperature-controlled laser soldering of cuts in tissues. The system was used for laparoscopic soldering of incisions in the kidneys of pigs.

RESULTS

We carried out laparoscopic pyeloplasty successfully in a porcine model using fiberoptic laser soldering. Laparoscopic laser soldering was found to be faster than suturing. It was easier to use and provided watertight bonding.

CONCLUSIONS

This technique will be useful in pyeloplasty as well as other laparoscopic surgical procedures.

Closure of skin incisions in rabbits by laser soldering: I: Wound healing pattern

BACKGROUND AND OBJECTIVES

Temperature-controlled tissue laser soldering is an innovative sutureless technique awaiting only solid experimental data to become the gold-standard surgical procedure for incision closure. The goals of the current study were: (1) to define the optimal laser soldering conditions, (2) to explore the immediate skin reparative healing events after sealing the wound, and (3) to determine the long-term trajectory of skin wound healing.

STUDY DESIGN/MATERIALS AND METHODS

Skin incisions were generated over rabbit dorsa and were closed using different wound-closure interventions, in three groups: (a) closure, using a temperature-controlled infrared fiberoptic CO2 laser system, employing 47% bovine serum albumin as a solder; (b) wound closure by cyanoacrylate glues; and (c) wound closure by sutures. The reparative outcomes were evaluated macroscopically and microscopically, employing semi-quantitative grading indices.

RESULTS

Laser soldering of incisions at T = 65 degrees C emerged as the optimal method achieving immediate wound sealing. This in turn induced accelerated reparative events characterized by a reduced inflammatory reaction, followed by minimal scarring and leading to a fine quality healing.

CONCLUSIONS

Temperature-controlled laser soldering offers an accelerated wound reparative process with numerous advantages over the conventional methods. Further investigations may reveal additional benefits in the spectrum of advantages that this innovative surgical technology has to offer. This can introduce new scientific insight that will pave the way for clinical use.

Closure of skin incisions in rabbits by laser soldering II: Tensile strength

BACKGROUND AND OBJECTIVES

The basic characteristic property of wound closure is the immediate and long-term tensile strength (LTS). The objective of the current study was to compare tissue laser soldering to other available methods (i.e., cyanoacrylate glues and sutures) in the performance and outcome of wound closure and reparative healing process, with an emphasis on the immediate and LTS.

STUDY DESIGN/MATERIALS AND METHODS

The animals were divided into three groups according to the type and details of the closure procedure. Group A: laser treatments at different temperatures were compared to sutured incisions, emphasizing the LTS after 10 days. Group B: laser soldering at 65 +/- 5 degrees C was compared to chemical glues (i.e., Histoacryl and Dermabond), emphasizing the immediate tensile strength (ITS). Group C: LTS of laser soldered incisions was compared to that of sutured incisions at various time intervals emphasizing LTS (3, 7, 14, 28 days).

RESULTS

Group A: LTS at 60 degrees C exhibited the highest values (0.48 MPa). Group B: no ITS difference was detected between laser soldering and chemical glues. Group C: soldered incisions at 65 degrees C exhibited higher LTS (1.81 MPa) than that of sutured incisions (1.08 MPa) (P < 0.043).

CONCLUSIONS

Temperature-controlled laser soldering at 65 degrees C provided sufficient ITS and higher bonding LTS values compared with sutures, resulting in better wound healing characteristics. The laser soldering system presented here should be tested on larger animal models before adopting it for clinical usage.