Use of titanium vascular staples in trauma

Elastomeric Polyesters in Cardiovascular Tissue Engineering and Organs-on-a-Chip

Cardiovascular tissue constructs provide unique design requirements due to their functional responses to substrate mechanical properties and cyclic stretching behavior of cardiac tissue that requires the use of durable elastic materials. Given the diversity of polyester synthesis approaches, an opportunity exists to develop a new class of biocompatible, elastic, and immunomodulatory cardiovascular polymers. Furthermore, elastomeric polyester materials have the capability to provide tailored biomechanical synergy with native tissue and hence reduce inflammatory response in vivo and better support tissue maturation in vitro. In this review, we highlight underlying chemistry and design strategies of polyester elastomers optimized for cardiac tissue scaffolds. The major advantages of these materials such as their tunable elasticity, desirable biodegradation, and potential for incorporation of bioactive compounds are further expanded. Unique fabrication methods using polyester materials such as micromolding, 3D stamping, electrospinning, laser ablation, and 3D printing are discussed. Moreover, applications of these biomaterials in cardiovascular organ-on-a-chip devices and patches are analyzed. Finally, we outline unaddressed challenges in the field that need further study to enable the impactful translation of soft polyesters to clinical applications.

Combat casualty care research: from bench to the battlefield

Hemorrhagic shock is the leading cause of death in civilian and combat trauma. Effective hemorrhage control and better resuscitation strategies have the potential of saving lives. The Trauma Readiness and Research Institute for Surgery (TRRI-Surg) was established to address the core mission of the Uniformed Services University, "Learning to Care for Those in Harm's Way," by conducting research to improve the outcome of combat casualties. This article highlights the salient achievements of this research effort in the areas of hemorrhage control, resuscitation, design and testing of devices, and some novel concepts such as the use of profound hypothermia. The impact of these basic science research findings on changes in military medical care and outcome of injured soldiers is also described.

Five years' world experience with nonpenetrating clips for vascular anastomoses

BACKGROUND

A new sutureless technique has been introduced clinically to facilitate the process of vascular reconstruction and improve patency. The Vessel Closure System (VCS) is nonpenetrating, creates an elastomeric everted anastomosis, and is easily and reproducibly applied. The objective of this report is to review the published world experience that has accrued regarding these clips with attention to the assets, liabilities, and pitfalls associated with the new technology.

DATA SOURCES

Medline search and manual cross-referencing were performed, after which 61 original articles were identified on the use of VCS clips for vascular anastomoses.

RESULTS

Advantages of the clips compared with sutures include the technical ease of application, the reduced anastomotic time, the superior hemodynamics, and the improved healing pattern of the anastomosis. Disadvantages include the potential problems in atherosclerotic vessels, lack of prospective randomized long-term follow-up, and initial costs. The best clinical results have been achieved in microvascular repair, as well as with vascular access and transplantation surgery.

CONCLUSIONS

The VCS clip technology has become an accepted vascular anastomosing technique, which in future could lead to the use of clips as a standard approach and the use of sutures only in case of severe atherosclerosis and other circumstances in which vessel edges are difficult to evert.

An historical tour of vascular injury management: from its inception to the new millennium

Advances have been made in times of war. Lessons learned from these experiences should be studied in order to avoid the costly mistakes made previously. Fortunately, major conflicts have not been common recently. Therefore, military surgeons depend on the stable environment of civilian trauma and research to lead the way. Documentation and careful record keeping such as the Vietnam Vascular Registry are vital in assisting surgeons with lessons to be learned.

Comparison of titanium vascular closure staples with suture repair of the thoracic aorta in swine

OBJECTIVE

Devices that reduce technical difficulty and anastigmatic time when repairing large vessels such as the thoracic aorta would be beneficial. The aim of this study was to determine if titanium vascular closure staples (3 mm) could be safely and quickly applied in the repair of large vessels such as the thoracic aorta.

DESIGN

Through a left thoracotomy in 10 female swine (110 to 130 lb), an interposition graft (14 to 16 mm textile) was placed into the aorta distal to the left subclavian artery. Animals were randomized at the time of repair to either running sutures (n = 5; 6-0 polypropylene) or vascular closure staples (n = 5; 3 mm). The anastomosis was evaluated after 2 months with aortograms, and the aorta was harvested to evaluate healing.

RESULTS

The clamp times (mean +/- SD) were 30.8 +/- 8.2 min for suture repair and 24.8 +/- 5.1 min for vascular closure staple repair (p = 0.2). Anastomosis times were 20. 0 +/- 6.2 min for the suture group and 16.4 +/- 6.4 min for the vascular closure staple group (p = 0.4). Arch aortograms at 2 months revealed no significant difference in luminal narrowing between the two groups. Gross and microscopic examination revealed no thrombosis, well-healed wounds with a continuous intimal layer, and no differences in intimal thickness or inflammation between the two groups.

CONCLUSION

Vascular closure staples were equivalent to sutures in terms of durability, graft patency, and wound healing at 2 months. Vascular closure staples may offer the trauma surgeon a quick and easy alternative when repairing large vessels such as the thoracic aorta.