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Weistra K, Kan HJ, van Alebeek VAHJ, Ritt MJPF. Proximal Interphalangeal Joint Arthroplasty Using a Silicone Implant: A Comparison Between Integra and NeuFlex in 72 Cases. Hand (N Y) 2024; 19:236-240. [PMID: 36168738 PMCID: PMC10953532 DOI: 10.1177/15589447221122829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Osteoarthritis of the hand can lead to pain, stiffness, and deformation, and thus to functional disability. The purpose of this study was to compare short-term clinical outcomes of 2 silicone proximal interphalangeal (PIP) joint implants, NeuFlex and Integra, in patients with primary osteoarthritis. METHODS We included 72 PIP joints, of which 40 were replaced by a NeuFlex implant and 32 by an Integra implant. The average follow-up was 12 months for the Integra group and 16 months for the NeuFlex group. RESULTS There was no change in active flexion preoperatively and postoperatively. Extension lag and Disabilities of the Arm, Shoulder, and Hand score decreased substantially in both groups, whereas grip strength and Patient-Specific Functional Scale (PSFS) score increased. All patients were satisfied. Between groups, there was a significant difference in the PSFS score, in favor of the Integra group. CONCLUSIONS Both implants have excellent results, but more research is needed with more patients to prevent bias and to determine the long-term outcome of these implants.
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Affiliation(s)
- Kelly Weistra
- Amsterdam UMC and University of Amsterdam, The Netherlands
| | - Hester J. Kan
- Amsterdam UMC and University of Amsterdam, The Netherlands
| | | | - Marco J. P. F. Ritt
- Amsterdam UMC and University of Amsterdam, The Netherlands
- The Hand Clinic, Amsterdam, The Netherlands
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2
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Kooi K, Martinez ET, Freundt L, Oflazoglu K, Ritt MJPF, Eberlin KR, Selles RW, Clemens MW, Rakhorst HA. From Data to Decisions: How AI Is Revolutionizing Clinical Prediction Models in Plastic Surgery. Plast Reconstr Surg 2024:00006534-990000000-02221. [PMID: 38194624 DOI: 10.1097/prs.0000000000011266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
SUMMARY The impact of clinical prediction models within Artificial Intelligence (AI) and machine learning (ML) is significant. With its ability to analyze vast amounts of data and identify complex patterns, machine learning has the potential to improve and implement evidence-based plastic, reconstructive, and hand surgery. Among others, it is capable of predicting the diagnosis, prognosis, and outcomes of individual patients. This modeling aids daily clinical decision making, most commonly at the moment, as decision-support.Therefore, the purpose of this paper is to provide a practice guideline to plastic surgeons implementing AI in clinical decision-making or setting up AI research to develop clinical prediction models using the 7-step approach and the ABCD validation steps of Steyerberg et al. Secondly, we describe two important protocols which are in the development stage for AI research: 1) the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) checklist, and 2) The PROBAST checklist to access potential biases.
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Affiliation(s)
- Kevin Kooi
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | | | - Liliane Freundt
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kamilcan Oflazoglu
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ruud W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Hinne A Rakhorst
- Department of Plastic Surgery, Ziekenhuisgroep Twente, The Netherlands
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Brinkmann SJH, van Houten J, Ritt MJPF. Trick of the Scrub Nurse: Using the Fringe of a Glove as a Vessel Loop. Tech Hand Up Extrem Surg 2023; 27:253-254. [PMID: 37523309 DOI: 10.1097/bth.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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van der Meulen C, van de Stadt LA, Claassen A, Kroon FPB, Ritt MJPF, Rosendaal FR, Terpstra SES, Vochteloo AJH, Kloppenburg M. Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review. RMD Open 2023; 9:e003134. [PMID: 37532467 PMCID: PMC10401234 DOI: 10.1136/rmdopen-2023-003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a research agenda. METHODS A systematic literature search was performed up to September 2022. Two investigators independently identified studies that reported on denervation for OA of the proximal interphalangeal, distal interphalangeal, metacarpophalangeal or carpometacarpal joints. Quality of studies was assessed and study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted. RESULTS Of 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. Sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. One non-randomised clinical trial reported no difference in outcome when comparing denervation of the first carpometacarpal (CMC I) joint to trapeziectomy. Adverse events were frequent, with sensory abnormalities occurring the most, followed by the need for revision surgery. All studies had significant risk of bias. CONCLUSION Surgical denervation for pain in hand OA shows some promise, but the available evidence does not allow any conclusions of efficacy and higher-quality research is needed. Techniques should be harmonised and more data regarding how denervation compares to current usual care, other denervation methods or placebo in terms of outcomes and adverse events are needed.
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Affiliation(s)
| | - Lotte A van de Stadt
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Aniek Claassen
- Dutch Society for Rheumatology, Utrecht, The Netherlands
| | - Féline P B Kroon
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frits R Rosendaal
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anne J H Vochteloo
- Department of Orthopaedics, OCON Orthopedische kliniek, Hengelo, The Netherlands
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Verhiel SHWL, Ritt MJPF, Chen NC. Predictors of Secondary Ulnar Shortening and Reoperation After Arthroscopic TFCC Debridement. Hand (N Y) 2022; 17:1147-1153. [PMID: 33530709 PMCID: PMC9608277 DOI: 10.1177/1558944720977534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting which patients will do well with arthroscopic triangular fibrocartilage complex (TFCC) debridement alone or which patients may benefit from arthroscopic debridement and ulnar shortening at the same time can be challenging. In this retrospective cohort study, we aimed to assess the rate and type of complications and reoperations after arthroscopic TFCC debridement. Furthermore, we aimed to identify factors associated with reoperation and specifically ulnar shortening osteotomy (USO) after this procedure. METHODS We included 163 patients who underwent arthroscopic TFCC debridement as a first surgery for treatment of their ulnar-sided wrist pain. Patient charts were manually reviewed, and ulnar variance was measured on preoperative posteroanterior radiographs of the wrist. Bivariate analysis and multivariable logistic regression analysis were performed to identify factors associated with reoperation. Additional subgroup analyses looking at USO after TFCC debridement were performed with Kaplan-Meier analysis and Cox regression survival analysis. RESULTS We found a complication rate of 14% and a reoperation rate of 19% (most common USO with 10%). Chondromalacia was independently associated with reoperation. Forty percent of patients with a positive ulnar variance later proceeded to USO. A hazard ratio of 1.8 per millimeter of ulnar variance was found. CONCLUSIONS Our data suggest that patients with a positive ulnar variance with frank chondral loss at the time of arthroscopic TFCC debridement may benefit from simultaneous USO.
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Verhiel SHWL, Blackburn J, Ritt MJPF, Simeone FJ, Chen NC. MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain. Hand (N Y) 2022; 17:483-490. [PMID: 32686539 PMCID: PMC9112747 DOI: 10.1177/1558944720937369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. Methods: We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. Results: We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis (P = .033), extensor carpi ulnaris (ECU) pathology (P = .028), and ulnar styloid fractures (P = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint (P = .040), more ulnocarpal abutment (P = .0081), and more degenerative tears (P < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. Conclusions: We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.
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Affiliation(s)
- Svenna H. W. L. Verhiel
- Massachusetts General Hospital, Boston, USA,Amsterdam UMC, location VUmc, The Netherlands,Svenna H. W. L. Verhiel, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
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Zijlker HJA, Fakkert RK, Beumer A, IJsselstein CB, Wessels M, Ritt MJPF. Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis. J Hand Surg Eur Vol 2022; 47:302-307. [PMID: 34796775 PMCID: PMC8892058 DOI: 10.1177/17531934211057389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes.Level of evidence: III.
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Affiliation(s)
- Hero J. A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruben K. Fakkert
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands,Coronel Institute of Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cees B. IJsselstein
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mascha Wessels
- Department of Radiology, Reade, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Marco J. P. F. Ritt, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUmc, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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8
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Haugen IK, Felson D, Abhishek A, Berenbaum F, Edwards JJ, Herrero Beaumont G, Hermann-Eriksen M, Hill CL, Ishimori M, Jonsson H, Karjalainen T, Leung YY, Maheu E, Mallen CD, Moe RH, Ramonda R, Ritschl V, Stamm TA, Szekanecz Z, van der Giesen FJ, Ritt MJPF, Wittoek R, Kjeken I, Osteras N, van de Stadt LA, Englund M, Dziedzic KS, Marshall M, Bierma-Zeinstra S, Hansen P, Greibrokk E, Smeets W, Kloppenburg M. Development of radiographic classification criteria for hand osteoarthritis: a methodological report (Phase 2). RMD Open 2022; 8:e002024. [PMID: 35121640 PMCID: PMC8819785 DOI: 10.1136/rmdopen-2021-002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In Phase 1 of developing new hand osteoarthritis (OA) classification criteria, features associated with hand OA were identified in a population with hand complaints. Radiographic findings could better discriminate patients with hand OA and controls than clinical examination findings. The objective of Phase 2 was to achieve consensus on the features and their weights to be included in three radiographic criteria sets of overall hand OA, interphalangeal OA and thumb base OA. METHODS Multidisciplinary, international expert panels were convened. Patient vignettes were used to identify important features consistent with hand OA. A consensus-based decision analysis approach implemented using 1000minds software was applied to identify the most important features and their relative importance influencing the likelihood of symptoms being due to hand OA. Analyses were repeated for interphalangeal and thumb base OA. The reliability and validity of the proposed criteria sets were tested. RESULTS The experts agreed that the criteria sets should be applied in a population with pain, aching or stiffness in hand joint(s) not explained by another disease or acute injury. In this setting, five additional criteria were considered important: age, morning stiffness, radiographic osteophytes, radiographic joint space narrowing and concordance between symptoms and radiographic findings. The reliability and validity were very good. CONCLUSION Radiographic features were considered critical when determining whether a patient had symptoms due to hand OA. The consensus-based decision analysis approach in Phase 2 complemented the data-driven results from Phase 1, which will form the basis of the final classification criteria sets.
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Affiliation(s)
- Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - David Felson
- Rheumatology section, Boston University School of Medicine, Boston, Massachusetts, USA
- Arthritis Research UK Epidemiology Unit, National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Francis Berenbaum
- INSERM CRSA, Sorbonne University, Paris, France
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - John James Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Gabriel Herrero Beaumont
- Department of Rheumatology, Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Catherine L Hill
- Rheumatology Department, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mariko Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Helgi Jonsson
- Department of Rheumatology, Landspitali, Reykjavik, Iceland
| | - Teemu Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Emmanuel Maheu
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Rikke Helene Moe
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Zoltan Szekanecz
- Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | | | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Osteras
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lotte A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - M Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Elsie Greibrokk
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Wilma Smeets
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Verhiel SHWL, Özkan S, Ritt MJPF, Chen NC, Eberlin KR. A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction. Hand (N Y) 2021; 16:375-384. [PMID: 31248288 PMCID: PMC8120580 DOI: 10.1177/1558944719855447] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: There are various treatments for post-traumatic distal radioulnar joint (DRUJ) dysfunction. The present study aimed to assess differences in long-term patient-reported outcomes on physical function, pain, and satisfaction between the Darrach and Sauvé-Kapandji procedures. Secondary aims were to describe the radiographic outcomes and to assess the difference in rate and type of complications and reoperations between these 2 procedures. Methods: We retrospectively analyzed 85 patients who had a post-traumatic DRUJ derangement and had been treated by either a Darrach (n = 57) or Sauvé-Kapandji procedure (n = 28). Fifty-two patients (61%) completed patient-rated outcomes surveys at a median of 8.4 years after their procedure. Radiographic measurements consisted of ulnar distance, radioulnar distance, and ulnar gap (only in Sauvé-Kapandji group). Results: There were no significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function score, pain score, satisfaction score, complications, and reoperations between patients who had a Darrach procedure or a Sauvé-Kapandji procedure. Seventeen patients (30%) in the Darrach group experienced a complication, and 14 patients (50%) in the Sauvé-Kapandji group experienced a complication (P = .09). The most common complication was instability of the ulnar stump (n = 10), followed by symptoms of the dorsal sensory branch of the ulnar nerve (n = 8). Patients who underwent a Sauvé-Kapandji procedure had more reoperations for excision of heterotopic ossification. Conclusions: Darrach and Sauvé-Kapandji procedures show comparable long-term patient-reported outcomes in treatment of post-traumatic DRUJ dysfunction. Complication and reoperation rate are relatively high, with non-significant differences between the 2 procedures.
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Affiliation(s)
| | - Sezai Özkan
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA
| | | | - Neal C. Chen
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA,Kyle R. Eberlin, Division of Plastic and
Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital,
Wang 435, 15 Parkman Street, Boston, MA 02114, USA.
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10
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de Vries CEE, Kalff MC, van Praag EM, Florisson JMG, Ritt MJPF, van Veen RN, de Castro SMM. The Influence of Body Contouring Surgery on Weight Control and Comorbidities in Patients After Bariatric Surgery. Obes Surg 2021; 30:924-930. [PMID: 31792701 PMCID: PMC7347702 DOI: 10.1007/s11695-019-04298-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction A considerable number of patients experience some long-term weight regain after bariatric surgery. Body contouring surgery (BCS) is thought to strengthen post-bariatric surgery patients in their weight control and maintenance of achieved improvements in comorbidities. Objectives To examine the impact of BCS on long-term weight control and comorbidities after bariatric surgery. Methods We performed a retrospective study in a prospective database. All patients who underwent primary Roux-en-Y gastric bypass (RYGB) and presented for preoperative consultation of BCS in the same hospital were included in the study. Linear and logistic mixed-effect model analyses were used to evaluate the longitudinal relationships between patients who were accepted or rejected for BCS and their weight loss outcomes or changes in comorbidities. Results Of the 1150 patients who underwent primary RYGB between January 2010 and December 2014, 258 patients (22.4%) presented for preoperative consultation of BCS. Of these patients, 126 patients eventually underwent BCS (48.8%). Patients who were accepted for BCS demonstrated significant better ∆body mass index (BMI) on average over time (− 1.31 kg/m2/year, 95% confidence interval (CI) −2.52 − −0.10, p = 0.034) and percent total weight loss (%TWL) was significantly different at 36 months (5.79, 95%CI 1.22 – 10.37, p = 0.013) and 48 months (6.78, 95%CI 0.93 – 12.63, p = 0.023) after body contouring consultation. Patients who were accepted or rejected did not differ significantly in the maintenance of achieved improvements in comorbidities. Conclusion BCS could not be associated with the maintenance of achieved improvements in comorbidities after bariatric surgery, whereas it could be associated with improved weight loss maintenance at 36 and 48 months after body contouring consultation. This association should be further explored in a large longitudinal study.
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Affiliation(s)
- C E E de Vries
- Department of Surgery, OLVG, Amsterdam, The Netherlands. .,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands.
| | - M C Kalff
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - E M van Praag
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - J M G Florisson
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
| | - S M M de Castro
- Department of Surgery, OLVG, Amsterdam, The Netherlands.,Obesity Center Amsterdam, OLVG West, Amsterdam, The Netherlands
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11
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Yin Q, Manoliu RA, Kichari JR, Ritt MJPF. Using an Office-Based, Dedicated Extremity MRI Scanner for Depicting Important Structures in Common Wrist Pathologies: A Pilot Comparison with a Conventional MRI Scanner. J Wrist Surg 2021; 10:84-92. [PMID: 33552700 PMCID: PMC7850809 DOI: 10.1055/s-0040-1715799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Background Compared with the conventional magnetic resonance imaging (MRI), dedicated MRI scanners are more accessible. Images of a dedicated 1.0-T MRI specifically developed for the hand and wrist were compared with images of a conventional 1.5-T MRI. Methods Paired images of the right wrist were randomized and separately graded by two experienced radiologists for the quality of anatomical details, including the triangular fibrocartilage complex, carpal ligaments, intercarpal cartilage, median and ulnar nerves, overall image quality, and artifacts. Interrater reliability was measured with the percentage of exact agreement and agreement within a range of ± 1 score point. Participant experience of undergoing the examination in both MRI scanners was evaluated using a questionnaire. Results The overall image quality of all sequences was considered to be moderate to high. In 25 of 38 paired images, no statistically significant difference was found between the MRI scanners. Ten scores were found to be in favor of the dedicated extremity MRI. Within a range of ± 1 score point, the extremity MRI and the conventional MRI demonstrated an interrater agreement of 67 to 100% and 70 to 100%, respectively. Among the respondents of the questionnaire, the extremity MRI scored better for participant satisfaction when compared with the conventional MRI. Conclusions In healthy volunteers, the dedicated extremity MRI generally is similar or superior to the conventional MRI in the depiction of anatomical structures of the wrists, image quality, and artifacts, and significantly scored better on participant satisfaction. Future clinical studies should focus on defining the diagnostic value of the extremity MRI in wrist pathologies.
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Affiliation(s)
- Qi Yin
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Radiology, St. Jansdal Hospital, Harderwijk, The Netherlands
| | | | - Jayant R. Kichari
- Department of Radiology, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Marco J. P. F. Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- The Hand Clinic Amsterdam, Amsterdam, TheNetherlands
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12
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Abstract
Background Excision of the pisiform is an infrequently used option for pisotriquetral joint dysfunction when nonoperative treatment is ineffective. This study reviews the patient-reported outcomes of patients treated with pisiformectomy, and furthermore focuses on the complications and the need for and time to revision procedure. Materials and Methods Medical records of 57 patients were manually reviewed and assessed for complications, rate of unplanned reoperations, and type of reoperations. Thirty-seven patients (65%) completed patient-rated outcomes surveys at a median of 10 years after their procedure. Results The complication rate was 13% ( n = 7). Ulnar nerve symptoms were noted in three patients. No reoperations were performed after the pisiform excision. Out of the 16 patients who had preoperative symptoms of ulnar nerve compression at the wrist, 10 patients reported that their symptoms had completely resolved after the surgery. The median Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after surgery was 4.5 (2.3-16), median score for pain 0 (interquartile range [IQR]: 0-2), and median score for overall satisfaction 10 (IQR: 8-10). Conclusions Pisiformectomy is a surgery used sparingly in cases with refractory pain associated with arthrosis of the pisotriquetral joint or enthesopathy of the flexor carpi ulnaris/pisiform interface. When utilized in this fashion, patients report limited disability on patient-rated outcome measures, low pain scores, and high satisfaction at mid- to late follow-up.
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Affiliation(s)
- Svenna H. W. L. Verhiel
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Plastic and Reconstructive Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Julia Blackburn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco J. P. F. Ritt
- Department of Plastic and Reconstructive Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Neal C. Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Abstract
BACKGROUND Transradial intervention (TRI) may impair digital perfusion with hand dysfunction as a result. However, the effect of TRI on digital perfusion has never been investigated, including the influence of variations of the collateral arterial network and the effect on hand dysfunction. METHODS AND RESULTS We investigated the effect of TRI on digital perfusion by laser Doppler perfusion imaging. Laser Doppler perfusion imaging was performed at baseline, during radial access, TR band application, and at discharge. We compared tissue perfusion of the homolateral thumb (access site) with the contralateral thumb (comparator) during radial access as primary outcome. The hand circulation was assessed with angiography. Upper extremity function was evaluated with the validated QuickDASH questionnaire at baseline and follow-up. A significant reduction of tissue perfusion was observed during radial access and TR band application in the homolateral thumb (-32%, -32%, respectively) and contralateral thumb (-34%, -21%, respectively). We detected no perfusion difference between the homolateral and contralateral thumb during radial access (217; interquartile range, 112-364 versus 209; interquartile range, 99-369 arbitrary flux units; P=0.59). Reduced perfusion of the thumb during radial access was not associated with incompleteness of the superficial palmar arch ( P=0.13). Digital perfusion improved at discharge, though it remained below baseline levels (homolateral -11% and contralateral -14%). Hand dysfunction at 18 months was not associated with TRI-induced perfusion reduction ( P=0.54). CONCLUSIONS TRI is safe. Digital perfusion is reduced in both hands during radial access and TR band application but is not associated with future loss of hand function and variations of the arterial hand supply.
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Affiliation(s)
- Maarten A H van Leeuwen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands (D.J.v.d.H.)
| | - Maurits R Hollander
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Mark J Mulder
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.)
| | - Marco J P F Ritt
- Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands
| | - Ferdinand Kiemeneij
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands
| | | | - Niels van Royen
- Department of Cardiology (M.A.H.v.L., D.J.v.d.H., M.R.H., M.J.M., F.K., N.v.R.), VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
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14
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Berkhout MJL, Yin Q, Ritt MJPF. Current Trends in Operative Treatment of Scaphotrapeziotrapezoid Osteoarthritis: A Survey among European Hand Surgeons. J Wrist Surg 2020; 9:94-99. [PMID: 32257609 PMCID: PMC7112996 DOI: 10.1055/s-0039-3402796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
Objective Based on the available evidence, the optimal surgical treatment for isolated scaphotrapeziotrapezoid oarthritis (STT OA) remains unclear. The purpose of this study is to explore the prevailing surgical practice for isolated STT OA among European hand surgeons. We hypothesized that a considerable variance exists in the current surgical practice among hand surgeons in Europe. Methods An online survey was distributed to 20 participating member states of the Federation of European Societies for Surgery of the Hand (FESSH). Respondents were questioned on their country of practice, surgical experience, preferred surgical procedure, frequency of performing this procedure, factors in decision-making, and other performed surgical procedures. Results Four hundred and sixty-five responses were received with an estimated response rate of 19%. Trapeziectomy with partial trapezoidal excision was the surgical treatment of choice among the participating hand surgeons in Europe (38%), followed by STT joint fusion (30%), and distal scaphoid excision (14%). Conclusion This survey provides an insight into the surgical management of isolated STT OA among hand surgeons in Europe. A wide variety of preferred treatment techniques were found. Evidence concerning the optimal surgical treatment has not been established. Future prospective randomized studies comparing different techniques are warranted.
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Affiliation(s)
- Merel J.-L. Berkhout
- Department of Plastic, Reconstructive and Handsurgery, Alrijne Hospital, Leiden, The Netherlands
- The Hand Clinic, Amsterdam, The Netherlands
| | - Qiqi Yin
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- The Hand Clinic, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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15
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Bachour Y, Poort L, Verweij SP, van Selms G, Winters HAH, Ritt MJPF, Niessen FB, Budding AE. PCR Characterization of Microbiota on Contracted and Non-Contracted Breast Capsules. Aesthetic Plast Surg 2019; 43:918-926. [PMID: 31049639 PMCID: PMC6652165 DOI: 10.1007/s00266-019-01383-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aetiology of capsular contracture around breast implants remains unclear. The leading theory is that a subclinical infection around the implant plays a role in the development of capsular contractions. Several studies found associations between the presence of bacteria and the occurrence of capsular contraction. However, it is unclear whether detected bacteria originate from the breast capsule, breast glandular tissue or skin contamination. Moreover, this has never been investigated with molecular techniques. The aim of this study was to assess the bacterial microbiota on breast capsules, glandular tissue and skin using a highly sensitive PCR assay. MATERIALS AND METHODS Fifty breast capsules were collected during implant removal or replacement. Ten specimens of glandular breast tissue and breast skin were collected in females who were undergoing reduction mammoplasty. A sample specimen (4 mm) was sterilely obtained from all tissues. All specimens were analysed by IS-pro, a 16S-23S interspace region-based PCR assay. RESULTS Low numbers of Staphylococcus spp. (four species in four capsules) were found on breast capsules. There was no difference in bacterial presence between normal and contracted capsules. The skin of the breast-harboured Streptococcus spp. and Staphylococcus spp. while the glandular tissue was sterile. CONCLUSION The low numbers of bacteria found on the capsules are most likely caused by contamination during capsule removal. More and larger studies are needed to investigate the bacterial presence on breast capsules using a PCR assay. This is the first study in which breast capsules have been studied using a highly sensitive PCR assay. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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16
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Bachour Y, Ritt MJPF, Heijmans R, Niessen FB, Verweij SP. Toll-Like Receptors (TLRs) Expression in Contracted Capsules Compared to Uncontracted Capsules. Aesthetic Plast Surg 2019; 43:910-917. [PMID: 30937475 PMCID: PMC6652164 DOI: 10.1007/s00266-019-01368-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/17/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The etiology of capsular contracture after surgical implantation of breast implants remains unclear, but an important role is seen for the immune system. Toll-like receptors are immune receptors recognizing both pathogen-associated molecular patterns and damage-associated molecular patterns. The former are present on bacteria such as Staphylococcus epidermidis (bacteria earlier associated with capsular contracture), and the latter are released after (mechanical) stress. The aim of this study was to investigate the expression of TLRs 1-10 in relation to capsular contracture. MATERIALS AND METHODS Fifty consecutive breast capsules were collected during implant removal or replacement. The extent of capsular contracture was scored according to the Baker score. A sample specimen (0.5 cm3) was obtained from all tissues. cDNA was synthesized from isolated mRNA from the collected specimens. PCR analyses were conducted to test for cDNA presence and to quantify concentration. TLR1-10 expression was measured for each of the Baker scores separately and compared to all Baker scores. RESULTS Expression of all TLRs in all Baker scores was seen. TLR2 and TLR6 were more often present in contracted samples (Baker 3 or 4) compared to uncontracted samples (Baker 1 or 2) [Baker 2 vs. 3 (p = 0.034) and Baker 2 vs. 3 (p = 0.003), respectively]. None of the TLRs displayed a significantly higher expression in contracted capsules compared to uncontracted capsules. CONCLUSION This study shows that TLR2 and TLR6 are more often expressed in contracted capsules compared to non-contracted capsules however not in higher concentrations. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Y Bachour
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - R Heijmans
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - F B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S P Verweij
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
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17
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Abstract
Universal 2 implants may be an alternative to total wrist arthrodesis for the salvage of failed Biaxial total wrist prostheses. We assessed 40 Universal 2 revision implants retrospectively. Fourteen of these wrists were converted to total wrist arthrodeses, and two wrists received a third total wrist arthroplasty after a mean period of 5.5 years. Twenty-four of the Universal 2 implants that remained in situ after a mean follow-up of 9 years (range 4 to 13 years) were re-examined. Sixteen functioned satisfactorily. Patient-Rated Wrist and Hand Evaluation scores and Quick Disabilities of the Arm, Shoulder and Hand scores were 53 and 47, respectively. Twenty-nine patients would choose the Universal 2 again and would also recommend it to other patients. The survival of the revision implants was 60% at a mean follow-up of 9 years. Level of evidence: IV.
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Affiliation(s)
- Hero J. A. Zijlker
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands,Hero J. A. Zijlker, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Van Ostadestraat 278-3, 1073TW, Amsterdam, The Netherlands.
| | - Merel J. Berkhout
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Leeuwen
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Cees B. IJsselstein
- Department of Plastic, Reconstructive and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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18
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Negenborn VL, Smit JM, Dikmans REG, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Tuinder S, Eltahir Y, Posch NAS, van Steveninck-Barends JM, van der Hulst RRWJ, Ritt MJPF, Bouman MB, Mullender MG. Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial. Br J Surg 2019; 106:586-595. [PMID: 30835827 PMCID: PMC6593424 DOI: 10.1002/bjs.11102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/11/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022]
Abstract
Background Implant‐based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one‐stage IBBR with use of an acellular dermal matrix (ADM) is more cost‐effective than two‐stage (expander‐implant) breast reconstruction. Methods The BRIOS (Breast Reconstruction In One Stage) study was an open‐label multicentre RCT in which women scheduled for skin‐sparing mastectomy and immediate IBBR were randomized between one‐stage IBBR with ADM or two‐stage IBBR. Duration of surgery and hospital stay, and visits for the primary surgery, unplanned and cosmetic procedures were recorded. Costs were estimated at an institutional level. Health status was assessed by means of the EuroQol Five Dimensions 5L questionnaire. Results Fifty‐nine patients (91 breasts) underwent one‐stage IBBR with ADM and 62 patients (92 breasts) two‐stage IBBR. The mean(s.d.) duration of surgery in the one‐stage group was significantly longer than that for two‐stage IBBR for unilateral (2·52(0·55) versus 2·02(0·35) h; P < 0·001) and bilateral (4·03(1·00) versus 3·25(0·58) h; P = 0·017) reconstructions. Costs were higher for one‐stage compared with two‐stage IBBR for both unilateral (€12 448 (95 per cent c.i. 10 722 to 14 387) versus €9871 (9373 to 10 445) respectively; P = 0·025) and bilateral (€16 939 (14 887 to 19 360) versus €13 383 (12 414 to 14 669); P = 0·002) reconstructions. This was partly related to the use of relatively expensive ADM. There was no difference in postoperative health status between the groups. Conclusion One‐stage IBBR with ADM was associated with higher costs, but similar health status, compared with conventional two‐stage IBBR. Registration number: NTR5446 (
http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, Den Haag, the Netherlands
| | | | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centrum, Sittard, the Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - M-B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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19
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Abstract
BACKGROUND Distal pole resection of the scaphoid is one of the surgical techniques applied for the treatment of painful scaphotrapeziotrapezoid osteoarthritis (STT-OA). METHODS In this retrospective study, we evaluated midterm outcomes in a consecutive series of patients who underwent distal pole resection of the scaphoid: 13 patients (15 wrists) with a mean follow-up of 4.1 years. We examined objective functional and patient-reported outcome measures. In addition, we assessed the degree of dorsal intercalated segment instability (DISI) and postoperative complications. RESULTS All patients scored within a normal range on objective functional and patient-reported outcome measures. We observed a mild postoperative DISI deformity with an average lunocapitate angle of 22° (range, 0°-44°), which did not correlate with pain scores. In the opposite wrists, with and without STT-OA, the average lunocapitate angle was 6° (range, 0°-20°). CONCLUSIONS According to this study, midterm results for distal pole resection of the scaphoid are satisfactory.
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Affiliation(s)
- Merel J.-L. Berkhout
- VU University Amsterdam, The Netherlands,The Hand Clinic, Amsterdam, The Netherlands,Merel J.-L. Berkhout, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, VU University Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | | | - Daan Wessing
- VU University Amsterdam, The Netherlands,The Hand Clinic, Amsterdam, The Netherlands
| | - Marco J. P. F. Ritt
- VU University Amsterdam, The Netherlands,The Hand Clinic, Amsterdam, The Netherlands
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20
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van Rappard JRM, de Jong T, Hummel WA, Ritt MJPF, Mouës CM. Radiation Exposure to Surgeon and Assistant During Flat Panel Mini C-Arm Fluoroscopy in Hand and Wrist Surgical Procedures. J Hand Surg Am 2019; 44:68.e1-68.e5. [PMID: 29934087 DOI: 10.1016/j.jhsa.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 03/25/2018] [Accepted: 05/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE During mini C-arm fluoroscopy, both the patient and surgical team are exposed to scatter radiation. The objective of this study was to quantify body, thyroid, and hand radiation exposure to surgeon and assistant during intraoperative use of flat panel mini C-arm fluoroscopy in hand and wrist surgical procedures. METHODS Over 5 months, the surgeon's and assistant's radiation exposure was recorded during all osseous hand and wrist surgical procedures. Whole-body and thyroid radiation exposure were measured with 2 types of dosimeters: a photon thermoluminescence detector and a RaySafe i2 real-time dosimeter. Ring dosimeters were used to quantify hand radiation exposure. RESULTS Mini C-arm fluoroscopy was used in 94 surgical procedures. Total fluoroscopy time was 1,996 seconds and varied between surgical procedures (range, 1-152 seconds; median, 11 seconds). No thermoluminescence detector photon dosimeter exceeded the threshold limit of 0.1 mSv. The RaySafe i2 real-time dosimeters recorded a cumulated dose of 0.029 mSv for the body and 0.012 mSv for the thyroid position of the surgeon. The assistant received a cumulated dose of 0.011 mSv for the body and 0.011 mSv for the thyroid position. The ring dosimeters showed a cumulated dosage of 1.28 mSv for the surgeon and 0.20 mSv for the assistant. CONCLUSIONS Our results show that the surgeon's and assistant's body, thyroid, and hands were exposed to acceptable levels of scatter radiation during intraoperative use of the flat panel mini C-arm. The surgeon received the highest radiation exposure: 2.9% of the yearly radiation limits for the body, 0.05% for the thyroid position, and 2.56% for the hands. The assistant was exposed to less scatter radiation: 1.1% for the body, 0.04% for the thyroid, and 0.4% for the hands. CLINICAL RELEVANCE This study quantified radiation levels to which surgeon and assistant are exposed during mini C-arm fluoroscopy in hand and wrist surgical procedures.
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Affiliation(s)
- Juliaan R M van Rappard
- Department of Plastic and Reconstructive Surgery, Medisch Centrum Leeuwarden, Amsterdam, The Netherlands.
| | - Tijmen de Jong
- Department of Plastic and Reconstructive Surgery, Medisch Centrum Leeuwarden, Amsterdam, The Netherlands
| | - Willy A Hummel
- Department of Clinical Physics, Medisch Centrum Leeuwarden, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic and Reconstructive Surgery, Vrije University Medical Center, Amsterdam, The Netherlands
| | - Chantal M Mouës
- Department of Plastic and Reconstructive Surgery, Medisch Centrum Leeuwarden, Amsterdam, The Netherlands
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21
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Dikmans RE, Krouwel EM, Ghasemi M, van de Grift TC, Bouman MB, Ritt MJPF, Elzevier HW, Mullender MG. Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands. Eur J Plast Surg 2018; 41:707-714. [PMID: 30524177 PMCID: PMC6244988 DOI: 10.1007/s00238-018-1452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 12/21/2022]
Abstract
Background Patient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with their patients, and if there is a need for improvement. Methods We developed a survey to assess whether topics pertaining to sexual function were discussed during plastic surgical consultations. In 2016, all 385 members of the Dutch Association for Plastic Surgery were invited via post mail to participate. Results We received 106 completed surveys (27.5%). The median age of the respondents was 45 (29–66) years. Most participants (78.3%) indicated that they rarely to never discuss sexuality with their patients. Surgeons in the subspecialization gender and genital surgery discussed sexual function most frequently. Two thirds of all respondents indicated that their current knowledge on this topic was insufficient, yet there was generally no interest expressed in receiving additional training (78.6%). However, there was a need for proper patient brochures (43.4%) and an organized referral network (36.5%) regarding sexuality. Conclusions In plastic surgery practice, sexuality appears to be a rarely discussed subject, with the gender and genital surgery subspecialties as the exception. Although professionals and patients emphasize the importance of sexuality, plastic surgeons express limited urge to be trained and prefer written patient information and referring patients to other healthcare professionals. The authors stimulate more education on sexuality during (continued) plastic surgery training. Level of Evidence: Not ratable
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Affiliation(s)
- Rieky E Dikmans
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Esmée M Krouwel
- 2Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Mahsa Ghasemi
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Tim C van de Grift
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands.,3Department of Medical Psychology, VU University Medical Center, Amsterdam, Netherlands
| | - Mark-Bram Bouman
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Marco J P F Ritt
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Henk W Elzevier
- 2Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Margriet G Mullender
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
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de Bakker E, van den Broek LJ, Ritt MJPF, Gibbs S, Niessen FB. The Histological Composition of Capsular Contracture Focussed on the Inner Layer of the Capsule: An Intra-Donor Baker-I Versus Baker-IV Comparison. Aesthetic Plast Surg 2018; 42:1485-1491. [PMID: 30187083 PMCID: PMC6280822 DOI: 10.1007/s00266-018-1211-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
Background Capsular contracture remains one of the major complications after breast implantation surgery. The extent of capsular contraction is scored using the Baker scale. The aim of this study was to compare intra-individual Baker-I with Baker-IV capsules, and in particular the prevalence and histological properties of the inner capsule layer. Methods Twenty capsules from ten patients were included after bilateral explantation surgery due to unilateral capsular contracture (Baker-IV) after cosmetic augmentation with textured implants. All capsules underwent (immune-)histochemical analysis: haematoxylin–eosin (morphology), CD68 (macrophages), cytokeratin (epithelial cells) and vimentin (fibroblasts), and were visually scored for cell density and the presence of an inner layer and measured for thickness. Results Baker-IV (n = 10) capsules were significantly thicker compared to Baker-I (n = 10) capsules (P = 0.004). An inner layer was present in 8 Baker-I capsules. All Baker-I capsules were vimentin and CD68-positive and cytokeratin-negative. Positive vimentin was seen throughout the inner layer, and CD-68 staining was observed adjacent to the intermediate capsule layer. In contrast, only 2 Baker-IV capsules had an inner layer, of which only 1 showed the same profile as Baker-I capsules (P = 0.016). No cytokeratin positivity was seen in any capsule. In Baker-IV capsules, outer layers showed more positivity for both vimentin and CD68. Conclusion The inner layer is morphologically consistent with synovial metaplasia and is more prevalent in healthy, uncontracted Baker-I capsules. This inverse relation between the presence of the inner layer and higher Baker classification or pathological contracture could indicate a protective role of the inner layer against capsular contracture formation. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- E de Bakker
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - L J van den Broek
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - S Gibbs
- Department of Dermatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - F B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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23
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Groen JW, Piatkowski AA, Sawor JH, Wilschut JA, Ritt MJPF, van der Hulst RRJW. European Survey Study Among Plastic/Breast Surgeons on the Use of and Opinion Toward Autologous Fat Transfer: With Emphasis on Breast Surgery. Surg Innov 2018; 25:602-615. [PMID: 30249166 PMCID: PMC6293441 DOI: 10.1177/1553350618799553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective. The aim of this study is to examine the experience of
European surgeons on autologous fat transfer (AFT) and highlight differences
between countries and levels of experience. Background Data.
The popularity of AFT causes an increase in sophisticated scientific research
and clinical implementation. While results from the former are well-documented,
important aspects of the latter are far less recognized.
Methods. An international survey study about surgeon
background, besides AFT familiarity, technique, and opinion, was distributed
among surgeons from 10 European countries. The differences between countries and
levels of experience were analyzed using a logistic regression model.
Results. The mean respondent age, out of the 358 completed
questionnaires, was 46 years. Ninety-seven percent of the respondents were
plastic surgeons, who practiced AFT mostly in breast surgery and considered
themselves experienced with the technique. The thigh and abdomen were less
favored harvest locations by the Belgium and French respondents, respectively,
and both the French and Austrian respondents preferred manual aspiration over
liposuction in harvesting the fat. Despite minor differences between countries
and experience, the intraglandular space was injected in all subgroups.
Conclusions. The expanding use of AFT in Europe will lead
to more experience and heterogeneity regarding the technique. However, despite
an obvious adherence to Coleman’s method, deviations thereof become more
apparent. An important example of such a deviation is the ongoing practice of
intraglandular AFT despite being a contraindication in various European
guidelines. These unsafe practices should be avoided until scientific
clarification regarding oncological safety is obtained and should therefore be
the focus of surgeon education in Europe.
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Affiliation(s)
- Jan-Willem Groen
- Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
| | - Andrzej A Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - John H Sawor
- Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Janneke A Wilschut
- Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
| | - Rene R J W van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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24
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Groen JW, Piatkowski AA, Sawor JH, Wilschut JA, Khouri RK, van der Hulst RRJW, Ritt MJPF. Autologous Fat Transfer After Augmentation and Reconstruction of the Female Breast: An International, Cross-Sectional Photo-Comparison Study Among Different Physician and Laymen Study Groups. Surg Innov 2018; 25:594-601. [PMID: 30196770 PMCID: PMC6293439 DOI: 10.1177/1553350618798435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective. The aim of this study is to compare the cosmetic
evaluation of autologous fat transfer (AFT) for various indications between
surgeons and different laymen groups. Background Data. Despite
the upsurge in AFT scientific/clinical interest, objectifying satisfaction has
only recently progressed beyond simple Likert-type/Visual Analog Scales.
Furthermore, differences in satisfaction between laymen and surgeons has not
been thoroughly studied. Method. A photo comparison study
between European plastic surgeons and different laymen groups was conducted to
investigate agreement on cosmetic evaluation of AFT. Three sets of
preoperative/postoperative photographs illustrating patients treated with
External Vacuum Expansion (EVE) + AFT for various indications in breast surgery
were scored according to the Harris Scale, and the interrater agreement was
analyzed using Cohen’s κ. Results. The overall agreement
between the surgeons and the groups of former augmentation, control group, and
deep inferior epigastric artery perforator patients was fair, moderate, and
substantial, respectively. Interrater agreements among different laymen groups
and surgeons from different countries among themselves was substantial to almost
perfect. Finally, we found that laymen are generally more optimistic about
postoperative results than surgeons. Conclusion. In our study,
former augmentation patients showed the lowest agreement with surgeons, in the
cosmetic appreciation of EVE + AFT and this group might benefit from a more
thorough preoperative consultation regarding expectations when choosing AFT.
However, overall laymen tend to be more optimistic about postoperative results
and surgeon education in general does not seem influenced by surgeon
nationality. The significant differences between surgeons and laymen in the
cosmetic evaluation of EVE + AFT justifies further studies that focus on the
qualitative aspects of these differences to further balance patients’ and
surgeons’ expectations.
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Affiliation(s)
- Jan-Willem Groen
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,2 Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
| | - Andrzej A Piatkowski
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,3 Department of Plastic, Reconstructive and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands
| | - John H Sawor
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,3 Department of Plastic, Reconstructive and Hand Surgery, Viecuri Medical Center, Venlo, The Netherlands
| | | | - Roger K Khouri
- 5 Miami Breast Center, Key Biscayne, Florida, United States
| | - Rene R J W van der Hulst
- 1 Department of Plastic, Reconstructive and Hand Surgery/ GROW: School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marco J P F Ritt
- 2 Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands
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25
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van Leeuwen MAH, Hollander MR, van der Heijden DJ, van de Ven PM, Opmeer KHM, Taverne YJHJ, Ritt MJPF, Kiemeneij F, van Mieghem NM, van Royen N. The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005753. [PMID: 29127118 DOI: 10.1161/circinterventions.117.005753] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The palmar arches serve as the most important conduits for digital blood supply, and incompleteness may lead to digital ischemia when the radial artery becomes obstructed after cardiac catheterization. The rate of palmar arch incompleteness and the clinical consequences after transradial access are currently unknown. METHODS AND RESULTS The vascular anatomy of the hand was documented by angiography in 234 patients undergoing transradial cardiac catheterization. In all patients, a preprocedural modified Allen test and Barbeau test were performed. Upper-extremity function was assessed at baseline and 2-year follow-up by the QuickDASH. Incompleteness of the superficial palmar arch (SPA) was present in 46%, the deep palmar arch was complete in all patients. Modified Allen test and Barbeau test results were associated with incompleteness of the SPA (P=0.001 and P=0.001). The modified Allen test had a 33% sensitivity and 86% specificity for SPA incompleteness with a cutoff value of >10 seconds and a 59% sensitivity and 60% specificity with a cutoff value of >5 seconds. The Barbeau test had a 7% sensitivity and 98% specificity for type D and a 21% sensitivity and 93% specificity for types C and D combined. Upper-extremity dysfunction was not associated with SPA incompleteness (P=0.77). CONCLUSIONS Although incompleteness of the SPA is common, digital blood supply is always preserved by a complete deep palmar arch. Preprocedural patency tests have thus no added benefit to prevent ischemic complications of the hand. Finally, incompleteness of the SPA is not associated with a loss of upper-extremity function after transradial catheterization.
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Affiliation(s)
- Maarten A H van Leeuwen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Maurits R Hollander
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Dirk J van der Heijden
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Peter M van de Ven
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Kim H M Opmeer
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Yannick J H J Taverne
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Marco J P F Ritt
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Ferdinand Kiemeneij
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Nicolas M van Mieghem
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.)
| | - Niels van Royen
- From the Department of Cardiology (M.A.H.v.L., M.R.H., D.J.v.d.H., K.H.M.O., F.K., N.v.R.) and Department of Plastic Surgery (M.J.P.F.R.), VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands (P.M.v.d.V.); Department of Cardiology (N.M.v.M.) and Department of Cardiothoracic Surgery (Y.J.H.J.T.), Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.); and Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands (M.A.H.v.L.).
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Bachour Y, Bargon CA, de Blok CJM, Ket JCF, Ritt MJPF, Niessen FB. Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2018; 71:e29-e48. [PMID: 29980456 DOI: 10.1016/j.bjps.2018.05.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/18/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Capsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Several patient-, surgery-, and implant-specific risk factors have been related to cause capsular contracture. This review aims to provide a clear overview of all risk factors for capsular contracture. METHODS A systematic literature review was performed focusing on patient-, surgery-, and/or implant-related factors related to capsular contracture in breast implants. PubMed, Embase, and Wiley/Cochrane Library databases were searched for relevant articles published from inception up to October 20, 2016. The included studies were assessed for the following main variables: study characteristics, patient characteristics, indication for surgery, type of surgery, implant characteristics, and other characteristics. RESULTS Data on the risk factors for the development of capsular contracture were retrieved from 40 studies. A presumptive increased risk in the development of capsular contracture is shown for the following variables: longer duration of follow-up, breast reconstructive surgery in patients with a history of breast cancer, subglandular implant placement, postoperative hematoma, and a textured implant surface. There is little, weak, or no evidence for the association of other factors with capsular contracture. This review also shows a large heterogeneity between studies and within the definition of capsular contracture. CONCLUSION This review provides an overview of the relationship between patient-, surgery-, and implant-specific risk factors in the development of capsular contracture.
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Affiliation(s)
- Yara Bachour
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Claudia A Bargon
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Christel J M de Blok
- Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, University Library, VU University, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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27
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Bachour Y, Heinze ZCM, Dormaar TS, van Selms WG, Ritt MJPF, Niessen FB. Poly Implant Prothèse silicone breast implants: implant dynamics and capsular contracture. Eur J Plast Surg 2018; 41:563-570. [PMID: 30294070 PMCID: PMC6153863 DOI: 10.1007/s00238-018-1427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/21/2018] [Indexed: 01/20/2023]
Abstract
Background The Poly Implant Prothèse (PIP) implants were withdrawn from the market in 2010 due to the use of low-grade silicone, causing a high risk for implant rupture. The aim of this study was to investigate the implant dynamics of PIP breast implants, as well as to determine the rate and predictors of implant gel bleeding, rupture, and capsular contracture in PIP implants. Methods Eighty women with a total of 152 PIP implants who underwent a reoperation in 2012 were enrolled in this study. Physical investigation included assessing the Baker score and demographics were retrospectively traced in medical records. The pre- and post-operative volumes of the implants were calculated and their state was determined intraoperatively by the surgeon. Results The implants were removed after a mean implant duration of 11 ± 2.1 years. Gel bleed and implant rupture occurred in respectively 42 and 25% of the implants. Intact implants had post-operative volume increase as well as decrease. There was a correlation between gel bleeding and more post-operative implant volume increase (P ≤ 0.05). Capsular contracture had a protective effect against post-operative implant volume increase (P ≤ 0.05), while a post-operative implant volume increase provided a protective influence in developing capsular contracture (P ≤ 0.05). Additionally, implant rupture led to a higher risk of capsular contracture (P ≤ 0.05). Conclusions We managed to illustrate that PIP implant shells were too permeable and that there is a correlation between gel bleeding and the increase of the post-operative implant volume. Implant rupture led to a higher risk for developing capsular contracture. Level of evidence: Level III, risk / prognostic study. Electronic supplementary material The online version of this article (10.1007/s00238-018-1427-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y Bachour
- 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Z C M Heinze
- 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - T S Dormaar
- Department of Plastic, Reconstructive and Hand Surgery, OLVG location West, 1061 AE Amsterdam, The Netherlands
| | - W G van Selms
- Department of Plastic, Reconstructive and Hand Surgery, OLVG location West, 1061 AE Amsterdam, The Netherlands
| | - M J P F Ritt
- 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - F B Niessen
- 1Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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28
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Negenborn VL, Dikmans REG, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Hommes J, Eltahir Y, Posch NAS, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg 2018; 105:1305-1312. [PMID: 29663320 PMCID: PMC6099293 DOI: 10.1002/bjs.10865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/12/2017] [Accepted: 02/19/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. METHODS Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications. RESULTS Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance. CONCLUSION Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - M A Meesters-Caberg
- Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centre, Sittard, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
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van der Heijden D, van Leeuwen MAH, Janssens GN, Hermie J, Lenzen MJ, Ritt MJPF, van de Ven PM, Kiemeneij F, van Royen N. Endothelial dysfunction and the occurrence of radial artery spasm during transradial coronary procedures: the ACRA-Spasm study. EUROINTERVENTION 2017; 12:1263-1270. [PMID: 27866135 DOI: 10.4244/eijv12i10a207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to analyse the relation between endothelial dysfunction (ED) and the occurrence of radial artery spasm (RAS) during transradial coronary procedures. METHODS AND RESULTS From May 2014 to June 2015, endothelial function was assessed by EndoPAT and FMD before the procedure in 165 patients referred for coronary angiography or intervention. The primary endpoint was RAS, defined by patient's symptoms and procedural characteristics. The mean age of the study population was 63 years and 71% were male. In total 16% of the patients experienced RAS. The incidence of RAS did not differ between patients with and without ED (13.8% vs. 20.2%, OR 0.63, 95% CI: 0.25-1.58, p=0.32). The strongest predictors of RAS were a ratio of radial artery inner diameter and sheath outer diameter smaller than 1 (OR 4.7, 95% CI: 1.35-16.5, p=0.009) and a combination of clinical characteristics presented as an RAS risk score of at least 4 (p=0.007, OR 3.7, 95% CI: 1.37-9.89). CONCLUSIONS Endothelial dysfunction was not found to be a predictor of the occurrence of radial artery spasm in a cohort of patients undergoing elective heart catheterisation. Radial artery-sheath mismatch is the strongest pre-procedural predictor of RAS.
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Affiliation(s)
- Dirk van der Heijden
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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30
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Dikmans REG, Negenborn VL, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Eltahir Y, Posch NA, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol 2016; 18:251-258. [PMID: 28012977 DOI: 10.1016/s1470-2045(16)30668-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The evidence justifying the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR) is limited. We did a prospective randomised trial to compare the safety of IBBR with an ADM immediately after mastectomy with that of two-stage IBBR. METHODS We did an open-label, randomised, controlled trial in eight hospitals in the Netherlands. Eligible women were older than 18 years with breast carcinoma or a gene mutation linked with breast cancer who intended to undergo skin-sparing mastectomy and immediate IBBR. Randomisation was done electronically, stratified per centre and in blocks of ten to achieve roughly balanced groups. Women were assigned to undergo one-stage IBBR with ADM (Strattice, LifeCell, Branchburg, NJ, USA) or two-stage IBBR. The primary endpoint was quality of life and safety was assessed by the occurrence of adverse outcomes. Analyses were done per protocol with logistic regression and generalised estimating equations. This study is registered at Nederlands Trial Register, number NTR5446. FINDINGS 142 women were enrolled between April 14, 2013, and May 29, 2015, of whom 59 (91 breasts) in the one-stage IBBR with ADM group and 62 (92 breasts) in the two-stage IBBR group were included in analyses. One-stage IBBR with ADM was associated with significantly higher risk per breast of surgical complications (crude odds ratio 3·81, 95% CI 2·67-5·43, p<0·001), reoperation (3·38, 2·10-5·45, p<0·001), and removal of implant, ADM, or both (8·80, 8·24-9·40, p<0·001) than two-stage IBBR. Severe (grade 3) adverse events occurred in 26 (29%) of 91 breasts in the one-stage IBBR with ADM group and in five (5%) of 92 in the two-stage IBBR group. The frequency of mild to moderate adverse events was similar in the two groups. INTERPRETATION Immediate one-stage IBBR with ADM was associated with adverse events and should be considered very carefully. Understanding of selection of patients, risk factors, and surgical and postsurgical procedures needs to be improved. FUNDING Pink Ribbon, Nuts-Ohra, and LifeCell.
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Affiliation(s)
- Rieky E G Dikmans
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - P Quinten Ruhé
- Department of Plastic, Reconstructive, and Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands
| | - Marc A M Mureau
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Stefania Tuinder
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Yassir Eltahir
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - Nicole A Posch
- Department of Plastic, Reconstructive, and Hand Surgery, Haga Ziekenhuis, Den Haag, Netherlands
| | | | - Marleen A Meesters-Caberg
- Department of Plastic, Reconstructive, and Hand Surgery, Orbis Medisch Centrum, Sittard, Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands.
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31
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Zwaan EM, IJsselmuiden AJJ, van Rosmalen J, van Geuns RJM, Amoroso G, Moerman E, Ritt MJPF, Schreuders TAR, Kofflard MJM, Holtzer CAJ. Rationale and design of the ARCUS: Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function. Catheter Cardiovasc Interv 2016; 88:1036-1043. [PMID: 27037641 DOI: 10.1002/ccd.26525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/05/2016] [Accepted: 02/27/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study is to provide a complete insight in the access-site morbidity and upper extremity function after Transradial Percutaneous Coronary Intervention (TR-PCI). BACKGROUND In percutaneous coronary intervention the Transradial Approach (TRA) is gaining popularity as a default technique. It is a very promising technique with respect to post-procedure complications, but the exact effects of TRA on upper extremity function are unknown. METHODS AND RESULTS The effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) trial is a multicenter prospective cohort study that will be conducted in all patients admitted for TR-PCI. Clinical outcomes will be monitored during a follow-up of 6 months, with its primary endpoint at two weeks of follow-up. To investigate the complete upper extremity function, a combination of physical examinations and validated questionnaires will be used to provide information on anatomical integrity, strength, range of motion (ROM), coordination, sensibility, pain, and functioning in everyday life. Procedural and material specifications will be registered in order to include all possible aspects influencing upper extremity function. CONCLUSIONS Results from this study will elucidate the effect of TR-PCI on upper extremity function. This creates the opportunity to further optimize TR-PCI, to make improvements in functional outcome and to prevent morbidity regarding full upper extremity function. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Eva M Zwaan
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Giovanni Amoroso
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Esther Moerman
- Department of Plastic, Reconstructive, and Hand Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Marcel J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Carlo A J Holtzer
- Department of Plastic, Reconstructive, and Hand Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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32
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Negenborn VL, Botman M, Winters HAH, Ritt MJPF. Letter Regarding "Management of Osteoarthrosis of the Thumb Joints". J Hand Surg Am 2016; 41:488. [PMID: 26920118 DOI: 10.1016/j.jhsa.2015.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/09/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Vera L Negenborn
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Matthijs Botman
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Henri A H Winters
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
UNLABELLED Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- T C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands The Hand Clinic, Amsterdam, The Netherlands
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34
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van Gelein Vitringa VM, van Noort A, Ritt MJPF, van Royen BJ, van der Sluijs JA. Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions. J Brachial Plex Peripher Nerve Inj 2015; 10:e23-e29. [PMID: 27917235 DOI: 10.1055/s-0035-1558425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 06/03/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of obstetric brachial plexus lesion (OBPL). In OBPL a shoulder joint contracture is a frequent finding. We hypothesize that residual internal and external rotator strength and their balance are related to the extent of shoulder joint contracture. METHODS Clinical assessment was performed in 34 children (mean 10.0 years) with unilateral OBPL and Narakas classes I-III. External and internal rotation strengths were measured with the shoulder in neutral position using a handheld dynamometer. Strength on the affected side was given as percentage of the normal side. Contracture was assessed by passive internal and external rotations in degrees (in 0° abduction). Mallet classification was used for active shoulder function. RESULTS External and internal rotation strengths on the affected side were approximately 50% of the normal side and on average both equally affected: 56% (SD 18%) respectively 51% (SD 27%); r = 0.600, p = 0.000. Residual strengths were not related to passive internal or external rotation (p > 0.200). Internal rotation strength (r = - 0.425, p <0.05) was related to Narakas class. Mallet score was related to external and internal rotation strengths (r = 0.451 and r = 0.515, respectively; p < 0.01). CONCLUSION The intuitive notion that imbalances in residual muscle strength influence contracture formation cannot be confirmed in this study. Our results are of interest for the understanding of contracture formation in OBPL.
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Affiliation(s)
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Ziekenhuis, Hoofddorp, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Barend J van Royen
- Department of Orthopaedic Surgery, VU Medical Center, Amsterdam, The Netherlands
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35
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Berkhout MJL, Bachour Y, Zheng KH, Mullender MG, Strackee SD, Ritt MJPF. Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years. J Hand Surg Am 2015; 40:1349-54. [PMID: 25701487 DOI: 10.1016/j.jhsa.2014.12.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the long-term outcomes of proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) in a consecutive series of patients surgically treated between 1989 and 1998 in a single teaching hospital. METHODS We included 12 patients (14 wrists) in the PRC group and 8 patients (8 wrists) in the FCA group. Mean follow-up time was 17 years. We compared functional outcome measures (range of motion and grip strength) and patient-reported outcome measures (visual analog score for pain, Mayo Wrist Score, and Michigan Hand Questionnaire). Radiographic evaluation of joint degeneration using the Culp and Jebson scoring system and postoperative complications were assessed for both groups. RESULTS Active range of motion was slightly better after PRC. There were no differences in grip strength and patient-reported outcomes between groups. Severity of degenerative changes did not differ between groups and was not correlated with pain scores. The FCA group showed more postoperative complications. CONCLUSIONS Considering the objective and patient-reported outcomes of this study, both types of surgery perform well in the long run. Proximal row carpectomy seems to result in slightly better movement of the wrist with fewer surgical complications and no need for hardware removal. Moreover, postoperative immobilization time was much shorter. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Merel J L Berkhout
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Yara Bachour
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Kang He Zheng
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
Extensor carpi radialis brevis (ECRB) transfer to the hamate bone is a novel procedure that offers a new surgical treatment option for select patients with midcarpal instability (MCI) who do not respond to conservative treatment. We present our early experience with this procedure. In total, 12 patients (13 wrists) were reviewed with a follow-up duration ranging from 1 to 6 years. Complications and changes in active range of motion (AROM) were noted. Patient related outcome was measured using the Patient Rated Wrist/Hand Evaluation (PRWHE) questionnaire, amongst others. Two patients failed to show a positive response to the surgery. ECRB transfer to the ulnar side of the wrist is a new procedure that offers a potential option for the surgical treatment of MCI in select patients; however, further biomechanical and clinical studies are required. The level of evidence for this study is IV (therapeutic).
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Affiliation(s)
- Marco J. P. F. Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- The Hand Clinic, Amsterdam, The Netherlands
| | - Peter J. M. de Groot
- Division of Hand Therapy, Department of Rehabilitation, VU University, Medical Center, Amsterdam, The Netherlands
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Post SF, Selles RW, McGrouther DA, Ritt MJPF, Hovius SER, Fridén J, Walbeehm ET. Levels of evidence and quality of randomized controlled trials in hand and wrist surgery: an analysis of two major hand surgery journals. J Hand Surg Eur Vol 2014; 39:900-2. [PMID: 23821675 DOI: 10.1177/1753193413495369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S F Post
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - D A McGrouther
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S E R Hovius
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J Fridén
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E T Walbeehm
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Maijers MC, de Blok CJM, Niessen FB, van der Veldt AAM, Ritt MJPF, Winters HAH, Kramer MHH, Nanayakkara PWB. Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med 2013; 71:534-540. [PMID: 24394743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Since their introduction, the safety of silicone breast implants has been under debate. Although an association with systemic diseases was never established, women continuously blamed implants for their unexplained systemic symptoms. In 2011, a pattern of symptoms caused by systemic reactions to adjuvants (e.g. vaccines, silicone) was identified: 'autoimmune syndrome induced by adjuvants' (ASIA). Our aim was to collect a cohort of women with silicone breast implants and unexplained systemic symptoms to identify a possible pattern and compare this with ASIA. METHODS Women with silicone breast implants and unexplained systemic symptoms were invited through national media to visit a special outpatient clinic in Amsterdam. All were examined by experienced consultant physicians and interviewed. Chest X-ray and laboratory tests were performed. RESULTS Between March 2012 and 2013, 80 women were included, of which 75% reported pre-existent allergies. After a symptom-free period of years, a pattern of systemic symptoms developed, which included fatique, neurasthenia, myalgia, arthralgia and morning stiffness in more than 65% of women. All had at least two major ASIA criteria and 79% fulfilled ≥ 3 typical clinical ASIA manifestations. After explantation, 36 out of 52 women experienced a significant reduction of symptoms. CONCLUSIONS After excluding alternative explanations, a clear pattern of signs and symptoms was recognised. Most women had pre-existent allergies, suggesting that intolerance to silicone or other substances in the implants might cause their symptoms. In 69% of women, explantation of implants reduced symptoms. Therefore, physicians should recognise this pattern and consider referring patients for explantation.
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Affiliation(s)
- M C Maijers
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, the Netherlands
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39
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Jurgens WJFM, Kroeze RJ, Zandieh-Doulabi B, van Dijk A, Renders GAP, Smit TH, van Milligen FJ, Ritt MJPF, Helder MN. One-step surgical procedure for the treatment of osteochondral defects with adipose-derived stem cells in a caprine knee defect: a pilot study. Biores Open Access 2013; 2:315-25. [PMID: 23914338 PMCID: PMC3731690 DOI: 10.1089/biores.2013.0024] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Regenerative therapies offer attractive alternatives for the treatment of osteochondral defects. Adipose-derived stromal vascular fraction (SVF) cells allow the development of one-step surgical procedures by their abundant availability and high frequency. In this pilot study we evaluated the in vivo safety, feasibility, and efficacy of this concept using scaffolds seeded with freshly isolated (SVF) or cultured adipose stem cells (ASCs), and compared these to their acellular counterparts. Osteochondral defects were created in medial condyles and trochlear grooves in knees of eight goats. Defects were filled with acellular collagen I/III scaffolds or scaffolds seeded with SVF cells or cultured ASCs. Osteochondral regeneration was evaluated after 1 and 4 months by macroscopy, immunohistochemistry, biomechanical analysis, microCT analysis, and biochemistry. After 1 month, no adverse effects were noted. Microscopic, but not macroscopic evaluation showed considerable yet not significant differences, with cell-loaded constructs showing more extensive regeneration. After 4 months, acellular constructs displayed increased regeneration, however, to a lesser degree than cell-treated constructs. The latter exhibited more extensive collagen type II, hyaline-like cartilage, and higher elastic moduli, and their glycosaminoglycan content in the cartilaginous layer better approached native tissue values. Moreover, their defect regions contained higher levels of regenerated, mature subchondral bone with more intense collagen type I staining. SVF cells tended to perform best on all parameters. In summary, this pilot study demonstrated the preclinical safety and feasibility of a one-step surgical procedure for osteochondral defect regeneration. Similar regeneration was found between freshly isolated SVF cells and cultured ASCs. Larger studies with longer follow-up are required to substantiate these findings.
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Affiliation(s)
- Wouter J F M Jurgens
- Department of Plastic, Reconstructive, & Hand Surgery, VU University Medical Center (VUmc), Amsterdam, The Netherlands . ; MOVE/Skeletal Tissue Engineering Group Amsterdam (STEGA) , Amsterdam, The Netherlands
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van Alphen NA, van Doorn-Loogman MH, Maas H, van der Sluijs JA, Ritt MJPF. Restoring wrist extension in obstetric palsy of the brachial plexus by transferring wrist flexors to wrist extensors. J Pediatr Rehabil Med 2013; 6:53-7. [PMID: 23481892 DOI: 10.3233/prm-130237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Wrist extension is essential in the development of motor skills in young children. Adequate wrist extension is important for good grip function of the hand, as a slightly extended wrist results in a better and stronger grip. This retrospective study reviews the transfer of the flexor carpi ulnaris (FCU) or flexor carpi radialis (FCR) to the extensor carpi radialis brevis (ECRB) and/or longus (ERCL) to reconstruct wrist extension in 19 patients with obstetric brachial plexus palsy (OBPP). The average age at surgery was 7.2 (range 4-18) years. The mean follow-up was 3 years. Preoperatively, none of the patients had active wrist extension, with an average wrist extension-lag of 37.4 (SD 15.1) degrees. Postoperatively, average active wrist extension was 9.2 (SD 25.5) degrees. Average gain in wrist extension was 46.6 (SD 28.2) degrees, however individual gain varied substantially, i.e. between 0 and 100 degrees. Two patients were unable to reach the neutral wrist position postoperatively and in two patients wrist extension did not increase. The results of the tendon transfer to provide improvement of wrist extension in OBPP were satisfactory in most patients.
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Affiliation(s)
- N A van Alphen
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Jurgens WJFM, Lu Z, Zandieh-Doulabi B, Kuik DJ, Ritt MJPF, Helder MN. Hyperosmolarity and hypoxia induce chondrogenesis of adipose-derived stem cells in a collagen type 2 hydrogel. J Tissue Eng Regen Med 2011; 6:570-8. [PMID: 21916017 DOI: 10.1002/term.464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/13/2011] [Accepted: 07/04/2011] [Indexed: 12/17/2022]
Abstract
Apart from soluble growth factors, various other biophysicochemical cues are known to promote chondrogenesis. Under physiological conditions, cartilage in the joint comprises a hyperosmotic and hypoxic environment. Therefore, in this study, we examined the inductive effects of hyperosmotic and/or hypoxic conditions on adipose stem cells (ASCs) and compared them with conventional TGFβ1-induction. After encapsulation in collagen type II hydrogels and specific induction, ASCs were assessed for viability, proliferation, morphology and chondrogenic differentiation potential. Viability was similar under all conditions, with low proliferative activity. After 4 days, hypoxia and/or hyperosmolarity did not affect round cell morphology, while cells were mainly stretched in the TGFβ1-induced group. At 21 days, the TGFß1-treated group had aggregated into a cell nodule. Hyperosmolarity mimicked this aggregation to a lesser extent, whereas cells under hypoxia stretched out after 21 days, with a combined effect in the hypoxic/hyperosmotic group. Both individual and combined hyperosmotic and/or hypoxic conditions significantly upregulated SOX5, SOX9, COMP and Link-p gene expression compared with the non-induced group, and to similar levels as the TGFβ1-induced group. GAG synthesis in both hydrogel and medium was increased under hypoxic conditions, whereas hyperosmolarity decreased GAG formation in the hydrogels, but increased GAG formation in the medium. We conclude that in a joint mimicking the three-dimensional (3D) micro-environment, a combination of hyperosmolarity and hypoxia is able to induce chondrogenesis to the same extent as TGFβ1. This might lead to an interesting alternative when considering short-term triggering in a one-step surgical procedure for the treatment of cartilaginous defects.
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Affiliation(s)
- Wouter J F M Jurgens
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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Jurgens WJ, Kroeze RJ, Bank RA, Ritt MJPF, Helder MN. Rapid attachment of adipose stromal cells on resorbable polymeric scaffolds facilitates the one-step surgical procedure for cartilage and bone tissue engineering purposes. J Orthop Res 2011; 29:853-60. [PMID: 21246614 DOI: 10.1002/jor.21314] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 10/08/2010] [Indexed: 02/04/2023]
Abstract
The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In this study, we evaluated the suitability of both a macroporous poly(L-lactide-co-caprolactone) and a porous collagen type I/III scaffold for this purpose. Surprisingly, cell attachment was rapid (∼10 min) and sequestered the majority of adipose stem cells, as deduced from colony-forming unit assays. Proliferation occurred in both polymeric scaffolds. Upon chondrogenic induction, up-regulation of chondrogenic genes, production of glycosaminoglycans, and accumulation of collagen type II was observed, indicating differentiation of scaffold-attached SVF cells along the chondrogenic lineage. Osteogenic differentiation was achieved in both scaffold types, as visualized by up-regulation of osteogenic genes, increase of alkaline phosphatase production over time, and accumulation of bone sialoprotein and osteonectin. In conclusion, this study identifies both poly(L-lactide-co-caprolactone) and collagen type I/III as promising scaffold materials for rapid attachment of adipose stem cell-like (stromal) cells, enhancing the development of one-step surgical concepts for cartilage and bone tissue engineering.
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Affiliation(s)
- Wouter J Jurgens
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Berkhout MJ, Shaw MN, Berglund LJ, An KN, Berger RA, Ritt MJPF. The effect of radioscapholunate fusion on wrist movement and the subsequent effects of distal scaphoidectomy and triquetrectomy. J Hand Surg Eur Vol 2010; 35:740-5. [PMID: 20427404 DOI: 10.1177/1753193410370926] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radioscapholunate arthrodesis is a salvage procedure indicated for osteoarthritis of the radiocarpal joint involving the lunate facet of the radius. This cadaver study examines changes in wrist motion resulting from radioscapholunate arthrodesis, and the effects of surgical techniques to improve the range of motion. Simulated radioscapholunate arthrodesis, distal scaphoidectomy and triquetrectomy were carried out sequentially on six cadaver forearms and measurements (maximum flexion/extension and radial/ulnar deviation) were taken in the intact situation and after each surgical step using a magnetic tracking device. Radioscapholunate arthrodesis diminishes the amplitudes of movements of the wrist in all directions, but range of motion in the radioscapholunate fused wrist improves after scaphoidectomy and improves further after triquetrectomy (88% of original flexion/extension and 98% of original radial/ulnar deviation). Radioscapholunate arthrodesis causes a significant change in kinematics between the hamate and the triquetrum in flexion/extension.
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Affiliation(s)
- M J Berkhout
- Department of Plastic, Reconstructive and Hand Surgery, VU University Hospital, Amsterdam, The Netherlands.
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Abstract
We analysed hand and wrist injury and disorder related liability claims in the Netherlands to identify causes and to contribute to the prevention of such claims. Data was collected from 743 hand and wrist claims filed between 1993 and 2007. Consultants were involved in 417 claims (56.1%). Treatment in the emergency department (ED) accounted for 64.9% of these 287 claims involved residents (59.5%). The majority of accepted claims in the ED included treatment by general surgeons (89.2%). The percentage of accepted claims was highest in the general surgery group (26.4%). Of accepted claims in the ED which involved a resident, 93.2% involved a general surgery resident. Better training and supervision is indicated. This paper supports hand injury treatment by adequately trained surgeons and preferably, where possible, by a trained hand surgeon.
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Affiliation(s)
- B Mahdavian Delavary
- Department of Plastic and Reconstructive Surgery, VU University Medical Centre Amsterdam, and MediRisk, Utrecht, The Netherlands
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Jurgens WJFM, van Dijk A, Doulabi BZ, Niessen FB, Ritt MJPF, van Milligen FJ, Helder MN. Freshly isolated stromal cells from the infrapatellar fat pad are suitable for a one-step surgical procedure to regenerate cartilage tissue. Cytotherapy 2010; 11:1052-64. [PMID: 19929469 DOI: 10.3109/14653240903219122] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AIMS Stem cell therapies are being evaluated as promising alternatives for cartilage regeneration. We investigated whether stromal vascular fraction cells (SVF) from the infrapatellar (Hoffa) fat pad are suitable for a one-step surgical procedure to treat focal cartilage defects. METHODS SVF was harvested from patients undergoing knee arthroplasty (n = 53). Colony-forming unit (CFU) assays, growth kinetics and surface marker profiles were determined, and the chondrogenic differentiation capacity of freshly isolated SVF was assessed after seeding in three-dimensional poly (L-lactic-co-epsilon-caprolactone) scaffolds. RESULTS SVF yield per fat pad varied between 0.55 and 16 x 10(6) cells. CFU frequency and population doubling time were 2.6 +/- 0.6% and +/-2 days, respectively. Surface marker profiles matched those of subcutaneous-derived adipose-derived stem cells (ASC). CFU from Hoffa SVF showed differentiation toward osteogenic and adipogenic lineages. Cartilage differentiation was confirmed by up-regulation of the cartilage genes sox9, aggrecan, collagen type II and cartilage oligomeric matrix protein (COMP), collagen II immunostaining, Alcian Blue staining and glycosaminoglycan production. Compared with passaged cells, SVF showed at least similar chondrogenic potential. CONCLUSIONS This study demonstrates that SVF cells from the infrapatellar fat pad are suitable for future application in a one-step surgical procedure to regenerate cartilage tissue. SVF shows similar favorable characteristics as cultured ASC, and chondrogenic differentiation even appears to be slightly better. However, because of variable harvesting volumes and yields, SVF from the infrapatellar fat pad might only be applicable for treatment of small focal cartilage defects, whereas for larger osteoarthritic defects subcutaneous adipose tissue depot would be preferable.
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Affiliation(s)
- Wouter J F M Jurgens
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
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van Andel CJ, Roescher WBM, Tromp MF, Ritt MJPF, Strackee SD, Veeger DHEJ. Quantification of wrist joint laxity. J Hand Surg Am 2008; 33:667-74. [PMID: 18590849 DOI: 10.1016/j.jhsa.2008.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 01/10/2008] [Accepted: 01/17/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Laxity may be a trigger for chronic unidentified wrist pain. To determine whether this is the case, first an objective method to quantify wrist laxity needs to be defined. This study investigates different quantification methods (reference tests) from the literature and compares these with the judgment of 2 independent experienced clinicians (index test, or gold standard). METHODS Fifty healthy women (ages 19-43 y) without wrist complaints were included. For each subject, both clinicians were asked to give a laxity score for both wrists on a Likert scale of 1 to 5 (1 = very stiff, 5 = very lax). Subjects also had 3 reference tests: the Garcia-Elias method (passive range of motion), the Beighton method (general hypermobility), and the active range of motion method (specially designed measurement device). RESULTS There was no significant difference between the average laxity scores of clinicians 1 and 2. The intraclass correlation between clinician 1 and clinician 2 was significant but low. Correlation between the clinicians with the Garcia-Elias test as well as the Beighton method was significant but low (0.431 and 0.378). The correlation between reference tests was higher but still moderate. CONCLUSIONS This study showed that the index test used (clinical assessment) did not produce a satisfactory quantification of wrist laxity. Also, the reference tests are not suitable for quantification of laxity and seem to measure mobility rather than laxity. To quantify wrist laxity in a reliable and clinically relevant manner, it seems that consensus needs to be established between clinicians as to what elements of (abnormal) wrist motion define the wrist as "lax." In addition the development and testing of a measurement device that quantifies wrist translation might be needed for determining an objective score for wrist laxity.
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Affiliation(s)
- Carolien J van Andel
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.
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Genders R, Meester HHM, Hekker TAM, Ritt MJPF. Mepitel: re-application after rinsing? J Hosp Infect 2006; 64:407-8. [PMID: 17046107 DOI: 10.1016/j.jhin.2006.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 08/02/2006] [Indexed: 11/19/2022]
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Abstract
The interobserver reliability of the Mallet score for active shoulder function was assessed by three experienced observers in a group of 30 children with an obstetric brachial plexus lesion (mean age 7.1 years, range 4.5-10 years). Interobserver reliability, measured using weighted kappa, was good. Kappa varied between 0.37 and 0.84 and differed between the different aspects of the Mallet score and different pairs of observers. In decreasing order, mean weighted kappa was 0.75 for abduction, 0.73 for hand to neck, 0.67 for hand to spine, 0.6 for external rotation and 0.53 for hand to mouth.
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Affiliation(s)
- Johannes A van der Sluijs
- Departments of aOrthopedic Surgery bRehabilitation cPlastic and Reconstructive Surgery, VU Medical Centre, Amsterdam, The Netherlands.
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Oedayrajsingh-Varma MJ, van Ham SM, Knippenberg M, Helder MN, Klein-Nulend J, Schouten TE, Ritt MJPF, van Milligen FJ. Adipose tissue-derived mesenchymal stem cell yield and growth characteristics are affected by the tissue-harvesting procedure. Cytotherapy 2006; 8:166-77. [PMID: 16698690 DOI: 10.1080/14653240600621125] [Citation(s) in RCA: 306] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Adipose tissue contains a stromal vascular fraction that can be easily isolated and provides a rich source of adipose tissue-derived mesenchymal stem cells (ASC). These ASC are a potential source of cells for tissue engineering. We studied whether the yield and growth characteristics of ASC were affected by the type of surgical procedure used for adipose tissue harvesting, i.e. resection, tumescent liposuction and ultrasound-assisted liposuction. METHODS Frequencies of ASC in the stromal vascular fraction were assessed in limiting dilution assays. The phenotypical marker profile of ASC was determined, using flow cytometry, and growth kinetics were investigated in culture. ASC were cultured under chondrogenic and osteogenic conditions to confirm their differentiation potential. RESULTS The number of viable cells in the stromal vascular fraction was affected by neither the type of surgical procedure nor the anatomical site of the body from where the adipose tissue was harvested. After all three surgical procedures, cultured ASC did express a CD34+ CD31- CD105+ CD166+ CD45- CD90+ ASC phenotype. However, ultrasound-assisted liposuction resulted in a lower frequency of proliferating ASC, as well as a longer population doubling time of ASC, compared with resection. ASC demonstrated chondrogenic and osteogenic differentiation potential. DISCUSSION We conclude that yield and growth characteristics of ASC are affected by the type of surgical procedure used for adipose tissue harvesting. Resection and tumescent liposuction seem to be preferable above ultrasound-assisted liposuction for tissue-engineering purposes.
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Affiliation(s)
- M J Oedayrajsingh-Varma
- Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
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van Kooten EO, Coster E, Segers MJM, Ritt MJPF. Early proximal row carpectomy after severe carpal trauma. Injury 2005; 36:1226-32. [PMID: 16214466 DOI: 10.1016/j.injury.2005.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 12/29/2004] [Accepted: 01/07/2005] [Indexed: 02/02/2023]
Abstract
Complex fracture dislocations of the wrist often result in post-traumatic arthrosis. In these cases, patients can experience severe pain and loss of function of the wrist and as a result many of them end up having a total arthrodesis. In trying to avoid the disadvantages of a total arthrodesis, alternative treatment strategies have been investigated, amongst which proximal row carpectomy (PRC). Basic conditions for a good outcome of PRC are an intact cartilage of the lunate fossa of the distal radius and an intact surface of the head of the capitate for the new radiocapitate joint (, schematic drawing post-PRC). Also, an intact (volar) radioscaphocapitate (RSC) ligament is necessary because it plays an essential role in stabilizing the new joint and preventing volar dislocation and ulnar translocation of the distal carpal row. Acute post-traumatic PRC can be indicated, but is rarely reported in literature. In this article, we present four patients whom we have treated with early PRC after severe trauma of the wrist. Three patients had a good outcome. In the patient with the bad outcome, the before-mentioned prerequisites were not met, which is discussed.
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Affiliation(s)
- E O van Kooten
- Department of Plastic and Reconstructive surgery, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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