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Leyendecker J, Prasse T, Park C, Payne C, Rückels P, Bieler E, Eysel P, Bredow J, Telfeian A, Derman P, Kashlan O, Konakondla S, Ogunlade J, Hofstetter CP. Pain alleviation and functional improvement: ultra-early patient-reported outcome measures after full endoscopic spine surgery. J Neurosurg Spine 2024; 40:465-474. [PMID: 38181496 DOI: 10.3171/2023.11.spine231048] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Questions regarding anticipated pain improvement and functional recovery postsurgery are frequently posed in preoperative consultations. However, a lack of data characterizing outcomes for the first postoperative days only allows for anecdotal answers. Hence, the assessment of ultra-early patient-reported outcome measures (PROMs) is essential for patient-provider communication and patient satisfaction. The aim of this study was to elucidate this research gap by assessing and characterizing PROMs for the first days after full endoscopic spine surgery (FESS). METHODS This multicenter study included patients undergoing lumbar FESS from March 2021 to July 2023. After informed consent was provided, data were collected prospectively through a smartphone application. Patients underwent either discectomy or decompression. Analyzed parameters included demographics, surgical details, visual analog scale scores for both back and leg pain, and the Oswestry Disability Index (ODI) score. Data were acquired daily for the 1st postoperative week, as well as after 2 weeks, 3 months, and 6 months. RESULTS A total of 182 patients were included, of whom 102 underwent FESS discectomy and 80 underwent FESS decompression. Significant differences between the discectomy and decompression groups were found for age (mean 50.45 ± 15.28 years and 63.85 ± 13.25 years, p < 0.001; respectively), sex (p = 0.007), and surgery duration (73.45 ± 45.23 minutes vs 98.05 ± 46.47 minutes, p < 0.001; respectively). Patients in both groups reported a significant amelioration of leg pain on the 1st postoperative day (discectomy group VAS score: 6.2 ± 2.6 vs 2.4 ± 2.9, p < 0.001; decompression group: 5.3 ± 2.8 vs 1.9 ± 2.2, p < 0.001) and of back pain within the 1st postoperative week (discectomy group VAS score: 5.5 ± 2.8 vs 2.8 ± 2.2, p < 0.001; decompression group: 5.2 ± 2.7 vs 3.1 ± 2.4, p < 0.001). ODI score improvement was most pronounced at the 3-month time point (discectomy group: 21.7 ± 9.1 vs 9.3 ± 9.1, p < 0.001; decompression group: 19.3 ± 7.8 vs 9.9 ± 8.3, p < 0.001). For both groups, pain improvement within the 1st week after surgery was highly predictive of later benefits. CONCLUSIONS Ultra-early PROMs reveal an immediate pain improvement after FESS. While the benefits in pain reduction plateaued within the 1st postoperative week for both groups, functional improvements developed over a more extended period. These results illustrate a biphasic rehabilitation process wherein initial pain alleviation transitions into functional improvement over time.
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Affiliation(s)
- Jannik Leyendecker
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Tobias Prasse
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Christine Park
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Cathryn Payne
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Pia Rückels
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 3Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | - Eliana Bieler
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Peer Eysel
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Jan Bredow
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- 3Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | - Albert Telfeian
- 4Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Osama Kashlan
- 6Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Sanjay Konakondla
- 7Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania; and
| | - John Ogunlade
- 8Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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Leyendecker J, Benedict B, Gumbs C, Eysel P, Bredow J, Telfeian A, Derman P, Kashlan O, Amin A, Konakondla S, Hofstetter CP, Ogunlade J. Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes. J Neurosurg Spine 2024; 40:359-364. [PMID: 38064701 DOI: 10.3171/2023.10.spine23936] [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] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18-30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (-3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (-4.4 ± 3.2 vs -2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: -11.4 ± 11.4 vs -9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: -4.3 ± 3.9 vs -3.5 ± 3.8, p = 0.28). CONCLUSIONS The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.
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Affiliation(s)
- Jannik Leyendecker
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Braeden Benedict
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Peer Eysel
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Jan Bredow
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- 5Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | - Albert Telfeian
- 6Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Osama Kashlan
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
| | - Anubhav Amin
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Sanjay Konakondla
- 9Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania
| | | | - John Ogunlade
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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Peddireddy NS, Yalamanchi P, Kashlan O, Park P, Reddy RM, Chinn SB, Casper KA, Malloy KM, Stucken CL, Prince MEP, Rosko AJ, Spector ME. Anterior spinal hardware erosion of the pharyngoesophagus: A difficult reconstructive challenge-Our experience in nine patients. Clin Otolaryngol 2023; 48:264-268. [PMID: 36536995 DOI: 10.1111/coa.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/24/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Nithin S Peddireddy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Pratyusha Yalamanchi
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Osama Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Prasse T, Wagner R, Mahan MA, Kim R, Sivakanthan S, Telfeian AE, Bergquist J, Bredow J, Kashlan O, Hofstetter CP. 315 Incidence of Infections in Full-Endoscopic Spine Surgery: A Multicenter Study Including 1262 Patients. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kashlan O, Bergquist J, Prasse T, Greil M, Sivakanthan S, Williams JR, Hofstetter CP. 451 Dural Tears in Full-Endoscopic Unilateral Laminotomies for Bilateral Lumbar Decompression. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kashlan O, Frerich JM, Malcolm JG, Gary MF, Rodts GE, Refai D. Safety Profile and Radiographic and Clinical Outcomes of Stand-Alone 2-Level Anterior Lumbar Interbody Fusion: A Case Series of 41 Consecutive Patients. Cureus 2020; 12:e11684. [PMID: 33391920 PMCID: PMC7769802 DOI: 10.7759/cureus.11684] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The use of stand-alone 2-level anterior lumbar interbody fusion (ALIF) for degenerative lumbar disease has been increasing as an alternative to routinely augmenting these constructs with posterior fixation or fusion. Despite the potential benefits of a stand-alone approach (decreased cost and operative time, decreased pain and early mobilization), there is a paucity of information regarding these operations in the literature. This investigation aimed to determine the safety profile, radiographic outcomes including fusion rates, improvement in preoperative pain, and spinopelvic parameter modification, for patients undergoing stand-alone 2-level ALIF. Methods: This retrospective case series involved a chart review of all patients undergoing 2-level stand-alone ALIF at a single tertiary hospital from 2008 to 2018. Data included patient demographics, hospitalization, complications and radiological studies. Visual analog scale (VAS) back and leg scores were measured via patient-administered surveys preoperatively and up to 18 weeks postoperatively. Results: Forty-one patients who underwent L4-S1 stand-alone ALIF were included. Sixteen (39%) of patients had undergone previous posterior lumbar surgery. Length of stay averaged 4.2 days. Complication rates were comparable to 1-level ALIF. Two patients required reoperation. Fusion rates were 100% for L4-5 and 94.4% for L5-S1. There was no significant change in lumbar lordosis (LL) or LL-pelvic incidence (PI), but there was improved segmental lordosis (SL) and disc height at L4-S1 on final follow-up imaging. There was also modest but statistically significant improvement in VAS back and leg scores. Conclusions: Stand-alone 2-level ALIF is an option for a surgeon to perform in the absence of significant instability, even in the setting of prior posterior surgery. These procedures increase SL and disc height, but do not have the same effect on LL or LL-PI.
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Affiliation(s)
- Osama Kashlan
- Neurosurgery, University of Michigan, Ann Arbor, USA
| | - Jason M Frerich
- Neurosurgery, Emory University School of Medicine, Atlanta, USA
| | - James G Malcolm
- Neurosurgery, Emory University School of Medicine, Atlanta, USA
| | - Matthew F Gary
- Orthopedic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Gerald E Rodts
- Neurosurgery, Emory University School of Medicine, Atlanta, USA
| | - Daniel Refai
- Neurosurgery, Emory University School of Medicine, Atlanta, USA
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Kashlan O, Swong K, Alvi MA, Bisson EF, Mummaneni PV, Knightly J, Chan A, Yolcu YU, Glassman S, Foley K, Slotkin JR, Potts E, Shaffrey M, Shaffrey CI, Haid RW, Fu KM, Wang MY, Asher AL, Bydon M, Park P. Patients with a depressive and/or anxiety disorder can achieve optimum Long term outcomes after surgery for grade 1 spondylolisthesis: Analysis from the quality outcomes database (QOD). Clin Neurol Neurosurg 2020; 197:106098. [PMID: 32717562 DOI: 10.1016/j.clineuro.2020.106098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the current study, we sought to compare baseline demographic, clinical, and operative characteristics, as well as baseline and follow-up patient reported outcomes (PROs) of patients with any depressive and/or anxiety disorder undergoing surgery for low-grade spondylolisthesis using a national spine registry. PATIENTS AND METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing surgery for Meyerding grade 1 lumbar spondylolisthesis undergoing 1-2 level decompression or 1 level fusion at 12 sites with the highest number of patients enrolled in QOD with 2-year follow-up data. RESULTS Of the 608 patients identified, 25.6 % (n = 156) had any depressive and/or anxiety disorder. Patients with a depressive/anxiety disorder were less likely to be discharged home (p < 0.001). At 3=months, patients with a depressive/anxiety disorder had higher back pain (p < 0.001), lower quality of life (p < 0.001) and higher disability (p = 0.013); at 2 year patients with depression and/or anxiety had lower quality of life compared to those without (p < 0.001). On multivariable regression, depression was associated with significantly lower odds of achieving 20 % or less ODI (OR 0.44, 95 % CI 0.21-0.94,p = 0.03). Presence of an anxiety disorder was not associated with decreased odds of achieving that milestone at 3 months. The presence of depressive-disorder, anxiety-disorder or both did not have an impact on ODI at 2 years. Finally, patient satisfaction at 2-years did not differ between the two groups (79.8 % vs 82.7 %,p = 0.503). CONCLUSION We found that presence of a depressive-disorder may impact short-term outcomes among patients undergoing surgery for low grade spondylolisthesis but longer term outcomes are not affected by either a depressive or anxiety disorder.
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Affiliation(s)
- Osama Kashlan
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Kevin Swong
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - John Knightly
- Atlantic Neurosurgical Specialists, Morristown, New Jersey, United States
| | - Andrew Chan
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Yagiz U Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Steven Glassman
- Norton Leatherman Spine Center, Louisville, Kentucky, United States
| | - Kevin Foley
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, United States
| | | | - Eric Potts
- Goodman Campbell Brain and Spine, Indianapolis, Indiana, United States
| | - Mark Shaffrey
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Christopher I Shaffrey
- Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina, United States
| | | | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical College, New York City, NY, United States
| | - Michael Y Wang
- Department of Neurologic Surgery, University of Miami, Miami, Florida, United States
| | - Anthony L Asher
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina, United States
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
| | - Paul Park
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, United States
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Malcolm JG, Kashlan O, Lamanna JJ, Howard BM, Refai D. 170 Overlapping Spine Surgery. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kashlan O, Wilkinson DA, Morgenstern H, Maher CO. 202 Predictors of Surgical Treatment and Postoperative Complications in the Pediatric Patient With Isolated Tethered Cord Syndrome. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489771.82136.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Martanto W, Moore JS, Kashlan O, Kamath R, Wang PM, O'Neal JM, Prausnitz MR. Microinfusion using hollow microneedles. Pharm Res 2006; 23:104-13. [PMID: 16308670 DOI: 10.1007/s11095-005-8498-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/14/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the study is to determine the effect of experimental parameters on microinfusion through hollow microneedles into skin to optimize drug delivery protocols and identify rate-limiting barriers to flow. METHODS Glass microneedles were inserted to a depth of 720-1080 microm into human cadaver skin to microinfuse sulforhodamine solution at constant pressure. Flow rate was determined as a function of experimental parameters, such as microneedle insertion and retraction distance, infusion pressure, microneedle tip geometry, presence of hyaluronidase, and time. RESULTS Single microneedles inserted into skin without retraction were able to infuse sulforhodamine solution into the skin at flow rates of 15-96 microl/h. Partial retraction of microneedles increased flow rate up to 11.6-fold. Infusion flow rate was also increased by greater insertion depth, larger infusion pressure, use of a beveled microneedle tip, and the presence of hyaluronidase such that flow rates ranging from 21 to 1130 microl/h were achieved. These effects can be explained by removing or overcoming the large flow resistance imposed by dense dermal tissue, compressed during microneedle insertion, which blocks flow from the needle tip. CONCLUSIONS By partially retracting microneedles after insertion and other methods to overcome flow resistance of dense dermal tissue, protocols can be designed for hollow microneedles to microinfuse fluid at therapeutically relevant rates.
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Affiliation(s)
- Wijaya Martanto
- School of Chemical and Biomolecular Engineering and Center for Drug Design, Development and Delivery, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
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