Search Results (170)

Breast implants are among the most frequently used long-term implantable medical devices in aesthetic and reconstructive surgery. In addition to correcting anatomical deficits, they have significant psychosocial effects, influencing body image, self-esteem, and quality of life, particularly in patients undergoing postmastectomy reconstruction. This review provides a comprehensive overview of the historical development, biological interactions, material characteristics, and clinical outcomes of breast implants. Early reconstructive attempts using foreign materials and injectable substances were associated with severe complications, underscoring the need for safer technologies. The introduction of silicone gel implants in the 1960s marked a pivotal advancement, followed by the development of saline-filled devices and highly cohesive silicone gels with enhanced mechanical stability. Key surgical considerations, including incision type and implant placement plane (subglandular, submuscular, dual-plane, and subfascial), are discussed in relation to aesthetic outcomes and complication risk. Emphasis is placed on the implant–tissue interface and the foreign body response (FBR), a process involving protein adsorption, immune cell activation, fibrous capsule formation, and potential chronic inflammation. Persistent inflammatory stimulation, often associated with bacterial biofilm formation, contributes to capsular contracture, the most common long-term complication. Additional adverse events include implant rupture, silicone gel bleed, granulomatous reactions, infection, hematoma, implant malposition, and rare but clinically significant conditions such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The review also summarizes implant classification according to construction, filling material, shape, and surface topography, highlighting the influence of surface characteristics on host response and clinical outcomes. Advances in biomaterials, cohesive gel formulations, and surface engineering aim to enhance biocompatibility and long-term safety, supported by standardized mechanical and biological testing protocols. Full article

Following traumatic injury, nerve repair is essential to the restoration of muscle function and sensation. The current gold standard of nerve repair is microsuture repair, which requires trained microsurgeons to perform time-intensive and technically demanding procedures under high magnification. Microsuture repair suffers from inconsistent repair quality among surgeons and variable clinical outcomes. Neurorrhaphy sutures are non-resorbable and prone to fibrous tissue ingrowth and attendant foreign body reaction, both of which are believed to contribute to the observed shortfall in clinical outcomes. Here, we introduce a novel, sutureless, in situ forming, and fully degradable hydrogel coaptation device for nerve repair. The practical usability of the hydrogel device was assessed by procedure timing, tensile repair strength, and repair quality compared to the traditional microsuture approach. Human cadaveric nerves were used to perform hydrogel and suture repairs for comparison in a relevant model. Additionally, the hydrogel coaptation device was used for primary sciatic nerve repairs in rats to assess feasibility for use in nerve repair in vivo. We observed that hydrogel nerve repairs were performed nearly three times faster than microsuture repairs, without any significant difference in tensile strength when pulled to failure, and had favorable quality scores when blindly assessed by plastic surgeons. Histologically, the in vivo feasibility study showed nerve bridging visualized using H&E, neurofilament, and myelin staining. Our findings suggest the novel hydrogel coaptation device may serve as a potential alternative to suture repair, with features addressing several critical limitations inherent to microsuture and existing nerve repair methods. Full article

Achieving hemostasis is crucial in neurosurgery, yet conventional methods are not always feasible, making topical hemostatic agents necessary. Current resorbable hemostatic agents allow effective hemostasis but must remain in situ to prevent rebleeding. This can provoke foreign body reactions leading to prolonged microglia-mediated neuroinflammation, which may exacerbate damage and delay recovery. It highlights the need for new hemostatic materials that can be removed after controlling bleeding while being safe for neurons and microglia. One candidate is Hemo-Ionic, a non-resorbable hemostatic compress composed of calcium alginate and zinc (Zn²⁺). Hemo-Ionic previously demonstrated effective in vitro and in vivo hemostasis, comparable to Surgicel and TachoSil, and pro-repair properties. In this study, Hemo-Ionic’s effect on neuronal and microglial cells was investigated in vitro. Results showed that Hemo-Ionic preserved cell viability and had an antioxidant capacity through protection from lipid peroxidation. Hemo-Ionic also reduced nitric oxide and pro-inflammatory cytokines (IL-6, IL-1β and TNF-α) expression and release by lipopolysaccharide (LPS)-stimulated microglial cells. Finally, neuronal viability was restored when exposed to supernatants of Hemo-Ionic-treated microglia. These findings indicate that Hemo-Ionic’s safety and capacity to reduce neuroinflammation, combined with its hemostatic efficacy and non-resorbable nature, make it a promising alternative to resorbable hemostatic agents used in neurosurgery. Full article

Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies. Full article

Regenerative medicine aims to restore the structure and function for improved tissue health; reduced tissue health can arise from causes such as aging, which results in the ongoing degradation of the extracellular matrix (ECM) of the skin. Replacement of a single biological component is not sufficient for an esthetic treatment to be described as regenerative; it is the relative amounts, ratios, types and organization of stimulated components that are important in a treatment’s regenerative potential. Regenerative aesthetics aims to recapture the youthful structure and function of tissue by exploiting the body’s own systems. Poly-L-lactic acid (PLLA-SCA; Sculptra^®), an injectable, biodegradable, non-permanent biostimulator, induces a combination of mechanotransductional/mechanical stimulation and foreign body reaction response and promotes ECM remodeling via the production of collagen through the upregulation of cytokines interleukin-1b and CXCL6, elastin, proteoglycans and multiadhesive glycoproteins. In addition, PLLA-SCA stimulates adipocyte rejuvenation/adipogenesis and increases the thickness of the dermis and adipose layers. Hence, PLLA-SCA stimulates endogenous pathways, and the array of biostimulatory effects should not be considered individually but as interlinked with the overall goal of improvement in skin health. These effects manifest clinically as long-term improvements in the mechanical properties of the skin, the restoration of volume and elasticity, improvements in skin quality and thickness, and dermal remodeling. Full article

Background/Objectives: Hernia and pelvic organ prolapse often involve defects necessitating reinforcement with synthetic materials. Polypropylene meshes of varying weights are commonly used in abdominal wall repair; however, their impact on tissue response, potentially linked to adverse events during wound healing, remains incompletely understood. This study aimed to evaluate and compare the tissue response to lightweight polypropylene (LWPP) and heavyweight polypropylene (HWPP) grafts used for abdominal wall defect closure in Wistar rats. Methods: Abdominal wall defects were surgically created in male Wistar rats and repaired using either LWPP (43 g/m²) or HWPP (76 g/m²) mesh. Three weeks post-implantation, tissue response and wound closure were evaluated across different phases by assessing expression of CD68, CD56, GATA-3, CD138, vimentin, α-smooth muscle actin, and collagen deposition. Results: HWPP promoted a more pronounced foreign body response, as evidenced by increased CD68, CD56, and CD138 expression, while LWPP improved tissue compliance, enhanced fibroblast migration, and increased vimentin-associated cellular activity. Conclusions: Three weeks post-implantation, HWPP was found to induce a stronger inflammatory response, whereas LWPP implantation was associated with increased vimentin expression, indicating differences in the balance between inflammation and extracellular matrix remodelling during early wound healing. Full article

Oxidized cellulose (OC) and oxidized regenerated cellulose (ORC) are bioabsorbable polysaccharide-based materials widely used in surgery for topical hemostasis. Beyond their established hemostatic role, increasing attention has been directed toward their potential antimicrobial activity, primarily attributed to local acidification following carboxyl group dissociation. Discussing the possible implications of the antibacterial properties of OC/ORC in veterinary surgical practice, this review critically examines the existing evidence. In vitro studies show that viable bacterial counts are significantly reduced in both Gram-positive and Gram-negative pathogens, including antibiotic-resistant strains. Historical in vivo animal models further support a reduction in bacterial recovery in contaminated tissues treated with OC. However, contemporary veterinary clinical trials specifically evaluating surgical site infection (SSI) outcomes remain limited. Documented limitations include variability in formulation, quantity-dependent degradation kinetics, and the potential for foreign body reactions when excessive material is retained. Current evidence suggests that OC may provide adjunctive antimicrobial effects under controlled experimental conditions, primarily in vitro and in standardized animal models, but these properties should be interpreted with caution, and its role should be integrated within comprehensive infection prevention strategies rather than considered a substitute for established perioperative protocols. Full article

Objectives: Horizontal ridge augmentation remains a clinical challenge due to limitations in terms of spatial maintenance, graft stability and predictability of new bone formation. The umbrella-screw tent technique provides mechanical stability for particulate grafts, while adjuvants such as hyaluronic acid (HA) and polynucleotides (PN) may enhance biological remodeling. Evidence for this compound in implant-related bone augmentation is still scarce. Material and methods: In a single patient with a knife-edge alveolar ridge, augmentation was performed in regions 34 to 36 using the umbrella-screw tent technique. The defect was grafted with deproteinized bovine bone mineral (DBBM) mixed with hyaluronic acid (HA) and polynucleotides (PN), supplemented with platelet-rich fibrin (PFR) and covered with a resorbable collagen membrane. After six months, two implants were installed, and a biopsy was obtained by trepanation for histological and histomorphometric analysis. Results: Healing occurred without compromise, with no signs of infection or graft exposure. Horizontal bone gain averaged 4.5 mm, corresponding to a relative Target Performance Index (TPI-h) of 75%. Histomorphometric analysis revealed a total mineralized fraction of 76.4%, consisting of 36.1% newly formed bone and 40.3% residual DBBM particles. The xenogeneic granules were completely integrated into mature bone, with no signs of inflammation or foreign body reaction. Conclusion: The case report illustrates that the combination of DBBM with HA and PN, stabilized by the umbrella-screw tent technique, can lead to significant new bone formation and favorable graft integration. Although limited by its single-case design, the case report provides preliminary insights into the synergistic potential of HA and PN as biological enhancers in bone augmentation, warranting further controlled studies. Full article

Background and Objectives: Tubal reanastomosis is an alternative option for women seeking fertility after sterilization. Thus, anastomosis healing quality and peri-tubal adhesions play a crucial role. TISSEEL^® fibrin sealant may enhance tissue repair and reduce foreign-body reaction. We evaluated the effect of TISSEEL^®, used alone or with sutures, on anastomotic healing and adhesion formation in a rat uterine horn model. Materials and Methods: Thirty female Wistar rats were randomized to Suture, TISSEEL^®, or Suture + TISSEEL^® groups (n = 10 each). After bilateral uterine horn transection, reanastomosis was performed with sutures alone, fibrin sealant alone, or combined sutures and sealant. On postoperative day 14, reanastomosis segments were collected for blinded histologic assessment and evaluation of modified Ehrlich–Hunt score parameters (inflammation, fibrosis, neovascularization and collagen production). Intra-abdominal adhesions were also macroscopically assessed. Results: Two animals died perioperatively and 56 uterine horns were included in the final analysis (Suture n = 18, TISSEEL^® n = 18, Suture + TISSEEL^® n = 20). The distribution of inflammation and fibrosis severity grades, as assessed by the modified Ehrlich–Hunt scoring system, did not differ significantly between the study groups (p = 0.208 and p = 0.652, respectively). In contrast, high-grade neovascularization (grades 3–4) was more common in TISSEEL^® groups (77.8% TISSEEL^®, 80.0% Suture + TISSEEL^®, 33.3% Suture, p = 0.004), while increased collagen deposition was also more common in the TISSEEL^® groups (p = 0.011), after binary analysis. Severe adhesions were more common in the Suture group (66.7% vs. 11.1% in the TISSEEL^® group and 30.0% in the Suture + TISSEEL^® group, p = 0.037). Conclusions: TISSEEL^®, alone or as an adjunct to sutures, improves neovascularization and collagen production and is associated with milder adhesions without increased inflammation or fibrosis. The use of fibrin sealant TISSEEL^® may be a useful tool in tubal reconstructive surgery. Full article

Background/Objectives: Dental implant placement protocols including immediate (IIP) and delayed implant placement (DIP) are likely to affect bone tissue repair and regeneration after the surgery. Despite many benefits of IIP, it has remained unclear whether IIP demonstrates comparable healing processes and outcomes to those observed in DIP. This review aims to summarize and compare biological and clinical outcomes of IIP and DIP, focusing on success and survival rates, periodontal status, esthetics and radiographic outcomes, and biochemical markers. Methods: A literature search of electronic databases was conducted using PubMed/MEDLINE, Embase, and the Scopus databases (January 1983–February 2025). 109 articles published in English, consisting of in vitro, in vivo, and clinical studies met the inclusion criteria. Results: This review shows that both IIP and DIP show similar implant survival rates, but IIP may lead to a higher risk of mid-facial recession in esthetic areas. DIP, on the other hand, can result in better soft tissue and bone healing. Histological and radiographic evidence shows comparable bone to implant contact (BIC) between the two methods, although peri-implant bone loss tends to be higher with IIP. Lastly, although specific molecular markers are well-established in all phases of osseointegration following DIP, there is no available literature comparing differences in biomarkers during healing periods between IIP and DIP. Conclusions: This review highlights the similarities and differences in the outcomes of IIP and DIP, as well as the knowledge gaps that require further investigation, providing valuable insights for predicting treatment outcomes and managing complications associated with dental implant placement. Full article

Background and Objectives: Implant-associated complications, including foreign-body responses and infection risk, remain major concerns in reconstructive and aesthetic breast surgery. Antimicrobial polymer coatings have been proposed as potential preventive strategies, but early-stage development requires simple and ethically refined in vivo models. This pilot study aimed to (i) establish a practical workflow for applying PLGA–vancomycin coatings onto PTFE substrates used as experimental analogs for smooth silicone implants, and (ii) develop a small-animal implantation protocol for short-term evaluation of surgical feasibility and local tissue tolerability. Materials and Methods: PLGA microparticles and PLGA–vancomycin microparticles were prepared using a double-emulsion solvent-evaporation method and applied onto PTFE discs. Particle size and polydispersity were assessed based on dynamic light scattering (DLS), and surface charge was measured via zeta potential. A bilateral subcutaneous implantation model was used in four Wistar rats, each receiving a PTFE disc coated with PLGA-only on one side and a disc coated with PLGA–vancomycin on the other. Animals were monitored for postoperative recovery, wound appearance, and general condition. After four weeks, implants and surrounding tissues were harvested for macroscopic and preliminary histological evaluation. Results: Both PLGA-only and PLGA–vancomycin microparticles showed submicron mean hydrodynamic diameters and moderately polydisperse distributions typical for double-emulsion formulations. All animals recovered normally, maintained stable body weight, and exhibited no macroscopic signs of adverse reactions. Preliminary histology showed early fibrous capsule formation with mild inflammatory infiltrate around both types of coated implants, without qualitative differences observed in this pilot setting. Conclusions: This preliminary study demonstrates the feasibility of applying PLGA-only and PLGA–vancomycin coatings onto PTFE implant analogs and establishes a reproducible, minimal-use rat model for short-term evaluation of local tissue tolerability. The protocol provides a practical foundation for future work on coating stability, drug-release kinetics, antibacterial activity, and long-term tissue responses on medical-grade silicone substrates. Full article

Background: Otitis media with effusion (OME) is a widespread condition that causes hearing impairment, particularly in pediatric populations. Existing non-absorbable tubes often require elective or unplanned removal surgery. Bioabsorbable polylactic acid (PLA) offers a promising alternative due to its inherent biocompatibility and tunable degradation characteristics. In this study, we designed, fabricated, and comprehensively evaluated a novel PLA middle-ear ventilation tube. Methods: Bioabsorbable PLA tubes were designed and fabricated based on commercial models. In vitro biocompatibility was assessed according to ISO 10993 guidelines. A guinea pig model was used to perform in vivo evaluations, including otoscopic examinations, auditory brainstem response (ABR) measurements, micro-computed tomography (micro-CT) imaging, and histological analyses. Results: The PLA tubes were successfully designed and fabricated, exhibiting dimensions comparable to those of commercially available products. In vitro testing confirmed their biocompatibility. In vivo observations revealed that the PLA segments remained stable, with no significant inflammation detected. ABR measurements revealed no adverse impacts on hearing function. Micro-CT imaging confirmed tube integrity and indicated initial signs of degradation over a 9-month period, as evidenced by radiographic morphology. Histological analyses indicated a favorable tissue response with minimal foreign body reaction. Conclusions: The developed PLA middle-ear ventilation tube represents a highly promising alternative to conventional non-absorbable tubes. It demonstrates excellent biocompatibility, preserves auditory function, and exhibits a controlled degradation profile. This preclinical study provides strong support for further investigation and subsequent clinical trials to validate its safety and efficacy in human patients. Full article

Over the past decades, coronary revascularization has evolved dramatically with the introduction of bioresorbable scaffolds (BRSs), designed to provide temporary vessel support, elute antiproliferative drugs, and then fully resorb, ideally restoring natural vasomotion and eliminating long-term foreign-body reactions. Early enthusiasm for first-generation polymeric devices, such as the Absorb bioresorbable vascular scaffold, was tempered by increased rates of scaffold thrombosis and late adverse events, largely attributed to thick struts, suboptimal implantation techniques, and unpredictable degradation kinetics. Subsequent developments in polymeric (e.g., MeRes-100, NeoVas) and metallic magnesium-based scaffolds (e.g., Magmaris) have focused on thinner struts, improved radial strength, and refined resorption profiles. Clinical trials and meta-analyses, including ABSORB, AIDA, BIOSOLVE, and BIOSTEMI, reveal that optimized procedural strategies, especially the “PSP” approach (Prepare–Size–Post-dilate) and routine intravascular imaging, substantially reduce thrombosis and restenosis rates, aligning outcomes closer to those of contemporary drug-eluting stents (DESs). Nonetheless, challenges persist regarding inflammatory responses to degradation by-products, mechanical fragility in complex lesions, and patient selection. Ongoing innovations include hybrid polymer–metal designs, stimuli-responsive drug coatings, and AI-assisted imaging for precision implantation. While early-generation BRSs demonstrated both promise and pitfalls, next-generation platforms show steady progress toward achieving the dual goals of transient scaffolding and long-term vessel restoration. The current trajectory suggests that bioresorbable technology, supported by optimized technique and material science, may soon fulfill its original vision; offering safe, effective, and fully resorbable alternatives to permanent metallic stents in coronary artery disease. This review provides an updated synthesis of the design principles, clinical outcomes, and procedural considerations of drug-eluting bioresorbable scaffolds (BRSs). It integrates recent meta-analytic evidence and emerging insights on device mechanics, including the influence of strut thickness on radial strength and the potential role of non-invasive imaging in pre-implantation planning. Special focus is given to magnesium-based scaffolds and future directions in patient selection and implantation strategy. Full article

Background: Aorto-esophageal fistula (AEF) is a rare but life-threatening condition in children following foreign body (FB) ingestion, with button batteries (BB) being the most dangerous. These batteries involve severe tissue necrosis due to chemical and electrical reactions, often leading to fistula formation and catastrophic hemorrhage. Appropriate treatment for AEF is still undefined. Method: This report presents a novel case of AEF closure using a covered stent in a 4-year-old boy, complemented by a narrative review of 36 reported pediatric AEF cases from 1988 to 2024. Results: The review revealed that BB ingestion accounted for 67% of AEF cases, with a high mortality rate of 43%, underscoring the critical nature of this condition. Early symptoms are often nonspecific, leading to delayed diagnoses, which worsen outcomes. Computed tomography (CT) is the key imaging modality for detecting vascular complications such as AEF, while X-ray may help identify the foreign body, but is often insufficient to assess associated injuries. While surgical repair remains the mainstay of treatment, minimally invasive techniques, such as endovascular approaches, are emerging as viable options. Conclusions: This study highlights the need for heightened public awareness, safer battery designs, and prompt, multidisciplinary interventions to improve patient outcomes. Future research should focus on refining diagnostic protocols, evaluating innovative management strategies, and establishing comprehensive registries to inform evidence-based guidelines and optimize care. Full article

Gossypiboma is a retained surgical item, most commonly gauze or sponge, inadvertently left inside a patient’s body after surgery. Although preventable, it can cause severe complications and is often underreported due to medicolegal concerns. We present a case of a 61-year-old woman who experienced left lower abdominal pain for three days. Her history included lumbar disc surgery via the lower left abdomen a decade earlier. Physical examination revealed a non-tender pelvic mass, and abdominal computed tomography (CT) showed a 4.5 × 4.7 × 6.1 cm high-attenuation lesion with internal low-attenuation areas in the left retroperitoneal space. The mass was surgically removed, and gauze material was identified inside, confirming the diagnosis of gossypiboma. The patient recovered uneventfully postoperatively. Gossypiboma can present with subacute or chronic symptoms, making diagnosis challenging. While uncommon, gossypiboma should be considered in differential diagnoses of patients with unexplained abdominal masses and prior surgical history. Prompt surgical management is essential to prevent complications. This case highlights the importance of meticulous surgical counts and awareness of this rare but serious condition. Full article