Achilles Tendon for Sternal Synthesis in the Treatment of Mediastinitis
Marisa De FeoAntonio CarozzaAlessandro Della CorteCesare QuartoMichele TorellaLuca Salvatore De SantoGianantonio NappiMaurizio Cotrufo
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Keywords:
Mediastinitis
Sternum
Debridement (dental)
Mediastinitis
Debridement (dental)
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We used a rat model to study the effects of immobilization of the calf muscle‐tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end‐to‐end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension‐ and load‐increasing without a significant increase in the risk of rerupture of the tendon.
Muscle Atrophy
Gastrocnemius muscle
Hindlimb
Achilles tendon rupture
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Objectives: Deep sternal wound infection is still a major complication in cardiac surgery. We compared the sternal reinfection rate in patients with poststernotomy mediastinitis after negative pressure wound therapy (NPWT) and conventional treatment.
Mediastinitis
Sternum
Negative-pressure wound therapy
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To determine tendon stump changes following unrepaired Achilles tendon lacerations in an animal model.An experimental study.King Saud University, Riyadh, Saudi Arabia, from October 2013 to January 2014.Arabbit model was developed and studied tendon retraction and histological changes in the proximal and distal stumps following transection of the Achilles tendon.Over a period of 12 weeks, retraction of the distal tendon stump was minimal (2 - 3 mm). In contrast, retraction of the proximal tendon stump peaked to reach 6 mm at 4 weeks post-injury and plateaued to reach 7 - 8 mm at the 12-week interval.Following complete transection of the Achilles tendon, tendon retraction correlated with the density of myofibroblast expression within the tendon stump. Further research is needed to investigate the pathophysiology of these findings.
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Biomechanics
Muscle belly
Strain (injury)
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The metabolic activity of tendinous tissues has traditionally been considered to be of limited magnitude. However, recent studies have suggested that glucose uptake increases in the force-transmitting tissues as a response to contractile loading, which in turn indicates an elevated tissue metabolism. The purpose of the present study was to investigate whether such a mechanism could be observed for the human Achilles tendon following tensile loading. Six subjects participated in the study. Unilateral Achilles tendon loading was applied by 25-min intermittent voluntary plantar flexor contractions. A radioactive tracer ([18F]-2-fluoro-2-deoxy-D-glucose) was administered during muscle action, and glucose uptake was measured by use of PET. Regions of interest were defined on the PET images corresponding to the cross section of Achilles tendon at two longitudinally separated sites (insertion and free tendon). Glucose uptake index was determined within respective regions of interest for the active and resting leg. Tendon force during voluntary contractions was approximately 13% of maximal voluntary contraction force. Tendon loading induced an elevated glucose uptake index compared with that of the contralateral resting tendon in the region of tendon insertion (0.13 +/- 0.05 vs. 0.09 +/- 0.02; P < 0.05) and at the free tendon (0.12 +/- 0.01 vs. 0.08 +/- 0.02; P < 0.05). The present data suggest that tissue metabolism is elevated in the human Achilles tendon in response to low-intensity loading.
Intensity
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Calf muscle
Triceps surae muscle
Muscle belly
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Mediastinitis
Sternum
Antibiotic Therapy
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Achilles tendon rupture
Treadmill
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Objective: To provide the biochemical and histological foundation for the vascularized tendon transfer to the Achilles tendon defect.Methods:Twelve New Zealand adult rabbits were divided into two groups randomly.The Achilles tendon defects were repaired with vascularlized flexor digitorum longus tendon, and the contralateral Achilles tendon served as a free tendon control.The histological observation and biochemical tests were made at 12 weeks after operation.Results: In the experimental sides, the histological structure closed to the normal Achilles tendon and the transfer tendon regained 67.7% of the tensile strength of the normal Achilles tendon.The results of the control sides indicated that the tendon fibre were wrapped by the scar tissue histological, and that the tendon transfers regained 35.3% of the tensile strength.The difference between the experimental group and the control group was significant ( P 0.01).Conclusion: The vascularized tendon transfer is superior to the free tendon transfer in the repair of the Achilles tendon defect.
Tendon transfer
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