Akif Gulec

Seprafilm® interposition for preventing adhesion formation after tenolysis: An experimental study on the chicken flexor tendons

BACKGROUND Hyaluronic acid and its derivatives have become increasingly popular for preventing adhesions in primary tendon repair. Their use in tenolysis, however, has not been established yet. The purpose of the current study was to evaluate the efficacy of Seprafilm, a combination of carboxymethylcellulose membrane and hyaluronate, in prevention of adhesion formation after tenolysis. MATERIALS AND METHODS Thirty chickens were initially operated on their right central toes in order to constitute an experimental setting of postoperative flexor tendon adhesion. They were then randomly assigned to 3 groups at 6 weeks. Group 1 received no further procedure, group 2 underwent simple tenolysis with physiologic saline injection, and group 3 had tenolysis with Seprafilm interposition. RESULTS Group 3 scored a significantly higher average gliding excursion value than the other groups. Histologic examination corroborated the biomechanical data. CONCLUSION Seprafilm was effective in preventing adhesions after tenolysis.

Vascularized pedicled iliac crest graft for selected total hip acetabular reconstructions: a cadaver study

Bone grafting is an essential part of most total hip acetabular reconstructions. There are a limited number of surgical options, each with inherent disadvantages for the management of structural acetabular defects. In this cadaver study, the authors aimed to evaluate the availability of vascularized pedicled iliac crest graft for the purpose of acetabular reconstruction. The hip joints, ilia and deep circumflex iliac artery pedicles of six adult preserved cadavers were dissected bilaterally. A segment of the iliac crest was elevated on the vascular pedicle and its access to different parts of the acetabulum was evaluated. The average pedicle length was sufficient for coverage of the superior and anterior acetabular walls. The access to the posterior wall, however, required modification of the bone size. A vascularized pedicled iliac crest graft is suitable for the reconstruction of selected acetabular deficiencies.

Biopsy of vertebral tumour metastasis for diagnosing unknown primaries

Purpose. To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours. Methods. 13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra. Results. The origins of the primary tumours were lung cancer (n=6), prostate cancer (n=5), colorectal cancer (n=5), kidney cancer (n=4) and lymphoma (n=1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer. Conclusion. Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Objective The aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon. Materials & methods Sixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured. Results Histopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm2 and in control group it was 281.7 ± 38.7 N/mm2 (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009). Conclusion The present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.

Bone and Joint Infections

Infectious diseases have threatened human beings from ancient times. Bone and joint infections continue to be serious conditions for the orthopedic surgeons. The use of implants in modern orthopedic surgery and low blood supply to bone and joint tissues increase the risk for infection. Infection is an important cause of morbidity and mortality in orthopedic surgery. The pathogenesis of infection must be well understood by orthopedic surgeons for the eradication of infection. Recognizing unique characteristics of joint and bone infections mentioned earlier, the best way is prevention.