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Gent, Belgium

Debels H.,AZ Maria Middelares
Acta Chirurgica Belgica | Year: 2015

Introduction: Regenerative therapies aim to repair or replace damaged tissues. Clinical applications may vary from organ replacement, to breast reconstruction or limb regeneration. In growing 3-dimensional tissue constructs, access to a nourishing vascular network is essential. Methods: In rats, an arteriovenous loop was surgically established from the femoral vessels and positioned inside a perforatedchamberinthegroin. Chamberswerefilledwith2mlAdipogel, anovelacellulartissueengineeringgelcontaining growth factors and polymers. Constructs were harvested at 6 and 12 weeks (n = 6) and assessed for volume and histological content. Results:Thechambersfilledwithtissuetoabouthalfoftheircontent. Histologicalassessmentshowedgrowthofdifferent tissue types within the chamber; not only had a vascular network grown throughout the construct by 12 weeks, adipose, muscular and connective tissue was abundantly present as well. The grown tissue-types seemed to resemble surrounding groin tissue. Conclusion: This in vivo study makes use of a novel technology for tissue generation. In a surgically established vascularized chamber, spontaneous tissue growth within an acellular gel was achieved. Most likely, stem cells residing in adjacent tissues were driven to the chamber to form new tissue. With this technology, hope rises for a variety of novel patient-tailored therapies, such as organ regeneration or soft tissue repair. In all of these strategies, the surgeon is playing an essential role. © Acta Chirurgica Belgica.

Thienpont E.,University hospital Saint Luc | Bellemans J.,University Hospital Pellenberg | Delport H.,Catholic University of Leuven | Van Overschelde P.,AZ Maria Middelares | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The aim of this study was (1) to survey the orthopaedic companies about the volume of patient-specific instruments (PSI) used in Europe and worldwide; (2) to survey a group of knee arthroplasty surgeons on their acceptance of PSI and finally; (3) to survey a medico-legal expert on PSI-related issues. Methods: Seven orthopaedic implant manufacturers were contacted to obtain their sales figures (in volume) of PSI in Europe and worldwide for the 2011 and 2012 period. During the Open Meeting of the Belgian Knee Society, a survey by a direct voting system was submitted to a selection of knee surgeons. Finally, a number of medico-legal 'PSI-related' questions were submitted to an adult reconstruction surgeon/legal expert. Results: The total volume, for all contacted companies, of PSI in Europe for 2012 was 17,515 total knee arthroplasty (TKA) and 82,556 TKA worldwide. Biomet (Warsaw, USA) was the number one in volume, both in Europe as worldwide with their Signature system. Biomet represented 27 % of the market share in PSI worldwide. Stryker preferred not to reply to the survey because of the FDA class 1 recall on ShapeMatch cutting guides. Eighty per cent of the Belgian knee surgeons expressed a great interest in PSI and especially, for 58 % of them, if it would increase their surgical accuracy. They valued it even more in unicompartmental arthroplasty, and 55 % was ready to use single-use instruments. Surprisingly, 47 % of surgeons thought it was the company's responsibility if something goes wrong with a PSI-assisted case. The medico-legal expert concluded that PSI is a complex process that exposes surgeons to new risks in case of failure and stated that companies should not produce surgical guides without validation of the planning by the surgeon. Conclusion: Patient-specific instruments is of great interest if it can proof to increase the surgical accuracy in knee arthroplasty to the level surgeons are expecting and if in the same time it would make the surgical process more efficient. Level of evidence: V. © 2013 Springer-Verlag Berlin Heidelberg.

Bergs J.,Hasselt University | Hellings J.,Hasselt University | Cleemput I.,Hasselt University | Zurel O.,Hasselt University | And 6 more authors.
British Journal of Surgery | Year: 2014

Background: The World Health Organization (WHO) surgical safety checklist (SSC) was introduced to improve the safety of surgical procedures. This systematic review evaluated current evidence regarding the effectiveness of this checklist in reducing postoperative complications. Methods: The Cochrane Library, MEDLINE, Embase and CINAHL were searched using predefined inclusion criteria. The systematic review included all original articles reporting a quantitative measure of the effect of the WHO SSC on postoperative complications. Data were extracted for postoperative complications reported in at least two studies. A meta-analysis was conducted to quantify the effect of the WHO SSC on any complication, surgical-site infection (SSI) and mortality. Yule's Q contingency coefficient was used as a measure of the association between effectiveness and adherence with the checklist. Results: Seven of 723 studies identified met the inclusion criteria. There was marked methodological heterogeneity among studies. The impact on six clinical outcomes was reported in at least two studies. A meta-analysis was performed for three main outcomes (any complication, mortality and SSI). Risk ratios for any complication, mortality and SSI were 0·59 (95 per cent confidence interval 0·47 to 0·74), 0·77 (0·60 to 0·98) and 0·57 (0·41 to 0·79) respectively. There was a strong correlation between a significant decrease in postoperative complications and adherence to aspects of care embedded in the checklist (Q = 0·82; P = 0·042). Conclusion: The evidence is highly suggestive of a reduction in postoperative complications and mortality following implementation of the WHO SSC, but cannot be regarded as definitive in the absence of higher-quality studies. Saves lives © 2014 BJS Society Ltd.

Muysoms F.E.,AZ Maria Middelares
Surgical technology international | Year: 2012

Since the introduction of laparoscopic ventral hernia repair, there has been an ongoing dispute over the optimal method of fixating the mesh against the abdominal wall. In general, one could say that the more penetrating the fixation used, the stronger the fixation, but at the cost of increased acute postoperative pain. The occurrence of chronic pain in some patients has led to the search for less permanent penetrating fixation, but without risking a less stable mesh fixation and increased recurrences due to shift or shrinkage of the mesh. Avoiding transfascial sutures by using a double crown of staples has been proposed and recently absorbable fixation devices have been developed. Some surgeons have proposed fixation with glue to reduce the number of staples, or even eliminate them entirely. The continuously increasing multitude of marketed meshes and fixating devices leads to unlimited options in mesh fixation combination and geometry. Therefore, we will never be able to get a clear view on the benefits and pitfalls of every specific combination. Clearance of the anterior abdominal wall from peritoneal fatty tissue and correct positioning of the mesh with ample overlap of the hernia defect are possibly as important as the choice of mesh and fixation. Other topics that are involved in successful outcomes but not addressed in this article are adequate training in the procedure, appropriate selection of patients, and careful adhesiolysis to minimize accidental visceral injuries.

De Backer J.W.,FluidDA | Vos W.G.,FluidDA | Vinchurkar S.C.,FluidDA | Claes R.,University of Antwerp | And 5 more authors.
Radiology | Year: 2010

Purpose: To compare the results obtained by using numerical flow simulations with the results of combined single photon emission computed tomography (SPECT) and computed tomography (CT) and to demonstrate the importance of correct boundary conditions for the numerical methods to account for the large amount of interpatient variability in airway geometry. Materials and Methods: This study was approved by all relevant institutional review boards. All patients gave their signed informed consent. In this study, six patients with mild asthma (three men; three women; overall mean age, 46 years 6 17 [standard deviation ]) underwent CT at functional residual capacity and total lung capacity, as well as SPECT/CT. CT data were used for segmentation and computational fluid dynamics (CFD) simulations. A comparison was made between air-flow distribution, as derived with (a) SPECT/CT through tracer concentration analysis, (b) CT through lobar expansion measurement, and (c) CFD through flow computer simulation. Also, the heterogeneity of the ventilation was examined. Results: Good agreement was found between SPECT/CT, CT, and CFD in terms of airflow distribution and hot spot detection. The average difference for the internal airflow distribution was less than 3% for CFD and CT versus SPECT/CT. Heterogeneity in ventilation patterns could be detected with SPECT/CT and CFD. Conclusion: This results of this study show that patient-specific computer simulations with appropriate boundary conditions yield information that is similar to that obtained with functional imaging tools, such as SPECT/CT. © RSNA, 2010.

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