Search Results (27)

Chitosan hydrogels are effective wound dressings that promote healing through the synergy of chitosan’s inherent biological properties and the moist environment they maintain. We previously developed hydrogel microparticles using a highly biocompatible chitosan derivative with superior therapeutic effects. This study aimed to enhance their clinical translation for Endoscopic Sinus Surgery (ESS) by optimizing preparation conditions to achieve an extrusion force of <20 N, facilitating ergonomic, single-handed administration by surgeons. While reducing the particle size alone was insufficient to lower the extrusion force significantly, the introduction of a mechanical “kneading” process to de-agglomerate microparticle aggregates resulted in a substantial reduction in the required force from 213 ± 80 N to approximately 47 N. By further optimizing the polymer concentration to 5.0% (w/v), we successfully reduced the maximum extrusion force to below 20 N (17 ± 1 N). These results demonstrate that the optimized injectable chitosan gel microparticles achieve the practical usability required for precise surgical maneuvers during ESS. Full article

Traditional surgical techniques are based on the manual application of force using mallets and osteotomes, which often result in uncontrolled impact forces, procedural inconsistencies, and patient discomfort. Magnetic mallets (MMs), magnetodynamic devices, provide a controlled application of force using electromagnetism, aiming to achieve greater precision, reduced operating time, and improved surgical outcomes. The aim of the present systematic review was to evaluate the effectiveness of MMs compared to conventional surgical techniques in oral and implant surgery. The focused question was as follows: “Do magnetic mallets improve clinical outcomes in oral and implant surgery compared to traditional instruments?” Only clinical studies comparing the use of MMs with traditional techniques in oral surgery were included. The following databases were searched up to 27 November 2025: Pubmed, Scopus, Web of Science. For quality assessment, the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized controlled trials (RCTs), while the Newcastle–Ottawa Scale (NOS) was used for non-randomized studies. Data were screened and synthesized by two reviewers. The systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. In total, 347 studies were initially found and 6 matched the inclusion criteria and were included in the review, for a total of 282 patients. Five RCTs were included, as well as one retrospective study. The studies investigated were as follows: implant site preparation (two studies with a total of 86 patients), sinus lift and contextual implant insertion (three studies, total: 102 patients), dental extraction (two studies, total: 70 patients), and split-crest (one study with 46 patients). The outcomes suggest that MMs may serve as a potential alternative to traditional techniques, exhibiting promising although preliminary outcomes. The studies included reported a lower incidence of benign paroxysmal positional vertigo with the use of MMs compared to hand osteotomes. Regarding quality assessment, RCTs raised some concerns, while the retrospective study had a moderate risk of bias. Despite the promising results, the paucity of high-quality controlled trials limits definitive conclusions on the superiority of MM over conventional techniques. Further well-designed comparative trials are needed to confirm the clinical benefits, optimize protocols across different indications, and evaluate MMs’ potential role in the management of critical bone conditions and complex surgery. Full article

Surgical Site Infection (SSI) can be a devastating complication, leading to increased morbidity, mortality, and healthcare costs. Pre-surgical hand preparation is an effective strategy to prevent SSI. The two most common pre-surgical hand preparation methods are antimicrobial soap for surgical hand scrub and alcohol-based surgical hand rub. The antimicrobial soap hand scrub remains more commonly used among operating theater staff. However, several studies showed that alcohol-based hand rubs are much more effective than antiseptic soap hand scrubs. Objective: This study aimed to compare the effect of the two methods of surgical hand preparation on the number of bacterial colonies. Methods: The design of this study was a comparative study with a pre-test and post-test approach in two groups (a surgical hand scrub using 4% chlorhexidine soap group and a surgical hand rub using 70% ethyl alcohol and 2.5% chlorhexidine group). Hand smear sampling was performed before surgical hand preparation (pre-test), immediately after surgical hand preparation (post-test 1), and after the surgery was completed (post-test 2). Seventy-one hand smear samples (35 samples applied the surgical hand rub, and 36 samples applied the surgical hand scrub) were divided into two groups and examined for colony counts in Colony Forming Units (CFU) using the total plate count method. Descriptive and comparative analysis were applied. Results: The surgical hand-scrub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.202 CFU/cm², 0.007 CFU/cm², and 0.016 CFU/cm², respectively, while the surgical hand-rub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.163 CFU/cm², 0.001 CFU/cm², and 0.001 CFU/cm² respectively. Statistical analysis using the Friedman test showed that both methods significantly reduced the number of colonies (p < 0.01). Based on the Mann–Whitney test, there was no significant difference between the two groups regarding the number of colonies (p > 0.05). Conclusions: Surgical hand-scrub and hand-rub have similar effectiveness in reducing and maintaining the number of colonies on hands during surgery, both gram-positive and gram-negative bacteria. Full article

Background/Objectives: It is essential that dental school graduates are adequately prepared to provide care to patients with craniofacial differences (PCD). This study aimed to identify potential educational deficiencies in predoctoral dental school curricula regarding the management of PCD. Methods: An electronic survey was distributed to predoctoral dental students across the United States. The 20-item questionnaire assessed students’ educational experiences, clinical encounters, and perceived knowledge and confidence in managing PCD. Results: The most taught didactic topic was diagnostic characteristics of craniofacial differences (77.1%), followed by psychosocial challenges (43.0%) and treatment/referral (36.3%). Respondents reported low levels of understanding and confidence in managing craniofacial conditions, with the lowest confidence in providing surgical treatment (30.1 ± 27.9) and the highest in referrals and communication (41.7 ± 30.1, on a 0–100 scale). Logistic regression showed that overall understanding was a significant predictor of confidence, increasing odds by 8% (OR = 1.08, 95% CI 1.05, 1.12). Participants noted that hands-on clinical experience would most improve their confidence in managing PCD. Conclusions: Predoctoral dental students exhibit low confidence and understanding in managing PCD. Incorporating more targeted craniofacial education, particularly hands-on clinical experience, into the curriculum is essential to better prepare dental graduates for craniofacial care. Full article

Objective: Frontal sinus surgery is still challenging for surgeons; the frontal osteotomy with the preparation of a frontal bone flap to access the sinus is usually hand-crafted by experienced surgeons. The objective of our study is to present a fully digital protocol for the manufacturing of “in-house” surgical cutting guides, customized to the patient’s anatomy, to perform precise frontal sinus osteotomy, showing the costs, times, and intraoperative complications reduction. Materials and Methods: A prospective study was conducted on 12 patients with complex pathologies involving the frontal sinus who underwent frontal sinus osteotomy in the Maxillofacial Surgery Unit of the Federico II University of Naples, from January 2021 to April 2025, considering the last surgery in November 2023. The same digital protocol to manufacture the surgical cutting guide was used for all the 12 patients. The first step was to upload the preoperative CT images in DICOM format to the software Mimics Medical to perform a rapid segmentation of the skull region of interest to create a 3D object and to identify the frontal sinus margins and the osteotomy lines. The second step was to realize the surgical cutting guide, incorporating the design of titanium plates to fix onto the skull in order to make a precise osteotomy. The final digital step was to export the cutting guide 3D object in the software “Formlab-Form 3B” to print the model with a specific resin. The model was then used during the surgery to perform the precise frontal osteotomy by piezo surgery. The clinical outcomes, in terms of complications and recurrences, were then recorded. Results: In all the patients, no intraoperative complications occurred; the median follow-up was 31.7 months and at one year of follow-up only one patient experienced a recurrence. The mean operative time was about 4 h, with a frontal osteotomy time of about 23 min. Digital protocol time was about 4 h while printing times were between 2 and 4 h. Conclusions: This “in-house” protocol seems to demonstrate that the use of intraoperative templates for the realization of the frontal sinus osteotomy reduces preoperative and intraoperative costs and times, reducing the risk of intraoperative complications, and also allows less experienced surgeons to perform the procedure safely. Obviously, this study is to be considered a “pilot study”, and other studies with large cohorts of patients will have to confirm these promising results. Full article

Background/Objectives: Integra Dermal Regeneration Template (IDRT) has emerged as a viable reconstructive option in exposed avascular structures, such as exposed bone devoid of periosteum. This systematic review aimed at examining success rates by comparing different wound types and their characteristics, as well as the surgical methods involved. Methods: A systematic review was conducted to identify studies using IDRT in the reconstruction of defects with exposed bone devoid of periosteum. Primary outcomes of interest were IDRT and skin graft success rates, followed by patient and wound characteristics, and different surgical methods used. The results were accompanied by an illustrative case report of IDRT-based hand reconstruction after a deep burn injury. Results: The review included 40 studies, with a total of 202 individual defects. The primary indication for IDRT-based reconstruction was post-oncologic defects in the elderly population. Although surgeons mostly used burring/fenestration as a bone preparation method prior to IDRT placement, decorticated bones showed faster grafting time (23.8 vs. 27.9 days). The average success rate of IDRT was 87.54% (±25.9), with an excellent IDRT take rate (100%) observed in more than 50% of cases. In the majority of cases (95.5%), the skin graft acceptance rate was deemed to be higher than 95%, with an average graft take of 98.8%. Conclusions: The results of this review support the use of IDRT in managing complex defects involving exposed bone, offering fast coverage with good functional restoration, without any donor site morbidity. Additionally, bone preparation methods also play an important role in IDRT-based reconstruction by shortening the grafting time. Full article

Introduction: The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has revolutionized outpatient hand surgery, enabling procedures such as carpal tunnel release and trigger finger release without a tourniquet. Its benefits include patient cooperation during surgery, especially for tendon repairs. However, WALANT has limitations, including a steep learning curve, longer operative preparation time, and risks such as digital ischemia and adrenaline-induced cardiac ischemia. This study evaluates the safety and effectiveness of local anesthesia with a tourniquet for short-duration outpatient hand surgeries. Materials and Methods: This case series included 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024. Local anesthesia with lidocaine was administered, and a tourniquet was applied to the proximal arm. Demographic data, operative time, and pain levels during tourniquet use (measured by VAS) were recorded. Results: The average surgical time was 12 min. Most procedures involved carpal tunnel release. The average VAS pain score was 3.73, with older patients and longer surgeries reporting higher discomfort. Tourniquet release was required in only 1% of cases due to discomfort. Conclusions: For short outpatient hand surgeries, local anesthesia with a tourniquet is a safe, effective alternative to WALANT, challenging its routine use and highlighting the need for tailored anesthetic approaches. Full article

Background: This study aimed to evaluate the primary stability, according to the insertion torque value (ITV) and resonance frequency analysis (RFA), of dental implants placed in standardized blocks of bone quality equivalent to type II-A bone, using three surgical undersized protocols of 0.2 mm, 0.5 mm, and 0.8 mm, considering different dental implant diameters and lengths. Methods: One hundred and twenty dental implants (DIs) of different diameters (3.5, 3.8, 4.5, and 5.0 mm) and lengths (8.5, 10.0, 11.5, 13.0, and 15.0 mm) placed in polyurethane blocks equivalent to type II-A bone, according to the Lekholm and Zarb classification modified by Rosas et al., were examined with three surgical protocols of under-milling of 0.2, 0.5, and 0.8 mm. The ITV and the RFA were the determinants of primary stability, and their respective values were recorded as Ncm and the implant stability quotient (ISQ) immediately after the placement of the DIs. These were evaluated according to each surgical insertion protocol, length, and diameter of the DI under a multivariate analysis model (MANOVA). Statistical significance was set at p < 0.05. Results: It was observed that the average of the ITV was significantly higher when a 0.8 mm under-milling protocol was used (63.2 ± 14.9 Ncm) (p < 0.001). However, the ITV was significantly lower when a 0.2 mm under-milling protocol was used (25.1 ± 8.3 Ncm) (p < 0.001). On the other hand, the ISQ did not present significant differences (p = 0.166) when comparing the 0.2 (67.6 ISQ ± 5.4 ISQ), 0.5 (65.8 ISQ ± 3.4 ISQ), and 0.8 (65.7 ISQ ± 4.0 ISQ) under-milling protocols in the evaluation of the primary stability of the dental implant. The multivariate effect size (ηp² = 0.639) indicated that the variability detected in the insertion torque and the ISQ, at the same time, was explained by 63.9% (p < 0.001) due only to the compression protocol, while the implant diameter explained this variability by 27.0% (ηp² = 0.270) (p < 0.001) and the implant length only significantly explained this variability by 12.1% (ηp² = 0.121) (p = 0.030). Finally, any interaction between the compression protocol, implant diameter, and length did not influence insertion torque variability or the ISQ (p > 0.05). Conclusions: It can be concluded that when the surgical protocol for subpreparation is optimal according to the prepared bone bed, regardless of the diameter or length of the dental implant used, primary stability was assured according to the ITV and the RFA in 63.9%. This finding allows us to recommend carrying out a correct analysis of bone quality in order to subsequently select the most appropriate surgical protocol for the subpreparation of the bone bed to achieve better primary stability of the dental implant. Full article

Thumb carpometacarpal arthroplasty has become a widely used standard technique in the surgical treatment of thumb carpometacarpal osteoarthritis. One of the most critical steps during this procedure is proper surgical exposure of the trapezium and the base of the first metacarpal to allow for prosthesis implantation. This article introduces a surgical technique in which a roll constructed from gauze sponges tightly wrapped with medical tape facilitates several steps in thumb carpometacarpal arthroplasty. While performing a dorsoradial approach to the thumb carpometacarpal joint, this cost-effective tool is perfectly tailored to the joint’s unique anatomy. It aids in precise hand positioning and ensures optimal exposure of the trapezium and base of the first metacarpal, which is crucial for accurate cup and stem preparation as well as for unimpeded prosthesis implantation. Full article

Hydroxyapatite (HAp) is a widely used biocompatible material in orthopedic composite preparations. However, HAp composites that exhibit both anticancer and antibacterial activities through bioactive coordination complexes are relatively rare. To explore orthopedic applications, we blended several silver camphorimine compounds with HAp to create [Ag(I)] composites. All compounds [Ag(NO₃)(L)_n] (n = 1,2) based on camphorimine (L^A), camphor sulfonimine (L^B) or imine bi-camphor (L^C) ligands demonstrated significant cytotoxic activity (IC₅₀ = 0.30–2.6 μg_Ag/mL) against osteosarcoma cancer cells (HOS). Based on their structural and electronic characteristics, four complexes (1–4) were selected for antibacterial evaluation against Escherichia coli, Burkholderia contaminans, Pseudomonas aeruginosa, and Staphylococcus aureus. All complexes (1–4) revealed combined anticancer and antibacterial activities; therefore, they were used to prepare [Ag(I)]:HAp composites of 50:50% and 20:80% weight compositions and the activities of the composites were assessed. Results showed that they retain the dual anticancer and antibacterial characteristics of their precursor complexes. To replicate the clinical context of bone-filling applications, hand-pressed surfaces (pellets) were prepared. It is worth highlighting that no agglutination agent was necessary for the pellet’s consistency. The biological properties of the so-prepared pellets were assessed, and the HOS cells and bacteria spreading on the pellet’s surface were analyzed by SEM. Notably, composite 4B, derived from the bicamphor (L^C) complex [Ag(NO₃)(OC₁₀H₁₄N(C₆H₄)₂NC₁₀H₁₄O)], exhibited significant anticancer activity against HOS cells and antibacterial activity against P. aeruginosa, fostering potential clinical applications on post-surgical OS treatment. Full article

Despite the advantages of surgical handrub in terms of the ease of application and effectiveness, chlorhexidine (CHG)-based hand scrubbing remains the preferred method for surgical hand preparation. However, it does not systematically meet the non-inferiority requirement of the European norm (EN) 12791 with respect to n-propanol (the reference product) and does not provide the sustained efficacy expected for these long-lasting agents. Commercially available alcohol-based products have also failed to demonstrate sustained efficacy according to EN 12791. Multi-step protocols enhance the efficacy of hand scrubbing, yet their extended disinfection duration might diminish their allure for healthcare professionals. In this study, we show that hand scrubbing with CHG 4% followed by a 1 min rubbing with the novel formulation of ethanol (Et) 70%/CHG 3% plus 0.3% potassium sorbate food additive (PS) meets the non-inferiority requirement and demonstrates sustained efficacy when tested according to EN 12791. The immediate and 3 h effect of this protocol was significantly higher than that of n-propanol and the homologous disinfection protocol without PS (CHG 4% hand scrub plus Et 70%/CHG 3% rub), demonstrating that the inclusion of PS confers a notable residual effect. We speculate that this non-volatile ingredient acts synergistically with CHG. This promising combination represents an alternative method for the development of new disinfection strategies. Full article

This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens (n = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time. Full article

The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical and partial nephrectomy procedures that demand extensive training and planning. Furthermore, artificial intelligence (AI) can potentially aid the training process in the field of kidney cancer. This review explores how artificial intelligence (AI) can create a framework for kidney cancer surgery to address training difficulties. Following PRISMA 2020 criteria, an exhaustive search of PubMed and SCOPUS databases was conducted without any filters or restrictions. Inclusion criteria encompassed original English articles focusing on AI’s role in kidney cancer surgical training. On the other hand, all non-original articles and articles published in any language other than English were excluded. Two independent reviewers assessed the articles, with a third party settling any disagreement. Study specifics, AI tools, methodologies, endpoints, and outcomes were extracted by the same authors. The Oxford Center for Evidence-Based Medicine’s evidence levels were employed to assess the studies. Out of 468 identified records, 14 eligible studies were selected. Potential AI applications in kidney cancer surgical training include analyzing surgical workflow, annotating instruments, identifying tissues, and 3D reconstruction. AI is capable of appraising surgical skills, including the identification of procedural steps and instrument tracking. While AI and augmented reality (AR) enhance training, challenges persist in real-time tracking and registration. The utilization of AI-driven 3D reconstruction proves beneficial for intraoperative guidance and preoperative preparation. Artificial intelligence (AI) shows potential for advancing surgical training by providing unbiased evaluations, personalized feedback, and enhanced learning processes. Yet challenges such as consistent metric measurement, ethical concerns, and data privacy must be addressed. The integration of AI into kidney cancer surgical training offers solutions to training difficulties and a boost to surgical education. However, to fully harness its potential, additional studies are imperative. Full article

Hand tendon/ligament structural ruptures (tears, lacerations) often require surgical reconstruction and grafting, for the restauration of finger mechanical functions. Clinical-grade human primary progenitor tenocytes (FE002 cryopreserved progenitor cell source) have been previously proposed for diversified therapeutic uses within allogeneic tissue engineering and regenerative medicine applications. The aim of this study was to establish bioengineering and surgical proofs-of-concept for an artificial graft (Neoligaments Infinity-Lock 3 device) bearing cultured and viable FE002 primary progenitor tenocytes. Technical optimization and in vitro validation work showed that the combined preparations could be rapidly obtained (dynamic cell seeding of 10⁵ cells/cm of scaffold, 7 days of co-culture). The studied standardized transplants presented homogeneous cellular colonization in vitro (cellular alignment/coating along the scaffold fibers) and other critical functional attributes (tendon extracellular matrix component such as collagen I and aggrecan synthesis/deposition along the scaffold fibers). Notably, major safety- and functionality-related parameters/attributes of the FE002 cells/finished combination products were compiled and set forth (telomerase activity, adhesion and biological coating potentials). A two-part human cadaveric study enabled to establish clinical protocols for hand ligament cell-assisted surgery (ligamento-suspension plasty after trapeziectomy, thumb metacarpo-phalangeal ulnar collateral ligamentoplasty). Importantly, the aggregated experimental results clearly confirmed that functional and clinically usable allogeneic cell-scaffold combination products could be rapidly and robustly prepared for bio-enhanced hand ligament reconstruction. Major advantages of the considered bioengineered graft were discussed in light of existing clinical protocols based on autologous tenocyte transplantation. Overall, this study established proofs-of-concept for the translational development of a functional tissue engineering protocol in allogeneic musculoskeletal regenerative medicine, in view of a pilot clinical trial. Full article

Purpose: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons’ perceptions of robot-assisted epiretinal membrane peeling (RA-MP). Methods: We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. Results: RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36–65) min. Task III had a mean time of 72.4 (range of 57–100) min. A mean time of 27.9 (range of 9–46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. Conclusions: A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP. Full article