Gore-tex a magic sheet for symblepharon prevention!

Background: Symblepharon occurs as chronic sequelae of severe chemical injuries. The risk of recurrence is high due to unpredictable wound healing of conjunctiva and tenons following excision in young patients. Gore-tex aids in prevention of the recurrence of pterygium 1. Purpose: To present a surgical video on role of Gore-tex in grade 4 Symblepharon lysis. Synopsis: A 28-year-old male with a previous history of Grade 4 chemical injury presented with symblepharon and total obliteration of both upper and lower fornices after one year in the right eye. He underwent symblepharon lysis, Living related conjunctival allograft, Amniotic membrane graft and Gore-tex. The video explains the surgical steps in detail. A 360-degree complete peritomy was done, Symblepharon was released from the corneal surface, and the fibrotic tissue was extensively dissected away from the corneal surface and released into the fornix. Further, cryopreserved AMG was placed over the entire raw ocular surface and sutured to the episclera with glue. Prepared Gore- tex was placed on the superior and inferior fornix and sutured with 10-0 nylon suture. Again, AMG was placed over the Gore-tex in the fornices and covered with glue. A small 2x2mm biopsy of limbal stem cells from the superior limbus was already excised from the fellow eye (CLAG) and then Lr-CLAL was prepared from the patient’s mother. These two grafts were placed on the nasal and temporal bulbar surface over the AMG and sutured to the underlying AMG and the episclera with glue. The entire surface was then covered with the AMG to promote epithelisation. At one month postoperative period, patient had stable ocular surface with intact Limbal conjunctival graft with mild conjunctival recurrence of fibrosis superiorly. Highlights: The video clearly explains the surgical steps of Symblepharon and the benefits of using Gore-tex.

Comparación de recidiva posterior a hernioplastía diafragmática con cierre directo versus colocación de parche / Comparison of recurrence after diaphragmatic hernioplasties with direct closure versus patch placement

Resumen Objetivo: Investigar con cuál técnica quirúrgica, cierre directo o con parche de Goretex, las hernias diafragmáticas congénitas operadas tienen más recidiva. Metodología: Los datos de los pacientes sometidos a reparación por hernia diafragmática congénita en el Hospital Nacional de Niños, entre enero 2008 y el 31 diciembre de 2017, fueron revisados retrospectivamente. De los 94 pacientes, solo 59 cumplen con los criterios de inclusión. Para la comparación de las variables cuantitativas se empleó pruebas de T de Student e intervalos de confianza al 95 %; las variables cualitativas se analizaron por la prueba de Fisher con un nivel de significancia de 0,05. Resultados: La mayoría de las hernias diafragmáticas operadas fueron izquierdas (78 %) y posterolaterales (91 %). La técnica de reparación más frecuente utilizada fue el cierre directo (68%). Hubo más recidivas posteriores a cierre con parche de Goretex. Se presentaron entre 1 y 12 meses postoperatorio. No hubo diferencia estadísticamente significativa entre recidivas con técnica de cierre directo versus cierre con parche de Goretex. Conclusión: Realizar un cierre directo del diafragma es una buena opción quirúrgica para reparación de hernia diafragmática congénita. No hubo en este estudio diferencias estadísticamente significativas en cuanto a recidiva entre utilizar técnica con cierre directo o con parche.

Abstract Objective: To investigate with which surgical technique, direct closure or use of a Goretex patch, congenital diaphragmatic hernias recurre more. Methodology: The data of the patients who underwent repair of congenital diaphragmatic hernia at the National Children's Hospital from January 2008 to December 31, 2017, were reviewed retrospectively. Of the 94 patients, only 59 met the inclusion criteria. For the comparison of the quantitative variables, Student's t-test and 95% confidence intervals were used, the qualitative variables were analyzed by the Fisher's test with a significance level of 0.05. Results: Most of the operated diaphragmatic hernias were left 78% and posterolateral 91%. The most frequent repair technique used was direct closure, 68%. There were more recurrences after closing when a Goretex patch was used. They occurred between 1 and 12 months post-operatively. There was no statistically significant difference between recurrences with the direct closure technique versus closure with the Goretexpatch. Conclusion: Performing a direct closure of the diaphragm is a good surgical option for surgical repair of congenital diaphragmatic hernias. There were no statistically significant differences in relapse in this study between using the direct closure or patch technique.

Gore-Tex Medialisation Thyroplasty for Unilateral Vocal Cord Palsy: A Tertiary Centre 7 Years Experience

The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods: Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord palsy at our institution and medical records were retrospectively reviewed. Results: There were 18 males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration which would otherwise be disabling for the patients.

Voice outcome after gore-tex medialization thyroplasty

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients andmore extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Aplicaciones del gore-tex en oftalmología / Applications of gore-tex in ophthalmology

OBJETIVO: evaluar los resultados terapéuticos en la corrección quirúrgica de afecciones oculares, con el uso del Gore-tex y con la modificación realizada a la técnica quirúrgica convencional de la suspensión al frontal. MÉTODOS: se realizó un estudio descriptivo prospectivo en una serie de 16 casos: 7 con ptosis, 5 con estrabismo y 4 con retracción palpebral inferior. Para la corrección de la retracción y la ptosis se utilizaron fragmentos del referido material y una sutura de Gore-tex en la corrección del estrabismo y en algunos casos con ptosis. Se colocaron 2 mm de Gore-tex por cada milímetro de retracción y de ptosis palpebral. Se corrigieron 2 dioptrías prismáticas por cada milímetro de retroinserción del músculo afectado. RESULTADOS: fueron satisfactorios en un total de 13 casos (87 %). La mayoría de los pacientes operados con la modificación realizada a la técnica de la suspensión al frontal disminuyeron los mm de caída hasta el nivel fisiológico palpebral. CONCLUSIONES: los resultados son satisfactorios en la mayoría de los casos operados con el uso del Gore-tex y con la técnica de suspensión al frontal modificada. .

OBJECTIVE: to evaluate the therapeutic results in the surgical correction of eye illnesses, with Gore-tex and with the modified conventional surgical technique of the frontalis suspension. METHODS: prospective and descriptive study in a series of 16 cases; 7 with ptosis, 5 with strabismus and 4 with inferior palpebral retraction. For the correction of the retraction and the ptosis, some Gore-tex fragments were used, and suture with this material for correction of strabismus and in some cases with ptosis. Two Gore-tex mm were placed per each mm of retraction and ptosis. Two prismatic dioptries were corrected per each mm of retroinsertion of the frontalis muscle. RESULTS: a total of 13 cases (87 %) had satisfactory results. Most of the patients operated on with the modified frontal suspension technique, reduced the amount of ptosis mm up to the palpebral physiological level. CONCLUSIONS: the results were satisfactory in most of the operated patients by using the Gore-tex and the modified frontalis suspension technique.

Alveolar Ridge Augmentation Using Titanium Reinforced Goretex (TRG) and Titanium Mesh in Severe Alveolar Bone Loss Area: Case Report

Usefulness of Preoperative Preparation in Using Gore-Tex / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gore-Tex is a popular graft material used in rhinoplasty. But there are several complications such as infection, seroma, and persistent swelling. Infection is the most common complication. The aim of this study was the evaluation of various protocols for Gore-Tex decontamination. SUBJECTS AND METHOD: Gore-Tex specimens were sectioned and separated into six groups. These were treated with povidone-iodine or antibiotics solution. Nasal cavity swab was performed both in the control group and patient group of chronic sinusitis. The culture of swab specimens incubated in agar plates were compared statistically. RESULTS: Povidone-iodine groups revealed significant decrease in the bacterial colony counts. CONCLUSION: The results suggested that impregnation of povidone-iodine supports the efficacy of decontamination Gore-Tex Implant.

A Case of Revision Augmentation Rhinoplasty with Dermofat Graft: 2 Years Follow-up Result

Many allograft materials have been used for performing augmentation rhinoplasty. But in cases involving complications such as infection, inflammation and foreign body reaction, these should be removed and replaced with an autograft material which is more suitable for revision surgery. Frequently, the use of autograft materials, including bone and cartilage, are restricted by many limitations such as unavailability, insufficiency in volume, and resorption. By using the dermofat, however, we achieved good surgical results in revision rhinoplasty from the aspect of volume and donor site morbidity. Thus, we report this case with a review of the literature.

A study on the biodegradable novel chitosan nanofiber membrane as a possible tool for guided bone regeneration / 대한치주과학회지

Chitosan has been widely researched as bone substitution materials and membranes in orthopedic/periodontal applications. Chitosan nanofiber membrane was fabricated by chitosan nanofiber using electrospinning technique. The structure of the membrane is nonwoven, three-dimensional, porous, and nanoscale fiber-based matrix. The aim of this study was to evaluate the biocompatibility of chitosan nanofiber membrane and to evaluate its capacity of bone regeneration in rabbit calvarial defect. Ten mm diameter round cranial defects were made and covered by 2 kinds of membranes (Gore-Tex membrane, chitosan nanofiber membrane) in rabbits. Animals were sacrificed at 4 weeks after surgery. Decalcified specimens were prepared and observed by microscope. Chitosan nanofiber membrane maintained its shape and space at 4 weeks. No inflammatory cells were seen on the surface of the membrane. In calvarial defects, new bone bridges were formed at all defect areas and fused to original old bone. No distortion and resorption was observed in the grafted chitosan nanofiber membrane. However bone bridge formation and new bone formation at the center of the defect could not be seen in Gore-Tex membranes. It is concluded that the novel membrane made of chitosan nanofiber by electrospinning technique may be used as a possible tool for guided bone regeneration.

Multicenter Evaluation on the Safety of Gore-Tex as an Implant in Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.

Nasal augmentation using goretex

A case of abdominal sacral colpopexy with use of GORE-TEX graft for vaginal vault prolapse after total hysterectomy / 대한산부인과학회잡지

Post-hysterectomy vaginal vault prolapse is rare complication. There are many surgical procedures to correct this problem. But abdominal colposacropexy, using Marlex mesh or Gore-Tex graft is standard procedure. We experienced one case who had repair of post-hysterectomy vaginal vault prolapse by transabdominal sacral colpopexy using Gore-Tex graft and report with brief review of literatures.

Biologic changes of implants and grafts in rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An array of materials have been used for rhinoplasty, however, the fate of these materials after rhinoplasty is not all clear. This study was performed to find post-operative gross and microscopic changes of the implants and grafts (cartilage, Gore-Tex , and Alloderm), and to guide selection of implants and graft. MATERIALS AND METHODS: We took the implants and grafts out from nine patients who underwent revision rhinoplasty for cosmetic problems, and studied gross and microscopic charaterizations. RESULTS: Autologous cartilages showed minor volume reduction and remodeling in gross examination, and mild degeneration, peripheral fibrosis, and fibroblast in-growth without inflammation under microscopic examination. Gore-Tex , which was a little difficulty to remove, had good volume preservation with focal in-growth of fibroblasts and inflammatory cells. A gross examination of Alloderm showed preserved volume, but thin, soft and weak appearance. A microscopic examination of Alloderm showed well preserved collagen materials without inflammation. CONCLUSIONS: Cartilages have good biocompatibility and stabilization, but it is necessary to study absorption and remodeling. We found that Gore-Tex is a good volume filler for dorsal augmentation, whereas Alloderm is a good material for camouflage.

The Clinical Use of Various Nasal Implants in Rhinoplasty

From an aesthetic surgical point of view, rhinoplasty is one of most important field. The nose of asian is characterized by thin and weak nasal septal cartilage, wide and small alar cartilage, bulbous nasal tip due to excessive fibrous tissue and thick skin. Conventional rhinoplasty is not enough to get a satisfactory result. In order to produce optimal nasal shape, it is extremely important to augment the tip along with nasal dorsum in most of the patients. From March of 1997 to June of 1999, total 162 patient underwent open rhinoplasty with various nasal implants. Surgical approach was done through the transcolumella incision and alar rim incision. The nasal dorsum was augmented with silicone implant, and columella shape was controlled by 0.85-mm thickness porous high-density polyethylene sheet(Medpor). Porous high-density polyethylene sheet was 4mm width and was placed between the medial crura. The nasal tip was corrected by Polytetrafluoroethylene(Gore-Tex) implant. Reverse pyramidal shaped onlay graft of Polytetrafluoroethylene(Gore-Tex"") implant was not palpable on nasal tip skin. We obtained harmonious nasal shape and high patient satisfaction. There was two infection and one exposure of Polytetra- fluoroethylene(Gore-Tex) implant, but there was no other major complications. We believe that this method is stable, reliable, predictable, valuable technique for rhinoplasty, but we think that further follow up and study are needed.

Histomorphometric Study of Tissue Reaction of Gore-Tex Implant in the Rat Model

To reconstruct the defect caused by losses of bone, cartilage and soft tissue, either autogenous tissue or alloplastic material can be used. Although the autogenous tissue is ideal choice for their reconstruction, the availability and problems associated with donor site morbidity limit its usage. Therefore the alloplastic material have been used widely for tissue replacement. Many synthetic material have been developed for alloplasty; among these, the silicone has been the most popular alloplastic material for plastic surgeon. Inherent problem related to the use of silicone are infection, exposure, implant migration, capsular formation, and poor penetration of bone or soft tissue into the implant. To solve these problems, many effort have been made. From 1970s the porous high density polyethylene(HDPE, Medpor) and expanded polytetrafluorethylene(Gore-Tex), which are porous substance, have been used because those have the advantage of less implant migration by the penetration of connective tissue into the pore, less capsule formation and reduced chance of infection due to high vascularity. The purpose of this study is to compare the tissue reaction of silicone and Medpor with that of Gore-Tex in rats. The 1.0 cm sized square shape plate of silicone, Medpor and Gore-Tex were implanted in the back of rat and bloc tissue specimen were obtained including the implant and their surrounding capsule in 4, 8, 12 weeks after implantation. The specimen were examined grossly and microscopically. The microscopic slide were prepared with H-E and Masson's trichrome stain. Grossly the capsule around the silicone rubber was easily peel off while the capsules around Medpor was strongly adherent to implant and that of Gore-Tex was mildly adherent to implant. Under microscope, the thickness of capsule were compared. 1he capsule of those implants were thicker in 4 weeks then 8, 12 weeks. The capsule of silicone were significant thicker than Medpor and Gore-Tex in 4 weeks (274.8+ 35.1 um vs 119.8+23.2um vs 177.2+27.9 um). Histologically the capsule of silicone and Gore-Tex consist of denser connective tissue and showed lesser foreign body reaction than Medpor. Many multinucleated giant cells were found around the Medpor, while none of them were found around silicone and Gore-Tex. The capsule of Medpor showed more new capillary formation than silicone due to tissue ingrowth into the pore in the implant material so Medpor fixed hardly around the soft tissue and was impossible to remove. But Gore-Tex, that is microporous alloplastic material, have less capsular formation, less foreign body reaction and limited tissue ingrowth and stabilization of implant while at the same time permitting easy removal when necessary. From this study the Gore-tex will be useful alloplastic material in clinical usage by virtue of limited tissue ingrowth and decreased chance of infection, implant migration and capsular formation.

Use of Gore-Tex in Bleb Revision after Trabeculectomy with Mitomycin

Trabeculectomy, as a surgical intervention in the treatment of glaucoma, has become most popular. The most common cause of filtration failure is obstruction of aqueous outflow due to bleb fibrosis. Adjunctive intraoperative mitomycin-C has been reported to improve the success of filtration surgery in eyes of high risk for failure. But its use increases the rate of complications after filtering surgery: especially postoperative hypotony, wound leakage, and scleral necrosis. We have experienced two patients whose scleral flaps were necrotized after trabeculectomy with mitomycin-C in uncomplicated glaucoma. We report successful results in revision of filtering bleb by using Gore-Tex as a patch graft.

The Successfully Redoaugmentation of Budd-Chiari Syndrome with Using Gore-Tex Patch of the IVC Obstruction / 대한흉부외과학회지

Budd-Chiari syndrome is a state of hepatic failure caused by impairment of blood flow anywhere from the inferior vena cava to the right atrium. In this case, a 45 year old patient had undergone membranotomy and dilatation with autogenous pericardial graft due to obstruction of the inferior vena cava caused by a congenital membrane in 1987. Ten years after the operation, restenosis occurred. Although a noninvasive method with a Gianturco stent dilatation was performed, a satisfactory result was not obtained. A reoperation was performed. The stenotic segment of inferior vena cava was excised and after augmentation with a prepared pentagon shaped Gore-Tex artificial graft allowing passage of two fingers. The patient's postoperative course was uneventful without signs of rebleeding or any other complications and the patient was discharged at postoperative two weeks without the use of anticoagulants. An excellent result was obtainable after operation using a prepared Gore-Tex graft and such a result. Reoperational case of Budd-Chiari syndrome may require rapid and excellent the operative techenic by prevention of massive bleeding under use of extracorporeal circulation.

Application of Goretex to Reconstruct Protrusion of the Prosthesis against Thin Tunicae Albuginea after Hydroflex Penile Prosthesis / 대한비뇨기과학회지

We recently experienced a case of protrusion of the penile prosthesis against thin tunicae albuginea after Hydroflex penile prosthesis in a 30-year-old man having neurogenic and vasculogenic impotence associated with urethral injury. The thin tunicae albuginea were reconstructed by application of Goretex.

Microvascular Polytetrafluoroethylene Graft in the Rat

With the recent advancement in the field of microvascular surgery, the demand for a microvascular prosthesis of 1-2 mm diameter has been increasing. The authors attempted to insert a Gore-tex graft of 1 mm inner diameter to the rat aorta and renal artery with different techniques and different suture materials. The telescoped technique was utilized for the anastomosis of the proximal part of the artery. They showed 80% patency of grafts up to 116 days with 10-0 ethilon and 83% patency up to 96 days with 7-0 silk in the rat aorta. In the rat renal artery, they showed 53.3% patency with 10-0 ethilon. These results showed that Gore-tex grafts of a 1 mm inner diameter could be used for microvascular reconstructions but further laboratory experimentation is needed before clinical application.