[Improving the biocompatibility of silicone implants using spider silk coatings: immunohistochemical analysis of capsule formation]. / Verbesserung der Biokompatibilität von Silikonimplantaten durch Spinnenseidenbeschichtung: Immunhistochemische Untersuchungen zum Einfluss auf die Kapselbildung.

INTRODUCTION: Optimisation of the biocompatibility of silicone implants and reduction of capsule formation around the surface of such implants are in the focus of plastic surgical biomaterial research. In addition to its extraordinary physical and biochemical properties, spider silk shows high biocompatibility. Therefore, the coating of silicone implant surfaces with recombinant spider silk was analysed regarding foreign body reactions. MATERIALS AND METHODS: In the context of a preclinical study, miniaturised silicone implants were implanted in the back of 60 Sprague-Dawley rats. The animals were randomised; 30 animals received a texturised implant coated with the recombinant spider silk protein eADF4(C16) and 30 animals received uncoated implants. 3, 6 and 12 months after implantation, implants together with the surrounding capsules were removed and submitted to histological and immunohistochemical assessment. RESULTS: Coating of silicone implants with the recombinant spider silk protein eADF4(C16) resulted in a delayed and significantly decreased foreign body reaction and a reduced capsule manifestation. CONCLUSION: eADF4(C16) seems to be a promising candidate for the reduction of foreign body-associated capsule formation. Moreover, coating of other medical implants with this recombinant spider silk protein may improve their biocompatibility with little additional effort.

[Midcarpal arthrodesis with cortical bolting chip for treatment of grade II/III scaphoid non-union and scapholunate advanced collapse]. / Mediokarpale Teilarthrodese mit kortikospongiösem Beckenkammspan zur Behandlung des karpalen Kollaps im Stadium II/III nach Skaphoidpseudarthrose oder skapholunärer Dissoziation.

INTRODUCTION: These case reports describe a mediocarpal arthrodesis with excision of the scaphoid using a cortical bolting chip and screw fixation instead of the use of Kirschner wires or Spider plates. METHODS: Four patients with a symptomatic SLAC/SLAC-wrist >or= grade II were treated. The evaluation occurred six months later. For the evaluation the Cooney and Bussey as well as DASH scores were used (pain, strength, range of motion, functional status, possible limitations of quality of life, subjective perception of the patient). The radiological evaluation was performed by conventional wrist X-ray in two projections. RESULTS: All patients were pain-free after the operation. From the radiological point of view a complete osseous consolidation has set in. The mean strength six months after surgical intervention was 53 % (preoperative 52 %) and the total range of motion 47 % (preoperative 59 %) compared to the opposite side. The Cooney and Bussey scores were at 69 (+ 25 %) and the DASH score at 44 (- 28 %) points. CONCLUSIONS: In case of an SNAC/SLAC-wrist a motion-preserving operation should always be given preference to a wrist stiffening procedure. The modified mid-carpal partial arthrodesis is an alternative operating procedure for the treatment of SNAC/SLAC-wrists in stage II/III. However, a higher number of cases and comparative studies are needed to confirm this concept.