Skip to main content
Erschienen in: Journal of Artificial Organs 1/2015

01.03.2015 | Original Article

In situ observation and enhancement of leaflet tissue formation in bioprosthetic “biovalve”

verfasst von: Marina Funayama, Yoshiaki Takewa, Tomonori Oie, Yuichi Matsui, Eisuke Tatsumi, Yasuhide Nakayama

Erschienen in: Journal of Artificial Organs | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Abstract

Biovalves, autologous tri-leaflet valved conduits, are formed in the subcutaneous spaces of animals. The valves are formed using molds encapsulated with autologous connective tissues. However, tissue migration into the small apertures in the molds for leaflet formation is generally slower than that for conduit formation around the molds. In this study, the formation of the leaflet tissues was directly and non-invasively observed using a wireless capsule endoscope. The molds were assembled from 6 parts, one of which was impregnated with the endoscope, and embedded into subcutaneous pouches in goats (n = 30). Tissue ingrowth into the apertures gradually occurred from the edges of the leaflet parts. Tissue formation was accompanied by capillary formation. At 63.1 ± 17.1 days after embedding, the apertures were completely replaced with autologous connective tissue, forming the leaflet tissues. Leaflet formation was enhanced by including fat tissue (46.7 ± 4.2 days) or blood (41.1 ± 6.9 days) in the apertures before embedding. The creation of slit openings, in conjunction with addition of blood to the apertures, further enhanced leaflet formation (37.0 ± 2.8 days). Since leaflet formation could be observed endoscopically, the appropriate embedding period for complete biovalve formation could be determined.
Literatur
1.
2.
Zurück zum Zitat Schoen FJ, Levy RJ. Calcification of tissue heart valve substitutes: progress toward understanding and prevention. Ann Thorac Surg. 2005;79:1072–80.CrossRefPubMed Schoen FJ, Levy RJ. Calcification of tissue heart valve substitutes: progress toward understanding and prevention. Ann Thorac Surg. 2005;79:1072–80.CrossRefPubMed
3.
Zurück zum Zitat Manji RA, Zhu LF, Nijjar NK, Rayner DC, Korbutt GS, Churchill TA, Rajotte RV, Koshal A, Ross DB. Glutaraldehyde-fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation. 2006;114:318–27.CrossRefPubMed Manji RA, Zhu LF, Nijjar NK, Rayner DC, Korbutt GS, Churchill TA, Rajotte RV, Koshal A, Ross DB. Glutaraldehyde-fixed bioprosthetic heart valve conduits calcify and fail from xenograft rejection. Circulation. 2006;114:318–27.CrossRefPubMed
4.
Zurück zum Zitat Le Tourneau T, Savoye C, McFadden EP, Grandmougin D, Carton HF, Hennequin JL, Dubar A, Fayad G, Warembourg H. Mid-term comparative follow-up after aortic valve replacement with Carpentier-Edwards and Pericarbon pericardial prostheses. Circulation. 1999;100:11–6.CrossRef Le Tourneau T, Savoye C, McFadden EP, Grandmougin D, Carton HF, Hennequin JL, Dubar A, Fayad G, Warembourg H. Mid-term comparative follow-up after aortic valve replacement with Carpentier-Edwards and Pericarbon pericardial prostheses. Circulation. 1999;100:11–6.CrossRef
5.
Zurück zum Zitat Sacks MS, Schoen FJ, Mayer JE. Bioengineering challenges for heart valve tissue engineering. Annu Rev Biomed Eng. 2009;11:289–313.CrossRefPubMed Sacks MS, Schoen FJ, Mayer JE. Bioengineering challenges for heart valve tissue engineering. Annu Rev Biomed Eng. 2009;11:289–313.CrossRefPubMed
6.
Zurück zum Zitat Nakayama Y, Ishibashi-Ueda H, Takamizawa K. In vivo tissue-engineered small-caliber arterial graft prosthesis consisting of autologous tissue (biotube). Cell Transplant. 2004;13:439–49.CrossRefPubMed Nakayama Y, Ishibashi-Ueda H, Takamizawa K. In vivo tissue-engineered small-caliber arterial graft prosthesis consisting of autologous tissue (biotube). Cell Transplant. 2004;13:439–49.CrossRefPubMed
7.
Zurück zum Zitat Hayashida K, Kanda K, Yaku H, Ando J, Nakayama Y. Development of an in vivo tissue-engineered, autologous heart valve (the biovalve): preparation of a prototype model. J Thorac Cardiovasc Surg. 2007;134:152–9.CrossRefPubMed Hayashida K, Kanda K, Yaku H, Ando J, Nakayama Y. Development of an in vivo tissue-engineered, autologous heart valve (the biovalve): preparation of a prototype model. J Thorac Cardiovasc Surg. 2007;134:152–9.CrossRefPubMed
8.
Zurück zum Zitat Hayashida K, Kanda K, Oie T, Okamoto Y, Ishibashi-Ueda H, Onoyama M, Tajikawa T, Ohba K, Yaku H, Nakayama Y. Architecture of an in vivo-tissue engineered autologous conduit “Biovalve”. J Biomed Mater Res B Appl Biomater. 2008;86:1–8.CrossRefPubMed Hayashida K, Kanda K, Oie T, Okamoto Y, Ishibashi-Ueda H, Onoyama M, Tajikawa T, Ohba K, Yaku H, Nakayama Y. Architecture of an in vivo-tissue engineered autologous conduit “Biovalve”. J Biomed Mater Res B Appl Biomater. 2008;86:1–8.CrossRefPubMed
9.
Zurück zum Zitat Yamanami M, Yahata Y, Tajikawa T, Ohba K, Watanabe T, Kanda K, Yaku H, Nakayama Y. Preparation of in vivo tissue-engineered valved conduit with the sinus of Valsalva (type IV biovalve). J Artif Organs. 2010;13:106–12.CrossRefPubMed Yamanami M, Yahata Y, Tajikawa T, Ohba K, Watanabe T, Kanda K, Yaku H, Nakayama Y. Preparation of in vivo tissue-engineered valved conduit with the sinus of Valsalva (type IV biovalve). J Artif Organs. 2010;13:106–12.CrossRefPubMed
10.
Zurück zum Zitat Nakayama Y, Yahata Y, Yamanami M, Tajikawa T, Ohba K, Kanda K, Yaku H. A completely autologous valved conduit prepared in the open form of trileaflets (type VI biovalve): mold design and valve function in vitro. J Biomed Mater Res B Appl Biomater. 2011;99:135–41.CrossRefPubMed Nakayama Y, Yahata Y, Yamanami M, Tajikawa T, Ohba K, Kanda K, Yaku H. A completely autologous valved conduit prepared in the open form of trileaflets (type VI biovalve): mold design and valve function in vitro. J Biomed Mater Res B Appl Biomater. 2011;99:135–41.CrossRefPubMed
11.
Zurück zum Zitat Mizuno T, Takewa Y, Sumikura H, Ohnuma K, Moriwaki T, Yamanami M, Oie T, Tatsumi E, Uechi M, Nakayama Y. Preparation of an autologous heart valve with a stent (stent-biovalve) using the stent eversion method. J Biomed Mater Res B Appl Biomater 2014 (in press). Mizuno T, Takewa Y, Sumikura H, Ohnuma K, Moriwaki T, Yamanami M, Oie T, Tatsumi E, Uechi M, Nakayama Y. Preparation of an autologous heart valve with a stent (stent-biovalve) using the stent eversion method. J Biomed Mater Res B Appl Biomater 2014 (in press).
12.
Zurück zum Zitat Clark RA, Tonnesen MG, Gailit J, Cheresh DA. Transient functional expression of alphaVbeta 3 on vascular cells during wound repair. Am J Pathol. 1996;148:1407–21.PubMedCentralPubMed Clark RA, Tonnesen MG, Gailit J, Cheresh DA. Transient functional expression of alphaVbeta 3 on vascular cells during wound repair. Am J Pathol. 1996;148:1407–21.PubMedCentralPubMed
13.
Zurück zum Zitat Thevenot PT, Baker DW, Weng H, Sun MW, Tang L. The pivotal role of fibrocytes and mast cells in mediating fibrotic reactions to biomaterials. Biomaterials. 2011;32:8394–403.CrossRefPubMedCentralPubMed Thevenot PT, Baker DW, Weng H, Sun MW, Tang L. The pivotal role of fibrocytes and mast cells in mediating fibrotic reactions to biomaterials. Biomaterials. 2011;32:8394–403.CrossRefPubMedCentralPubMed
14.
Zurück zum Zitat Song E, Ouyang N, Hörbelt M, Antus B, Wang M, Exton MS. Influence of alternatively and classically activated macrophages on fibrogenic activities of human fibroblasts. Cell Immunol. 2000;204:19–28.CrossRefPubMed Song E, Ouyang N, Hörbelt M, Antus B, Wang M, Exton MS. Influence of alternatively and classically activated macrophages on fibrogenic activities of human fibroblasts. Cell Immunol. 2000;204:19–28.CrossRefPubMed
15.
Zurück zum Zitat Broughton G, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):S12–34.CrossRef Broughton G, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):S12–34.CrossRef
17.
Zurück zum Zitat Watanabe T, Kanda K, Ishibashi-Ueda H, Yaku H, Nakayama Y. Development of biotube vascular grafts incorporating cuffs for easy implantation. J Artif Organs. 2007;10:10–5.CrossRefPubMed Watanabe T, Kanda K, Ishibashi-Ueda H, Yaku H, Nakayama Y. Development of biotube vascular grafts incorporating cuffs for easy implantation. J Artif Organs. 2007;10:10–5.CrossRefPubMed
18.
Zurück zum Zitat Watanabe T, Kanda K, Yamanami M, Ishibashi-Ueda H, Yaku H, Nakayama Y. Long-term animal implantation study of biotube-autologous small-caliber vascular graft fabricated by in-body tissue architecture. J Biomed Mater Res B Appl Biomater. 2011;98:120–6.CrossRefPubMed Watanabe T, Kanda K, Yamanami M, Ishibashi-Ueda H, Yaku H, Nakayama Y. Long-term animal implantation study of biotube-autologous small-caliber vascular graft fabricated by in-body tissue architecture. J Biomed Mater Res B Appl Biomater. 2011;98:120–6.CrossRefPubMed
19.
Zurück zum Zitat Luttikhuizen DT, Harmsen MC, Van Luyn MJ. Cellular and molecular dynamics in the foreign body reaction. Tissue Eng. 2006;12:1955–70.CrossRefPubMed Luttikhuizen DT, Harmsen MC, Van Luyn MJ. Cellular and molecular dynamics in the foreign body reaction. Tissue Eng. 2006;12:1955–70.CrossRefPubMed
20.
Zurück zum Zitat Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;2341:738–46. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;2341:738–46.
21.
Zurück zum Zitat Tonnesen MG, Feng X, Clark RA. Angiogenesis in wound healing. J Investig Dermatol Symp Proc. 2000;5:40–6.CrossRefPubMed Tonnesen MG, Feng X, Clark RA. Angiogenesis in wound healing. J Investig Dermatol Symp Proc. 2000;5:40–6.CrossRefPubMed
22.
Zurück zum Zitat Kishi A, Isoyama T, Saito I, Miura H, Nakagawa H, Kouno A, Ono T, Inoue Y, Yamaguchi S, Shi W, Abe Y, Imachi K, Noshiro M. Use of in vivo insert molding to form a jellyfish valve leaflet. Artif Organs. 2010;34:1125–31.CrossRefPubMed Kishi A, Isoyama T, Saito I, Miura H, Nakagawa H, Kouno A, Ono T, Inoue Y, Yamaguchi S, Shi W, Abe Y, Imachi K, Noshiro M. Use of in vivo insert molding to form a jellyfish valve leaflet. Artif Organs. 2010;34:1125–31.CrossRefPubMed
23.
Zurück zum Zitat Bates DO, Hillman NJ, Williams B, Neal CR, Pocock TM. Regulation of microvascular permeability by vascular endothelial growth factors. J Anat. 2002;200:581–97.CrossRefPubMedCentralPubMed Bates DO, Hillman NJ, Williams B, Neal CR, Pocock TM. Regulation of microvascular permeability by vascular endothelial growth factors. J Anat. 2002;200:581–97.CrossRefPubMedCentralPubMed
24.
Zurück zum Zitat Betsholtz C, Karlsson L, Lindahl P. Developmental roles of platelet-derived growth factors. Bioessays. 2001;23:494–507.CrossRefPubMed Betsholtz C, Karlsson L, Lindahl P. Developmental roles of platelet-derived growth factors. Bioessays. 2001;23:494–507.CrossRefPubMed
25.
Zurück zum Zitat Bhora FY, Dunkin BJ, Batzri S, Aly HM, Bass BL, Sidawy AN, Harmon JW. Effect of growth factors on cell proliferation and epithelialization in human skin. J Surg Res. 1995;59:236–44.CrossRefPubMed Bhora FY, Dunkin BJ, Batzri S, Aly HM, Bass BL, Sidawy AN, Harmon JW. Effect of growth factors on cell proliferation and epithelialization in human skin. J Surg Res. 1995;59:236–44.CrossRefPubMed
26.
Zurück zum Zitat Klinger MH, Jelkmann W. Role of blood platelets in infection and inflammation. J Interferon Cytokine Res. 2002;22:913–22.CrossRefPubMed Klinger MH, Jelkmann W. Role of blood platelets in infection and inflammation. J Interferon Cytokine Res. 2002;22:913–22.CrossRefPubMed
27.
Zurück zum Zitat Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15.PubMed Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15.PubMed
28.
Zurück zum Zitat Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;1:283–9.CrossRef Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;1:283–9.CrossRef
29.
Zurück zum Zitat Li W, Fan J, Chen M, Guan S, Sawcer D, Bokoch GM, Woodley DT. Mechanism of human dermal fibroblast migration driven by type I collagen and platelet-derived growth factor-BB. Mol Biol Cell. 2004;15:294–309.CrossRefPubMedCentralPubMed Li W, Fan J, Chen M, Guan S, Sawcer D, Bokoch GM, Woodley DT. Mechanism of human dermal fibroblast migration driven by type I collagen and platelet-derived growth factor-BB. Mol Biol Cell. 2004;15:294–309.CrossRefPubMedCentralPubMed
30.
Zurück zum Zitat Butterfield TA, Best TM, Merrick MA. The dual roles of neutrophils and macrophages in inflammation: a critical balance between tissue damage and repair. J Athl Train. 2006;41:457–65.PubMedCentralPubMed Butterfield TA, Best TM, Merrick MA. The dual roles of neutrophils and macrophages in inflammation: a critical balance between tissue damage and repair. J Athl Train. 2006;41:457–65.PubMedCentralPubMed
31.
Zurück zum Zitat De Ugarte DA, Ashjian PH, Elbarbary A, Hedrick MH. Future of fat as raw material for tissue regeneration. Ann Plast Surg. 2003;50:215–9.CrossRefPubMed De Ugarte DA, Ashjian PH, Elbarbary A, Hedrick MH. Future of fat as raw material for tissue regeneration. Ann Plast Surg. 2003;50:215–9.CrossRefPubMed
32.
Zurück zum Zitat Zhao J, Yi C, Zheng Y, Li L, Qiu X, Xia W, Su Y, Diao J, Guo S. Enhancement of fat graft survival by bone marrow-derived mesenchymal stem cell therapy. Plast Reconstr Surg. 2013;132:1149–57.CrossRefPubMed Zhao J, Yi C, Zheng Y, Li L, Qiu X, Xia W, Su Y, Diao J, Guo S. Enhancement of fat graft survival by bone marrow-derived mesenchymal stem cell therapy. Plast Reconstr Surg. 2013;132:1149–57.CrossRefPubMed
33.
Zurück zum Zitat Nakajima I, Muroya S, Tanabe R, Chikuni K. Extracellular matrix development during differentiation into adipocytes with a unique increase in type V and VI collagen. Biol Cell. 2002;94:197–203.CrossRefPubMed Nakajima I, Muroya S, Tanabe R, Chikuni K. Extracellular matrix development during differentiation into adipocytes with a unique increase in type V and VI collagen. Biol Cell. 2002;94:197–203.CrossRefPubMed
34.
Zurück zum Zitat Flynn L, Semple JL, Woodhouse KA. Decellularized placental matrices for adipose tissue engineering. J Biomed Mater Res A. 2006;79:359–69.CrossRefPubMed Flynn L, Semple JL, Woodhouse KA. Decellularized placental matrices for adipose tissue engineering. J Biomed Mater Res A. 2006;79:359–69.CrossRefPubMed
35.
Zurück zum Zitat Fraser JK, Wulur I, Alfonso Z, Hedrick MH. Fat tissue: an underappreciated source of stem cells for biotechnology. Trends Biotechnol. 2006;24:150–4.CrossRefPubMed Fraser JK, Wulur I, Alfonso Z, Hedrick MH. Fat tissue: an underappreciated source of stem cells for biotechnology. Trends Biotechnol. 2006;24:150–4.CrossRefPubMed
37.
Zurück zum Zitat Eto H, Suga H, Matsumoto D, Inoue K, Aoi N, Kato H, Araki J, Yoshimura K. Characterization of structure and cellular components of aspirated and excised adipose tissue. Plast Reconstr Surg. 2009;124:1087–97.CrossRefPubMed Eto H, Suga H, Matsumoto D, Inoue K, Aoi N, Kato H, Araki J, Yoshimura K. Characterization of structure and cellular components of aspirated and excised adipose tissue. Plast Reconstr Surg. 2009;124:1087–97.CrossRefPubMed
38.
Zurück zum Zitat Eto H, Kato H, Suga H, Aoi N, Doi K, Kuno S, Yoshimura K. The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg. 2012;129:1081–92.CrossRefPubMed Eto H, Kato H, Suga H, Aoi N, Doi K, Kuno S, Yoshimura K. The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg. 2012;129:1081–92.CrossRefPubMed
39.
Zurück zum Zitat Kidane AG, Burriesci G, Cornejo P, Dooley A, Sarkar S, Bonhoeffer P, Edirisinghe M, Seifalian AM. Current developments and future prospects for heart valve replacement therapy. J Biomed Mater Res B Appl Biomater. 2009;88:290–303.CrossRefPubMed Kidane AG, Burriesci G, Cornejo P, Dooley A, Sarkar S, Bonhoeffer P, Edirisinghe M, Seifalian AM. Current developments and future prospects for heart valve replacement therapy. J Biomed Mater Res B Appl Biomater. 2009;88:290–303.CrossRefPubMed
40.
Zurück zum Zitat Yamanami M, Yahata Y, Uechi M, Fujiwara M, Ishibashi-Ueda H, Kanda K, Watanabe T, Tajikawa T, Ohba K, Yaku H, Nakayama Y. Development of a completely autologous valved conduit with the sinus of Valsalva using in-body tissue architecture technology: a pilot study in pulmonary valve replacement in a beagle model. Circulation. 2010;122(11 Suppl):S100–6.CrossRefPubMed Yamanami M, Yahata Y, Uechi M, Fujiwara M, Ishibashi-Ueda H, Kanda K, Watanabe T, Tajikawa T, Ohba K, Yaku H, Nakayama Y. Development of a completely autologous valved conduit with the sinus of Valsalva using in-body tissue architecture technology: a pilot study in pulmonary valve replacement in a beagle model. Circulation. 2010;122(11 Suppl):S100–6.CrossRefPubMed
41.
Zurück zum Zitat Takewa Y, Yamanami M, Kishimoto Y, Arakawa M, Kanda K, Matsui Y, Oie T, Ishibashi-Ueda H, Tajikawa T, Ohba K, Yaku H, Taenaka Y, Tatsumi E, Nakayama Y. In vivo evaluation of an in-body, tissue-engineered, completely autologous valved conduit (biovalve type VI) as an aortic valve in a goat model. J Artif Organs. 2013;16:176–84.CrossRefPubMed Takewa Y, Yamanami M, Kishimoto Y, Arakawa M, Kanda K, Matsui Y, Oie T, Ishibashi-Ueda H, Tajikawa T, Ohba K, Yaku H, Taenaka Y, Tatsumi E, Nakayama Y. In vivo evaluation of an in-body, tissue-engineered, completely autologous valved conduit (biovalve type VI) as an aortic valve in a goat model. J Artif Organs. 2013;16:176–84.CrossRefPubMed
42.
Zurück zum Zitat Sumikura H, Nakayama Y, Ohnuma K, Takewa Y, Tatsumi E. In vitro evaluation of a novel autologous aortic valve (Biovalve) with a pulsatile circulation circuit. Artif Organs. 2014;38:282–9.CrossRefPubMed Sumikura H, Nakayama Y, Ohnuma K, Takewa Y, Tatsumi E. In vitro evaluation of a novel autologous aortic valve (Biovalve) with a pulsatile circulation circuit. Artif Organs. 2014;38:282–9.CrossRefPubMed
Metadaten
Titel
In situ observation and enhancement of leaflet tissue formation in bioprosthetic “biovalve”
verfasst von
Marina Funayama
Yoshiaki Takewa
Tomonori Oie
Yuichi Matsui
Eisuke Tatsumi
Yasuhide Nakayama
Publikationsdatum
01.03.2015
Verlag
Springer Japan
Erschienen in
Journal of Artificial Organs / Ausgabe 1/2015
Print ISSN: 1434-7229
Elektronische ISSN: 1619-0904
DOI
https://doi.org/10.1007/s10047-014-0793-x

Weitere Artikel der Ausgabe 1/2015

Journal of Artificial Organs 1/2015 Zur Ausgabe

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.