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Purpose: Congenital diaphragmatic herniae (CDH) may require patch closure in 50% of the cases. We assessed a biologic and composite mesh in a porcine CDH model. Methods: Left sided thoracotomy was performed in 20 pigs. Approximately, 30% of the diaphragm was excised and the patch (Surgisis® or Parietex®) inserted to close this defect. The pigs were killed at 6 months and the diaphragm was harvested for biomechanical and histological assessment. Results: The mean weight of the pigs at surgery and killing were 6.1 kg (4.2–8.4 kg) and 94.1 kg (80–131 kg), respectively. There were two recurrences and three eventrations, all with Surgisis®. There were less dense lung and abdominal adhesions in the Parietex group (P < 0.0001 and 0.025, respectively). The tensile strength of the Surgisis®, the Parietex® groups and controls were similar. There was significantly more muscle in-growth in the Parietex® patch over Surgisis® (p = 0.016). Conclusion: Parietex® and Surgisis® patches at 6 months have a similar tensile strength to normal tissue. All recurrences and eventrations were in the Surgisis® group. Parietex® patches demonstrated more muscle in-growth into the patch compared to Surgisis®. This is the first study utilising Parietex® composite patch in the repair of large diaphragmatic defects in a porcine model. [ABSTRACT FROM AUTHOR]

This manuscript presents experimental results of compression tests of repaired sandwich structure typical of a launch vehicle Payload Adapter Fitting (PAF) that is being considered for the National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) launch vehicle. Specimens with 8-ply quasi-isotropic carbon/epoxy face sheets and aluminum honeycomb core were damaged with representations of misdrilled holes, barely visible impact damage (BVID) or visible impact damage (VID). A patch repair technique not requiring removal of any material is presented and assessed for residual in-plane compressive load-carrying capability on each of the three types of damage. Edgewise compression tests on specimens demonstrated the repairs could recover all measured undamaged compressive load-carrying capability of the misdrilled hole and BVID specimens. For the specimens with VID, an average of about 91% of the average measured undamaged compressive load carrying capability was recovered indicating that larger patches, or perhaps removal and replacement of the damaged material, may be needed for more severe damage if all the measured undamaged compression strength needs to be regained. [ABSTRACT FROM AUTHOR]

Purpose: Infective endocarditis (IE) remains a prevalent and life-threatening disease. The choice to repair or replace the infected valve still remains a matter of debate, especially in aortic valve (AV) infections. We retrospectively analyze our two decades of experience in aortic valve repair (AVr) in IE. Long-term outcomes are described with particular attention to the impact of valve configuration and the use of patch techniques. Methods: From September 1998 to June 2017, 42 patients underwent AVr in a single center for IE. Techniques include leaflet patch repair and resuspension and aortic annulus stabilization. Results: Hospital mortality was 2.4% (n = 1). The median follow-up was 90.6 months. Survival was 89 ± 9.4% and 76.6 ± 16% at 5 and 10 years, respectively, with no significant differences between tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV). Freedom from reoperation was 100% and 92.9 ± 7.1% in TAV and 81.8 ± 18.2% and 46.8 ± 28.8% in BAV at 5 and 10 years, respectively (TAV vs BAV, p = 0.02). BAV, degree of preoperative aortic insufficiency, and AVr including patch were factors predicting a higher risk of reoperation during the follow-up. Conclusion: In our experience, AVr is a safe, feasible, and efficient choice in selected patients with healed or active IE. Durability of the repair is excellent in patients with limited lesions and in patients with TAV even with patch repair. Reoperations occurred principally in patients with BAV and severe preoperative AI, in whom patch repair was performed. In those patients, we actually recommend to replace the valve in case of active endocarditis. [ABSTRACT FROM AUTHOR]

The performance of reinforced concrete (RC) element may be deficient for a variety of causes. Correct actions should be taken to resume the performance of the deficient element to maintain the strength and serviceability of the structure. A deficient RC column element may be identified in the form of spalling of concrete cover. A patching method could be selected to recover the damaged area and, hopefully, regain the strength of the damaged RC column to its original value. This research aims to investigate the suitability of patch repair material to recover the performance of damaged RC column. The investigation is carried out by comparing the behaviour of patched RC columns with the corresponding normal RC column. The eccentric loading has been set up in this investigation to induce compression failure of the RC columns. The simulated area of damage is patched using unsaturated polyester resin mortar (UPR mortar). The results indicate that the mode of failure is not induced at the patched sections. The presence of patching causes a redistribution of stress at the patched section in such a way, so a higher stress transfer occurs in the undamaged zone and in the longitudinal reinforcements compared to those of the normal column. The capacity of the patched RC columns is only 71-92% of the normal RC column. [ABSTRACT FROM AUTHOR]

Adhesively bonded repairs are frequently used to repair aluminum structures due to their attractive options compared to traditional methods such as welding or riveting. A new method of increasing the repair's strength against uniaxial tensile loads is used in this study. For this purpose, standard single-strap (SS) and double-strap (DS) repairs were produced with aluminum patch. In the first step, an epoxy-based adhesive was employed to create SS and DS repairs using neat adhesive and 0.5 wt.% reduced graphene oxide (RGO)-reinforced adhesive. Afterward, samples of SS and DS joints with the reinforced adhesive were manufactured to study the effect of the added RGO. Uniaxial tensile tests were conducted and above 30% enhancement in the ultimate load was observed in the joints bonded with reinforced adhesive. The repaired joints were analyzed by finite element (FE) method using cohesive zone modeling technique to obtain failure loads. For this purpose, two sets of tests (a) double cantilever beam and (b) end notch flexure tests were implemented to estimate the cohesive zone model CZM parameters. Comparing the results obtained from experiments and the numerical simulations shows that FE models accurately predict the failure load in the reinforced and unreinforced repaired joints. [ABSTRACT FROM AUTHOR]

This review focuses on the surgical viewpoints on patch repairs in neonates with large congenital diaphragmatic hernia defects. The main focus  is on the various biomaterials that have been employed to date with regard to their source of origins, degradation properties as well as tissue integration characteristics. Further focus  is on the present knowledge on patch integration when biomaterials are placed in the diaphragmatic defect. The review will also look at the present evidence on the biomechanical characteristics of the most commonly used biomaterials and compares these materials to diaphragmatic tissue to offer more  insight on the present practice of patch repairs in large defects. Since tissue engineering and regenerative medicine has offered another dimension to diaphragmatic replacement, a detailed overview of this technology will be undertaken with regard to cell sourcing, scaffolds, in vitro versus in vivo implants as well as quality of tissue produced, to explore the limitations and the feasibility facing the scientific community in its clinical implementation of skeletal muscle-engineered tissue beyond laboratory research for diaphragmatic replacement. [ABSTRACT FROM AUTHOR]

Background: Infants with congenital diaphragmatic hernia (CDH) have variable outcomes. There is a considerable potential benefit in being able to predict perinatally, which infants have severe hypoplasia and are thus more likely to die or survive with significant morbidity. We examine the relationship between a need for patch repair of CDH (PR) and outcome, using a national database.Methods: Baseline characteristics of patients undergoing PR or non-patch repair (NPR) were compared. Multivariate analysis was performed to determine the association of PR with mortality and morbidity independent of other known predictors.Results: Baseline characteristics of PR and NPR infants were similar although those infants with PR had higher SNAP-II scores. PR was an independent predictor of mortality with an odds ratio of 17.1 (95%CI 2.0-149.2) and was independently associated with secondary outcome measures of morbidity, including the need for oxygen at discharge and the duration of ventilation.Conclusions: Infants requiring PR have significantly higher mortality and suffer greater morbidity than those undergoing NPR. This association is independent of other known predictors of mortality. Identifying prenatal features associated with this high risk group would be of great clinical value. [ABSTRACT FROM AUTHOR]

Substantial resources continue to be used worldwide to repair corroding reinforced concrete (RC) structures with the intent to meet or extend their design service life. Experimental observations have shown that the rate of steel corrosion as well as the extent of corrosion damage on RC structures is very much influenced by the level of the sustained load during the corrosion process. It is therefore expected that the effectiveness of interventions to maintain the serviceability of corroded structures will also be influenced by the level of the sustained load. This paper presents experimental results and a discussion on the effectiveness of patch repairs and fibre reinforced polymer (FRP) bonded plates to restore the serviceability state of quasi-full-scale RC beams (153 × 254 × 3,000 mm) that were corroded and repaired whilst under sustained service loads. Steel corrosion was induced using two sequential corrosion processes; firstly accelerated corrosion by impressing an anodic current followed by natural corrosion. It was found that under natural steel corrosion; (1) no additional widening of corrosion cracks was observed when the load applied on test beams was reduced without repairs. However, increasing the load increased the rate of corrosion crack widening; (2) despite having a significantly lower rate of steel corrosion, the rate of widening of corrosion cracks was at times comparable to the corresponding rate under the accelerated corrosion process; and (3) strengthening with FRPs without patch repairs increased the load-bearing capacity of the beams but worsened their serviceability state in terms of crack widths. It was concluded that strengthening of corrosion-affected RC structures with FRPs should be done subsequent to patch repairs. [ABSTRACT FROM AUTHOR]

Technically expedient repair of CDH defects is desirable. With increasing trend toward thoracoscopic repair, herein we examine physiologic predictors for the need for patch closure (PC) versus primary closure. All neonates who underwent surgical repair of CDH defects in a geographically defined region between 1992 and 2002 were included (n = 210). Two groups of patients were compared, primary repair (PR) versus PC. The 25th quartile was used as a cut off point for continuous variables. Univariate and multivariate logistic regression were performed. One hundred and fifty neonates underwent open PR (71.43%) versus 28.57% had PC. On univariate analyses the following variables were significantly associated with the need for PC: prenatal diagnosis, birth weight <2.7 kg, gestational age <37 weeks, APGAR at 5 min <6, immediate postnatal PCO(2) >34, Immediate oxygen saturation <93%, use of Nitric oxide and the need for high frequency oscillation (HFO). On multivariate analyses, only a PCO(2) >34 and the need for HFO were significantly associated with PC. Neonates with an initial PCO(2) >34 or need HFO pre-operatively should be excluded from attempts to repair the CDH thoracoscopically based on their higher potential need for PC with its entailed technical difficulty and increased operative time. [ABSTRACT FROM AUTHOR]

The most popular techniques for repairing large diaphragmatic defects involve the use of synthetic patches. We present an alternative approach using living tissue. We reviewed our cases of congenital diaphragmatic hernia (CDH) diagnosed within the first 24 h of life from 1991 to 2003. Toldt's fascia (TF) flap was used to repair defects that were too large to repair primarily even though the anterior rim of the diaphragm was present. After confirming that a small medial muscle remnant of the diaphragm was present, its mesothelial covering was incised, and the incision was extended to the TF far enough to create a flap sufficiently large to repair the defect. The TF flap, consisting of the small medial muscle remnant, TF, peritoneum, and retroperitoneal connective tissue, was mobilized carefully from the ipsilateral kidney and adrenal gland, and the repair completed with interrupted sutures using nonabsorbable material. We used this TF flap approach in seven of 43 patients with CDH. Two had right-sided CDH. Six survived. The mean size of the diaphragmatic defects in the seven TF flap cases was 5.43+/-0.53 x 3.86+/-1.07 cm, which was significantly larger than the defects in direct primary repair cases (3.40+/-0.77 x 2.03+/-0.59 cm) (p<0.01). The six survivors had good outcomes, and none of them have had recurrence of herniation or required any additional surgical intervention (mean follow-up period: 4.7 years). To the best of our knowledge, this is the first report of TF being used to repair large diaphragmatic hernias. Our technique is simple and has proven to be reliable for durable restoration of the diaphragm, suggesting that it could reduce the dependence on synthetic patch repair, which is associated with certain long-term complications. [ABSTRACT FROM AUTHOR]

Background: This study reviewed our experience with laparoscopic ventral postoperative (incisional) hernia repair.Methods: Clinical data from the first 100 cases were analyzed retrospectively.Results: Between 1997 and 2000, 64 women and 36 men (mean age, 58.4 +/- 13.6 years; range, 27-87 years) underwent laparoscopic hernioplasty. Hernias (mean diameter, 6.2 +/- 3.7 cm) were in a midline (74%), subcostal (10%), or other incision location, and were recurrent in 25%, of the patients. The mean operative time was 119 +/- 77 min. Extensive adhesiolysis was necessary in 37 cases. There was no mortality. The recorded complications included inadvertent enterotomies (n = 6), seromas (n = 11), prolonged ileus (n = 4), and prolonged fever (n = 3). Seven cases were converted; to repair accidental enterotomies (n = 4) due to difficult adhesiolysis (n = 2), or to control bleeding (n = 1). Six patients underwent reoperation because of enetric leak (n = 3) or bowel obstruction (n = 3). There were two documented recurrences (2%). The mean follow-up period was 19 months (range, 12-54 months).Conclusions: Laparoscopic intraperitoneal approach to postoperative ventral (incisional) hernia repair may be associated with significant complications and morbidity, which can be prevented in part by meticulous technique and liberal conversions. The justification of this procedure is the low recurrence rate, according to preliminary results. [ABSTRACT FROM AUTHOR]

Background: Surgery for infective endocarditis involving the aorto-mitral curtain (AMC) is challenging and requires extensive incisions and complex reconstruction procedures. However, in patients with preserved aortic annulus, reconstruction of the AMC is possible using a simple technique with limited incisions.Case presentation: A handmade bovine three-portion pericardial patch was used to reconstruct the AMC in a patient with severe endocarditis requiring double valve replacement; the technique allowed for steady anchorage of prosthetic valves without additional incisions other than conventional aortotomy and atriotomy. Postoperative echocardiography revealed normal cardiac function and no significant perivalvular leakage. The patient displayed complete recovery and was discharged on postoperative day 33. The patient was symptom-free at his 1-year follow-up and displayed normal laboratory and echocardiographic findings.Conclusion: The bovine three-portion pericardial patch is useful for reconstructing the AMC in patients with infective endocarditis accompanied by preserved aortic annulus. [ABSTRACT FROM AUTHOR]