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Introduction A rectocele is a hernation of the rectum into the vaginal lumen developing as a consequence of weakness of the rectovaginal septum. It affects about 18% of women after childbearing age. Symptoms associated with a rectocele include constipation, vaginal fullness or heaviness, feeling of a bulging mass within vagina, incomplete stool evacuation and dyspareunia. Current methods of surgical treatment of a rectocele often require implantation of a mesh graft. In most of cases, synthetic and non-absorbable meshes are used. Although implantation of a synthetic and non-absorbable mesh is effective in the treatment of rectocele, a high rate of mesh erosion has been reported. Case report This study presents a surgical technique and case report for the treatment of a rectocele in a 46-year-old women by implantation of a porcine-derived absorbable collagen mesh (Pelvicol®) by transvaginal approach, with six year follow-up. A review of the literature concerning implantation of Pelvicol® for the treatment of rectocele was also undertaken. Conclusions The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.

The purpose of this study was to determine, in principle, whether microdermabrasion can alter waffle-pattern (meshed split-thickness skin graft) burn scars after scar maturation. Matured waffle-pattern mesh-graft scars were treated with multiple microdermabrasion sessions over the course of a year (maximum 20). Before and after treatment, the treated scars and the control scar on the same patient were assessed with subjective and objective scar assessment tools (scar scales, cutometer [elasticity], laser Doppler flowmeter [vascularity], Semmes-Weinstein filaments [sensation], and high-resolution ultrasound [thickness]). The treatment resulted in continuous improvement of some physiologic skin functions like perfusion response (feedback), thickness, and elasticity when compared with nontreated scar, although no statistical significance was reached. Both Vancouver scar scale and patient assessment scales showed significant improvement. The study showed that even mature waffle pattern scars can be modified by minimally invasive interventions. Larger study groups and more economic treatment modalities need to be studied in the future.

Background: The surgical treatment for therapy-resistant venous leg ulcers is shave therapy with mesh graft transplantation. Objective: To demonstrate the need of complete shaving with help of histomorphological criteria. Methods: Biopsies were taken from the bottom and the border of the 28 ulcers and from nonulcer skin nearby. Specimens were analyzed in correlation to the clinical course 6 months after the treatment (healed/nonhealed/recurrent). Results: 10 ulcers healed, 10 were recurrent and 8 nonhealed. Nonhealed ulcers had an increased broadening of collagen fibers and rete ridges and reduced elastic fibers at the border of the ulcer. Significantly more obliterated vessels were in the upper dermis at the border of the nonhealed ulcers. Recurrent ulcers showed more signs of dermatoliposclerosis. Conclusion: In nonhealed and recurrent ulcers histomorphological aspects of dermatoliposclerosis are still detectable. Thus, a more extensive fibrosis seems to be associated with a poorer outcome. The hypothesis that possibly a more aggressive shave therapy can increase the healing rate should be verified in a prospective study.

PURPOSE: The purpose of this study was to describe indications, the operative technique and results of the two-staged buccal mucosa (BM) and mesh graft urethroplasty for treatment of -urethral strictures. MATERIAL AND METHODS: Between 3 / 1993 and 12 / 1999, urethral reconstructions were performed in 267 consecutive patients (group I), including 68 mesh graft urethroplasties (25 %) and 30 BM urethroplasties (12 %). Between 1 / 2000 and 8 / 2004, additional 249 urethroplasties were performed: Of those, 12 % were mesh graft and 50 % BM urethroplasties (group II). RESULTS: In patient group I, stricture recurrence was found to be the main complication of both procedures (BM 17 %, mesh 16 %). However, erectile dysfunction and curvature only occurred in the mesh graft group with 4 % and 9 %, respectively. Patient satisfaction was high in both groups (BM 96.7 %, mesh 83.3 %). Between 1 / 2000 and 8 / 2004 (group II) the number of BM urethroplasties increased to 50 %, whereas the number of mesh graft urethroplasty decreased (12 %). More than 80 % of the patients were satisfied with the results. CONCLUSIONS: Long strictures with severe spongiofibrosis represent an indication for two staged urethro-plasty (BM and mesh graft). Excellent -results can be achieved with both techniques with a similar rate of complications. The mesh graft technique remains the last option for a complex patient group.

Lower leg ulcers are characterized by a chronic and recurrent course, being considered as a difficult therapeutic problem. Based on epidemiological data chronic ulcers concern 0.2 to 2% of the Western European population. The above-mentioned problem affects women more often than men, and increases with age. Treatment and recurrence prevention methods remain under discussion and research.The aim of the study was to evaluate the early surgical treatment results of venous leg ulcers at the Department of Traumatology and Emergency Medicine, Medical University of Lublin.Material and methods. We evaluated patients hospitalized at the Department of Traumatology and Emergency Medicine, Medical University of Lublin during the period between 2009-2014. Inclusion criteria were as follows: venous leg ulceration, full documentation. The study group comprised 62 patients subjected to treatment for leg ulcerations, including 35 women and 27 men, aged between 30 and 94 years. The treatment method included the excision of the ulcers with the deep fascia, and the implantation of the mesh graft (thickness of skin) directly into the exposed muscle.Results. Amongst patients evaluated at discharge, the healing of the transplant was as follows: in case of 44 patients 90-100%, in 8 patients - 75-89%, in 5 patients 50-74% and in 5 patients less than 50%. The predominating bacteria collected from ulceration samples was Pseudomonas aeruginosa (32%) and Staphylococcus aureus (35%).Conclusions. The patient outcome shows that surgery is an effective method considering treatment of venous leg ulcers. Earlier qualification for this type of surgery will improve patient outcome.

On June 27, 2015, a flammable starch-based powder exploded at Formosa Fun Coast in Taipei, Taiwan, injuring 499 people, and more than 200 people were in critical condition with severe burns. Although a cultured epidermal autograft (CEA) was not approved or used in clinical practice, the Taiwan Food and Drug Administration requested a Japanese CEA manufacturer to donate CEA for the burn victims as part of international medical assistance. The authors cooperated in this project and participated in the patient selection, wound bed management for CEA, and technical assistance for CEA use. Here, we provide an overview of the project. Nine patients were enrolled, and two patients were excluded from the skin biopsy; seven skin biopsies were collected approximately 1 month after the disaster. The average TBSA% burned was 81.0%, and the mean age was 20.1 years. CEA was grafted in five patients; wound closure had been obtained in one patient, and one patient was severely ill at the time of grafting. The CEA was combined with a wide split auto mesh graft or patch graft. The mean re-epithelization rate at 4 weeks after the grafting was 84.2% by patient, and all of the patients survived. Although this project had many obstacles to overcome, CEA grafting was successful and contributed to wound closure and survival.

Objectives The technique of lateral fasciectomy (LF) sparing the superficial peroneal nerve with mesh graft coverage is a novel treatment of non-healing lateral leg ulcers of various vascular origin affecting the fascia. We report short- and long-term results of LF for recalcitrant lateral leg ulcers. Design This study is a single center, retrospective case series of consecutive patients treated by LF. Materials From 827 ulcers treated at our institution, 44 recalcitrant lateral leg ulcers affecting the fascia (41 patients) underwent lateral fasciectomy between 2006 and 2013. Methods Preoperative indications, step-by-step surgical procedures, and perioperative care methodologies are presented. Long-term effects of healing and recurrence were clinically investigated or obtained through telephone interviews with relatives and local practitioners. Results Three discrete etiologies were identified: venous ulcers ( n = 24), arterial–venous/mixed ulcers ( n = 11), and arteriolar Martorell hypertensive leg ulcers ( n = 9). Complete healing was achieved in 40 legs (91%) after 3 months, and in 43 of the affected legs (98%) in total. The median duration to complete healing was 64 days. There was no difference between the healing times of different etiologies. No local recurrence was observed during the follow-up period, which ranged from 1.8 to 8.7 years (median: 5.11, mean: 5.12). Twelve patients (27%) died within this period due to multimorbidity. Conclusions Following lateral fasciectomy and mesh graft coverage, 43 legs (98%) healed in previously treatment resistant lateral leg ulcers.

Objectives: To investigate posterior external ear canal wall reconstruction with a composite cartilage titanium mesh graft in canal wall down tympanoplasty and revision surgery for open mastoids.Study design: Retrospective case review.Setting: Tertiary referral centre.Methods: As a preliminary study, 15 selected patients underwent reconstruction of a posterior ear canal wall defect with titanium mesh. Large defects of the posterior external auditory canal wall, resulting from canal wall down tympanoplasty or present in revision surgery, were eliminated by reconstruction using a titanium mesh. The mesh was covered with conchal cartilage and attached to the cortical mastoid bone using 3-mm titanium screws.Results: All patients maintained a normal contour of the external ear canal, without depression, extrusion or infection. There were no failures, based on short-term post-operative controls. However, two procedures had to be revised due to incomplete coverage of the titanium mesh.Conclusions: This study shows that reconstruction of the posterior ear canal wall with a composite cartilage titanium mesh is a valuable method for preserving the morphology of the external auditory canal in selected cases. Problems occurring in canal wall down tympanomastoidectomy and radical cavities may therefore be avoided. However, long-term results have yet to be evaluated.

The engineering, design, manufacture, and rationale for use of printed titanium shells for alveolar bone reconstruction using BMP-2/ACS/allograft are described. This is proposed as a possible improvement to the current hand-configured mesh graft technique in common use today.

Object Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat persistently symptomatic vertebral compression fractures (VCFs). Both interventions usually involve injection of polymethyl methacrylate (PMMA). The purpose of this technical note was to review the theory and surgical technique for a novel percutaneous system for fracture reduction and stabilization of VCFs by using bone graft. Methods This technical note highlights the Optimesh system as an alternative method of minimally invasive VCF reduction and stabilization with the delivery of a bone graft containment device. Instead of using PMMA as in vertebroplasty or kyphoplasty, this system allows the delivery of allograft and/or autograft bone, with its osteoinductive, osteoconductive, and osteogenic properties. Conclusions This system allows for restoration of sagittal alignment of the spine with direct control of bone graft delivery by using a mesh graft containment device that allows for ingrowth of new bone and vascular tissue.

Two male patients presented to the surgical outpatient clinic with a paramedian abdominal bulge. In the first patient, the hardly known diagnosis linea arcuata hernia (LAH) had been missed at a previous exploration 8 years ago. In the second patient, pre-operative imaging showed an abdominal wall hernia. Diagnostic laparoscopy revealed an LAH. In both cases, the hernia was repaired with a mesh graft.

We previously have reported on the enhanced cosmetic and functional outcome with the use of sheet autografts. The recent goal has been to cover larger surface areas with sheet grafts, or for patients with larger burns, covering the hands and face with sheet grafts, if possible. To evaluate the use of sheet grafts in burns of more than 30% total body surface area (TBSA), the percentage covered with sheet and meshed autograft was reviewed in 105 patients admitted between January 1, 1990, and August 30, 1994. Results were that 18 patients (17%), with a mean of 44.3% TBSA burns, had all of their full-thickness wounds (mean, 36.5% +/- 2.2%; range, 20% to 55.5%) covered with sheet grafts (Group 1). Seventeen patients (16%), with mean burn size of 64.3%, had their wounds (mean, 35.1% +/- 4.4%; range, 15% to 79%) covered solely with mesh graft (Group 2). The lower percentage covered by mesh alone was skewed by the high mortality rate (53%) in this group. Seventy patients, 58.4% +/- 19% (range, 30% to 92%) TBSA burn, had their full-thickness wounds covered with a combination of mesh and sheet graft (Group 3). In Group 3, the mean percentage of TBSA covered by sheet grafts was 15.0% +/- 1.4% (range, 1% to 42.5%) and that covered by meshed grafts was 39.4% +/- 2.6% (range, 4% to 93%). Three quarters (73%) of patients in this group had sheet grafts placed on the face, whereas 63% had them placed on the hands. Extremities and the trunk were more often grafted with mesh graft. Sheet grafts were the sole coverage in patients with burns up to 55.5%. With even larger burns, sheet grafts were used to cover the face and hands. Because of its superior cosmetic and functional outcome, sheet autografting should be considered for covering moderately sized burns. Sheet autografting should be considered for more important cosmetic and functional areas, such as the face and hands, for massive burns.

Between 1977 and 1996 we treated 176 patients suffering from complicated urethral strictures with the mesh-graft urethroplasty. This operation technique has replaced the Bengt-Johanson-Operation which had been used frequently until that date. The Cecil-Operation has been totally abandoned, because in our opinion the usage of scrotal skin in urethral reconstruction is obsolete today. The mesh-graft technique is based on the free transfer of meshed prepuce (full-thickness skin or split-thickness skin) in a two stage procedure. In 37 patients the inner layer of the prepuce was used, in 63 patients we only used split-thickness skin grafts and in 76 patients we applied a combination of both, the inner layer of the prepuce in addition to a split-thickness skin graft. After complete healing of the graft (first stage) the formation of the neourethra follows as the second stage procedure. The mesh graft procedure can be used to treat all kinds of strictures independant of the etiology or localisation. Hair growth, diverticula development and stone formation that are observed frequently as complications with scrotal skin substitutes can be avoided. Due to these advantages encouraging long term results could be obtained with the mesh graft urethroplasty. In 162 patients (92 %) with a minimum follow-up of 7 years we achieved a successful result of the operations, a significant improvement could be obtained in 7 patients (4 %). Unfortunately in further 7 cases (4 %) the operation method ultimately failed. In particular in patients with complicated and severe strictures after numerous unsuccessfull prior reconstructive attempts, extensive long strictures and strictures in paraplegic patients, mesh graft urethroplasty has been shown to be a safe and reliable treatment option.

In many units, the standard mesh ratio is 1.5:1, but in our unit we have a 1:1 mesher, which does not expand the skin but provides regular fenestrations. There is some evidence that the unexpanded 1.5:1 meshed graft compares favourably with sheet grafts from a cosmetic perspective whilst reducing the risk of graft failure secondary to a subgraft haematoma, but none comparing the 1:1 meshed graft with the sheet graft. We conducted a randomized trial to compare surgical outcomes in unfenestrated sheet grafts with 1:1 meshed grafts.All patients aged ≥16 years undergoing skin grafts with either a sheet or a 1:1 mesh for burn reconstruction were included. Patients on steroids, those with conditions that impair healing, and burns20% were excluded. Patients were randomized into the sheet grafting or mesh graft using a computer-generated allocation system. The mean percentage of graft loss was assessed by a Visitrak overlay system. At 3-4 months, 7-8 months and at 1 year, photos were taken for scar assessment using the Vancouver Scar Score (VSS).Out of 72 patients, 48 patients (24 sheet vs. 24 mesh) completed the trial at 12 months. The mean age was 58 years (range 21-90). There was no total loss of graft in either group. The mean percentage of graft loss due to haematoma formation was higher in the sheet graft group (10%) compared to the 1:1 mesh group (6%) (P0.062). The VSS score was 5 in both groups at 12 months. There was no significant difference in scar quality between the treatment groups.These results show that the 1:1 mesh graft is superior to the sheet graft with regard to graft loss, although this result is not statistically significant. There are comparable findings in terms of cosmetic perspective at 12 months post-operatively in both arms of the trial.

A suburethral sling procedure using a Mersilene mesh has been performed in 24 patients. Six patients had recurrent incontinence after an unsuccessful past operation. A postoperative follow-up was done for an average of 24 months. Twenty-three patients were free of symptoms, while only 1 patient had recurrent incontinence. The suburethral sling procedure can be applied to all patients, particularly for recurrent stress urinary incontinence, with reasonable cure rates when performed with a proper technique.

A process of added qualification of transvaginal mesh (TVM) placement is desirable.Through a physician-led partnership of specialty societies, centers of excellence, and industry, a core curriculum encompassing mesh/graft biology, technical skills, and safety can be coupled with current educational endeavors instructing surgeons in the use of TVM. A posttest process can verify a knowledge-based competency in mesh/graft safety. An auditing process after implementation would be optimal.We recommend implementation of a five-step process in order to accomplish these goals.It is hoped through these efforts, the ultimate goal of patient safety may be reached.

Complex issues surround informed surgical consent for pelvic reconstructive surgery. Vaginally placed mesh/grafts are used with the intent to increase durability of the repair but potentially introduce unique complications, offering new challenges in informed surgical consent counseling. Informed consent is a process that takes place throughout the entire consultation with the patient. A written document often accompanies that process. This paper outlines necessary components of informed surgical consent and the theory behind each component. We explore elements that should be included in the consent process with regard to expected benefits, alternatives, and material risks that are specific to the use of a mesh/graft-augmented vaginal repair of prolapse. Included is an appendix that may serve as a template for the creation of a surgeon’s own written informed consent document.

Authors performed successful skin replacement with Integra, a dermal regeneration template, on a patient with circumferential avulsion injury including the elbow region and the dorsum of the hand. The take rate of Integra was 97%, followed by a 98% take rate of the split thickness mesh graft used for final wound coverage. Treatment modality provided excellent aesthetic and functional results, underlining the role of Integra in cases of extensive traumatic skin and soft tissue deficit, such as the treatment of avulsion injury. Orv. Hetil., 2011, 152, 1443–1446.

Using amniotic membrane as a skin graft fixator in children and burns involving the exterimities has become a routine modality of management in our burn center [1]. We certainly do not claim to know the best method and optimal care, but thought it might be of benefit to share our experience and evolving approach. Previously our method was just wrapping the amniotic membrane around the burned extremity over the grafted skin and no suture or staple was used. But, gradually as we became experienced in this method and our study population increased, we found that in some patients, when the skin graft is applied near the joints and the amniotic membrane is wrapped over it, postoperatively, the skin graft may slip beneath the amniotic membrane by joint movement which can result in small areas of graft loss that may bother the patient. According to our experience just a few anchoring sutures on the lateral borders of the skin can solve this problem. Also in patients with extensive burn who need mesh graft, this technique can help the surgeon to extend the skin as much as possible beneath the amniotic membrane, so that more areas of the wound can be covered with the graft. So, we recommend that in cases in which amniotic membrane is used as skin graft fixator on areas near the joints or in cases with extensive burn, it is advisable to apply at least a few anchoring sutures on the lateral borders of the grafted skin to increase the success rate of graft take.

Background The occurrence of skin metastases are rare events in the course of a follicular thyroid carcinoma (FTC) and usually indicate advanced tumor stages. The scalp is the most affected area of these metastases. Case presentation We present a case of a 76 year old Woman with multiple giant scalp metastases of a follicular carcinoma. These metastases had been resected and wounds had been closed with mesh graft. The 14-months follow up is presented. Conclusion We demonstrate another case with multicentric form. Because of its location and size a primary wound closure was not possible. A healing could be reached using vacuum therapy and mesh graft transplantation.

Objectives: Due to a partial rejection of mesh split-thickness skin grafts (mesh grafts) after application of povidone-iodine and silver nitrate and due to its better in vitro tolerance, polihexanide was investigated as an alternative and its applicability in the treatment of second-degree burn wounds. Methods: In 4 patients with poorly healing decubitus ulcers the mesh grafts were each divided into three areas which were pre-treated with either undiluted povidone-iodine solution, 1% silver nitrate solution or 0.04% polihexanide solution. After 7 days of application the wound areas were compared clinically and histologically. Thereafter 14 patients (average extent of burns 28% TBSA) were treated in the same way. Results: Clinically and histologically the mesh grafts treated with polihexanide showed by far the best re-epithelialization compared with the deep tissue necrosis and marked fibrin discharge observed for application of povidone-iodine and silver nitrate. The second-degree burn wounds treated with polihexanide epithelialized without any further débridement after an average of 10 days with remarkable freedom from pain. Compared with silver nitrate treatment, no fibrin film was observed on the wound. Conclusion: Polihexanide proved clinically and histologically superior to povidone-iodine and silver nitrate. For the treatment of second-degree burns, which cannot primarily be covered by plastic surgery, polihexanide is suitable because in addition to its antiseptic efficacy it does not inhibit the re-epithelialization process.

The connective tissue graft procedure is an effective method to achieve root coverage. Although multiple sites often need grafting, the palatal mucosa supplies only a limited area of grafting material. The expanded mesh graft provides a method whereby a graft can be stretched to cover a larger area. The aim of this study was to determine the effectiveness and the predictability of expanded mesh connective tissue graft (e-MCTG) in the treatment of multiple gingival recessions.Fifty-two buccal gingival recessions were treated in 10 systemically healthy patients. Fifteen recession treated operation sites with at least three adjacent Miller Class I and/or II recessions were performed. The connective tissue graft obtained from the palatal mucosa was expanded to cover the recipient bed, which was 1.5 times larger than the graft. Clinical measurements recorded at baseline and 12 months postoperatively included gingival recession depth (RD), gingival recession width (RW), percentage root coverage (RC), probing depth (PD), width of keratinized tissue (KT), and clinical attachment level (CAL).Twelve months after surgery, a statistically significant gain in CAL (3.2 +/- 0.8 mm, P0.001) and increase in KT (1.2 +/- 0.4, P0.001) were assessed. In 80% of the treated sites, 100% RC was achieved (mean 96%).The results of this study demonstrated that the use of e-MCTG technique allowed the treatment of multiple adjacent recessions with adequate wound healing and highly predictable root coverage. This procedure can be applied favorably in treating multiple gingival recessions in one surgery.

A major goal in the treatment of burn patients is to achieve wound closure in a rapid, cosmetically, and functionally satisfactory manner. In a previously published article [1] we demonstrated the successful wound management of a 19-year-old patient with 76% of his body surface burnt. On 63% of the body surface, a largely complication free wound healing could be achieved by using the dermis equivalent Integra® in combination with autologous keratinocytes, fibroblast suspensions of different concentration and split thickness skin as a 1:6 mesh graft. A correlation between the time needed for complete wound closure and the number of fibroblasts applied could be observed.

Pregnancy and delivery were uneventful in a woman who conceived within six weeks after an abdominal reconstruction with a Marlex® mesh graft for aesthetic reasons. One year after vaginal delivery, the abdominal wall reconstruction was still completely intact.

Sideways meshing of a split thickness skin graft can be of value where cosmesis requirements are high.

Reconstruction of long anterior urethral strictures that cannot be excised and reanastomosed remains controversial. We critically reviewed the literature on free-graft and pedicled skin-flap urethroplasty to determine the optimal method of repair. Overall, free grafts were successful in 84.3% of cases and flaps, in 85.9%. Buccal mucosa grafts are the most successful method for reconstruction of bulbar urethral strictures. For strictures in the penile urethral or a compromised graft bed a distal penile skin flap is the most reliable and tested approach. Dorsal free-graft urethroplasty may be considered when penile skin deficiency prevents use of a flap. For the most complex strictures, in which a flap is not possible and the graft bed is of poor quality, a mesh graft in two stages may be the only option. Thus, for reconstruction of complex anterior urethral strictures, both free-graft and flap procedures remain indispensable.

In skin grafting operations for patients with extensive burn injuries, mesh techniques are often employed to enlarge the effective surface area covered by autografts. However, substantial strips of autograft are required and the distribution of autograft elements on the wound surface is relatively uneconomical. An alternative technique for expanding autografts, first described by Meek in 1958, makes use of a special dermatome and prefolded gauzes to obtain a regular expansion of autograft squares from small pieces of split skin grafts. In a simple in vitro experiment using allograft skin, the expansion ratio obtained with the Meek micrograft technique was measured at almost 1:9. In contrast, the expansion ratio obtained with allograft meshed '1:6' with a Zimmer Dermatome II was measured at 1:4. The maximum distance between the graft elements obtained with the Meek technique was 9 mm, compared to a maximal distance between the strands of the mesh graft of 12 mm. The Meek technique is a useful alternative to mesh grafts when donor sites are limited. Clinical experience suggests that Meek grafts are also particularly suitable for grafting on granulating wounds under poor conditions.

A simple and economical mesh graft expansion wheel is described. The instrument does not need any consumables--carriers for example--and is very low priced compared with other expanders. A small institution or a private practising surgeon in this country can afford it. It is possible to increase or reduce the number of wheels to individual surgeon's requirements. Different expansion ratios can be obtained by simple changes in design.

Long urethral strictures remain one of the hazards of modern urology. Reconstructive operations with scrotal skin suffer a high rate of recurrent stricture. To avoid complications, meshed split thickness skin graft or foreskin was used to construct a neourethra. In stage 1 split thickness skin graft is harvested and transplanted along the opened urethra. In stage 2 the neourethra is formed 8 to 12 weeks later. Since 1977 mesh graft urethroplasty has been performed in 96 patients using meshed foreskin (76) or split thickness skin grafts (23). In all but 1 patient excellent anatomical and functional results were achieved regardless of which type of graft was used. This technique was most useful in exceedingly long or problematic strictures, for example in spinal cord injury patients. (J. Urol., 142: 1223-1226, 1989)

Lanz described mesh grafting in 1907. A similar device was used earlier by Paré and Heister for different applications. Historical analysis reveals a definite link between old scarificators and mesh graft machines.

This is the first case report of a perineal hernia repair following abdominoperineal excision of rectum employing a purely perineal approach for interposition of a mesh graft.

From 1977 to December 1983 a total of 64 patients with posterior, anterior or extended urethral stricture have been treated by using free-foreskin grafts after the mesh transplant procedure. This operation is completed as a two-stage procedure. Of paramount importance for success is the open and dry treatment of the graft to assure an ideal situation for later reconstruction. Healing without the formation of fibrous tissue is the rule. In 63 patients this method was applied with an excellent anatomical and functional result. The most important indications are recurrent strictures after several operations, extended strictures of the whole length of the urethra, strictures with chronic inflammations, as well as problematic strictures in paraplegics.

The primary treatment of extensive, deep 3 degrees burn injuries of the lower leg can lead to adhesion of the split-thickness graft with the anterior tibial shaft. Chronic recurring defects with correlative soft-tissue infection can be the consequences, which complicate the patient's rehabilitation. In most cases large defects are involved, so that the secondary reconstructive measures must be planned on accordingly generous scale. The transfer of a latissimus dorsi free flap enables the surgeon to cover defects of almost the entire anterior aspect of the lower leg as well as the ventral circumference. We covered the muscle surface with mesh graft. All patients on whom this technique was practiced achieved an adequate, stable skin coverage without further recurrence of infection. A description of the technique is given based on case reports and their subsequent follow-up.

Summary— In the last 3 years 268 patients with urethral strictures have attended this unit. We treat most strictures by urethrotomy and consider an open operation only after two recurrences or in patients whose strictures are considered unsuitable for urethrotomy. Open operations have been performed on 42 patients. Although several types of operation have been used, most comprised an end-to-end anastomosis or Blandy's scrotal flaps. In the last few years a split-skin mesh graft has been used to replace the posterior urethra and the advantage of this technique is that the new urethra is soft and hairless. We present our experience with this method and our overall results.

Using the mesh graft II dermatome (Zimmer) for split skin graft expansion, the 3 to 1 and 1·5 to 1 expansion rates were evaluated for true clinical expansion. In one hundred and one 1·5 to 1 expanded grafts the actual expansion was 1·2 and in sixty 3 to 1 expanded grafts, it was 1·5.

Four upper extremity replantations were carried out. In one patient amputation was complete at the wrist; a narrow pedicle of skin was spared in one case; one and two traumatized nerves remained in the other two. In two cases, postoperative arterial thrombosis required immediate reexploration with further revision of the artery. Lymph from reimplanted limb was allowed to drain freely through a long releasing incision covered with mesh graft to minimize increase of tissue pressure and likelihood of venous thrombosis. In all, circulation was successfully reestablished and a viable extremity obtained. Two patients have had excellent long-term results. In one patient, the radial nerve, successfully repaired, was inadvertently disrupted at the same level of the initial injury during a secondary procedure. It was repaired again and regenerated fully.