Search

Apichat Asavamongkolkul,1 Ekkarin Chotikawanich2 1Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Apichat Asavamongkolkul, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand, Tel/Fax +66 2-419-7968, Email apichat.asa@mahidol.ac.thAbstract: We report the case of a patient with Ewing sarcoma involving the right pelvis in a 14-year-old girl who had multicycles of neo-adjuvant chemotherapy and preoperative radiation therapy. She underwent an internal hemipelvectomy type I resection, according to Enneking and Dunham’s classification without bony reconstruction. There was no intra- and perioperative complication. The patient has good function and needs no gait aids. She can walk with equinus foot compensated for leg shortening 5 centimeters and without a shoe-lift. There is no sign of disease relapse. However, she developed late ureteral stricture at 8-year postoperatively and was successfully treated with a ureteral stent.Keywords: internal hemipelvectomy, Ewing sarcoma, ureteric stricture, limb-sparing surgery, radiation therapy, mesh graft

Infectious complications such as invasive aspergillosis or infection with Stenotrophomonas maltophilia (SM) in immunocompromised patients are associated with a high mortality rate. Our report concerns a 40-year-old male newly diagnosed very severe aplastic anemia (vSAA) who in consequence of a mosquito bite was suffering from skin lesion and consecutive soft tissue phlegmon subsequent to the administration of antithymocyte globulin; a full-thickness autologous meshed skin graft successfully performed to cover skin ulcera after allogeneic stem cell transplantation (SCT). This unusual case illustrates the importance of appropriate diagnosis, anti-infective therapy and close interdisciplinary diagnostic algorithms to minimalize side effects and the selection of resistant strains and to improve patients’ outcome.

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Avulsion injuries involving upper extremity are challenging in most cases. The musculoskeletal and main neurovascular parts on the injured region are unharmed. Even though the hand functions are maintained well, it is difficult to reconstruct large areas of defective skin. This specific case report demonstrates the mesh autograft methodology to successfully reconstruct the skin loss after a forearm skin avulsion injury.

The use of foreign materials in modern herniology, on the one hand, reduces the number of recurrences, and on the other - increases the risk of several complications: profuse exudation and possible infection in the postoperative wound, extensive cicatricial deformation of a zone of operations, persistent pain syndrome and possible reduced fertility in men. In the experiment 30 rats were studied influence of drugs «mesogel®» and «iodopiron» in the course of wound process during operations using mesh explant. Histological methods were evaluated the usefulness of the formation of connective tissue, degree of involvement in cicatricial process is located in the area of operation of tissues and structures. Compared with the control group of animals is set to a relatively low density and fewer collagen fibers. In the control group of animals had a marked proliferative response in the surrounding tissue prosthesis, gross deformity and involvement in the scar process near structures.

Infectious complications such as invasive aspergillosis or infection with Stenotrophomonas maltophilia (SM) in immunocompromised patients are associated with a high mortality rate. Our report concerns a 40-year-old male newly diagnosed very severe aplastic anemia (vSAA) who in consequence of a mosquito bite was suffering from skin lesion and consecutive soft tissue phlegmon subsequent to the administration of antithymocyte globulin; a full-thickness autologous meshed skin graft successfully performed to cover skin ulcera after allogeneic stem cell transplantation (SCT). This unusual case illustrates the importance of appropriate diagnosis, anti-infective therapy and close interdisciplinary diagnostic algorithms to minimalize side effects and the selection of resistant strains and to improve patients' outcome. [ABSTRACT FROM AUTHOR]

Avulsion injuries involving upper extremity are challenging in most cases. The musculoskeletal and main neurovascular parts on the injured region are unharmed. Even though the hand functions are maintained well, it is difficult to reconstruct large areas of defective skin. This specific case report demonstrates the mesh autograft methodology to successfully reconstruct the skin loss after a forearm skin avulsion injury. [ABSTRACT FROM AUTHOR]

Background: muscle herniations usually present in athletes especially in the lower legs; occurring through defects in the deep fascial layer of the muscles and typically seen following local blunt trauma or muscle hypertrophy after strenuous exercise. Management of muscle hernias varies from conservative therapy to surgical repair and usually needs multidisciplinary collaboration for differential diagnosis. Methods: herein tibialis anterior muscle hernia in 17-year-old male soccer player was presented. The diagnosis was confirmed with dynamic ultra-sonographic views changing with the different movements of the ankle. Since the symptoms were not relieved with conservative methods, surgical repair of the defect was offered. Results: we preferred to repair fascial defect with double layer and Mesh graft that were placed over primary suture repair. No complications were reported such as wound or mesh infection postoperatively. The patient was clinically satisfied and returned his previous activity level after 3 months of surgery. After 2 years of follow-up the feature of the bulge was dissolved and player was satisfied with the operation. Conclusion: knowledge of the lower extremity muscle herniation is essential for both proper management and/or surgical referral. The importance of protective devices in prevention, dynamic ultra-sonography in diagnosis and double layer repair of the fascial defect with Mesh graft in treatment of muscle herniations were highlighted. [ABSTRACT FROM AUTHOR]

Purpose: Primary malignant bone tumours and soft tissue sarcomas of the chest wall are exceedingly rare entities. The aim of this study was a retrospective two-institutional analysis of surgical therapy with respect to the kind and amount of the resection performed, the type of reconstruction and the oncological outcome. Methods: Between September 1999 and August 2010 31 patients (seven women and 24 men) were treated due to a primary malignant bone tumour or soft tissue sarcoma of the chest wall in two centres. Eight low-grade sarcomas were noted as well as 23 highly malignant sarcomas. The tumours originated from the sternum in six cases, from the ribs in 12 cases, from the soft tissues of the thoracic wall in 11 cases and from a vertebral body and the clavicle in one case each. Results: In 26 cases wide resection margins were achieved, while four were intralesional and one was marginal. In all 31 cases the defect of the chest wall was reconstructed using mesh grafts. At a mean follow-up of 51 months 20 patients were without evidence of disease, three were alive with disease, seven patients had died and one patient was lost to follow-up. One recurrence was detected after wide resection of a malignant triton tumour. Conclusions: Primary malignant bone tumour or soft tissue sarcoma of the chest wall should be treated according to the same surgical oncological principles as established for the extremities. Reconstruction with mesh grafts and musculocutaneous flaps is associated with a low morbidity. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the effectiveness of prophylaxis antibiotic used for tension-free hernioplasty on prevention of surgical wound infection. Materials and Methods: After having permission from the Ethical Review Board of the hospital, this randomized double-blinded placebo-controlled trial was performed from September 2010 to June 2011. One hundred and six patients with inguinal hernias, American Society of Anesthesiologists (ASA) Class 1-2, who never had allergy to cephalosporin and aged over 18 years-old were included. Fifty and 56 patients were allocated to the intervention and control groups, respectively. Results: At one-week follow-up, there was no difference of infection rate among the control and intervention groups. In other words, there was no sign of wound infection found in all of 106 patients. All patients did well without sign of wound infection at one-month follow-up. Conclusion: There is no clear benefit of preoperative prophylactic antibiotic for prevention of post inguinal hernioplasty wound infection. For deep surgical site infection, a longer follow-up at one year is needed for completion of CDC criteria. [ABSTRACT FROM AUTHOR]

Background: Vacuum assisted closure (VAC) is established in the management of acute and chronic wounds. In recent years, few data have been published concerning VAC therapy after skin graft transplantation. Objectives: The aim of this study was to determine whether postoperative VAC helps assist closure of mesh grafts in chronic leg ulcer patients. Patients/Methods: We report a consecutive case series of 54 patients with chronic leg ulcers who received a total of 74 mesh grafts. A postoperative VAC therapy was performed in 28 mesh grafts, and 46 mesh grafts were treated with standard gauze therapy. Results: In the VAC group, 92.9% of grafts showed complete healing, compared to 67.4% in the control group without postoperative VAC therapy. Differential analysis revealed a negative correlation of the take rate in patients over 70 years of age or in patients suffering from diabetes mellitus or dermatoliposclerosis. Particularly patients with diabetes mellitus and of greater age exhibited improved take rates, both 100%, in the VAC group compared to 50 and 62%, respectively. Conclusion: The results of our retrospective study demonstrate for the first time the significant benefit of VAC therapy after skin grafting in chronic leg ulcer patients as evaluated in a clinical trial. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: The aim of this study is the preparation and characterization of cefazolin-impregnated meshes (Surgipro; Tyco Healthcare USSC, Norwalk, CT, USA) to be used as antimicrobial devices. Methods: During the impregnation, poly(dl-lactide-co-glycolide) solution with cephazolin in dichloromethane was used as coating material. In vitro release experiment was carried out first; later cefazolin-impregnated meshes were evaluated for the characteristics of antimicrobial efficacy and in the last part of the study native and cefazolin-impregnated meshes were implanted in the rats. Cefazolin content was proposed as the effective parameter to control the cefazolin release rate and it was concluded that the higher amounts of initial cefazolin content caused higher release rates. In all cases (or with different cefazolin content for each mesh), the release rates were very rapid in the first 24 h and in the following periods rather slow release rates were obtained. Results: Antimicrobial activity was increased in the case of cefazolin-impregnated form and this efficiency was also increased by the higher amount of cefazolin in certain mesh pieces. Similar antimicrobial activities were observed in the in vitro studies. Conclusion: In this study, almost all of the cefazolin-impregnated mesh grafts showed very high antimicrobial activity compared with the bare mesh (or mesh without cefazolin). [ABSTRACT FROM AUTHOR]

Between 1994 and 2001 we used the vacuum-sealing technique in 478 skin grafts. Indications included large soft-tissue defects resulting from trauma, skin loss due to degloving injuries, burns, and infected/contaminated wound surfaces. The technique involves direct placement of the white polyvinyl alcohol pad directly onto the transplanted skin. The necessary negative pressure is generated by redon flasks yielding a negative pressure of 60–80 kPa (high-pressure system). In extensive wounds a vacuum pump is used. The high pressure used does not result in necrosis. In 11 patients poor wound conditions resulted in only partial healing. Three patients with pseudomonas infections experienced complete loss of the graft. The vacuum-sealing technique permits a moderate moist and warm wound treatment with stable fixation of the transplant even in cases of large wounds or those with irregular contours. The method is not suitable in cases of infection or contamination with pseudomonas species. [ABSTRACT FROM AUTHOR]

As a therapeutic option, grafting of venous ulcers has not been very successfully received despite the different types of grafting methods. Currently, there are only a few controlled randomized trials offering clear guidance to clinicians. The development of artificially bioengineered skin constructs has led to a renewed interest in wound bed preparation, and preliminary successes suggest that the role of skin grafting could be studied in the current context. [ABSTRACT FROM PUBLISHER]

Background Pouchitis is a non-specific inflammation of the ileal reservoir and the most frequent complication that patients experience in long periods. Diagnosis should be made based on the clinical, endoscopic, and histological aspects. Prediction of pouchitis is an important issue for the physician. Objectives The study was aimed to identify the predictive factors of pouchitis as well as their importance. Patients and Methods In the present study, two classification techniques entitled decision trees method and logistic regression analysis were used to help the physician in prediction of pouchitis in ulcerative colitis (UC) patients. These patients are submitted to a specific surgery. The ability of these two methods in prediction is achieved by comparison of the accuracy of the correct predictions (the minimum error rate) and the interpretability and simplification of the results for clinical experts. Results The accuracy rate in prediction is 0.6 for logistic regression method and 0.45 for decision tree algorithm. In addition, the mean squared error is lower for logistic regression (0.41 versus 0.48). However, the area under the ROC is more for decision tree than logistic regression (0.52 and 0.45 respectively). Conclusions The results are not in favor of none of these two methods. However, the simplicity of decision tree for clinical experts and theoretical assumptions of logistic regression method make the choice clear. But more sample size may be needed to choose the best model with more confident.

Introduction In spite of the advances in prenatal and neonatal medicine, giant omphalocele (GO) has remained as a challenge for pediatric surgeons. Although different techniques have been introduced for treating GO, the ideal treatment would be a primary closure without compromising the respiratory system or multiorgan failure. However, reaching this goal is challenging due to the high degree of visceroabdominal disproportion. This present study described the results of primary or secondary closure of five GO cases using the “bilateral mesh graft” technique. Case presentation Five consecutive GO patients were treated in our department. Two patients underwent a primary closure, while three other patients underwent a secondary closure using the “bilateral mesh graft” technique. When two mesh grafts were bilaterally fixed to the rectus abdominis muscles, the abdominal wall was reconstructed in the midline. All 5 patients were closely monitored for potential complications and a follow-up was also performed for each patient after they were discharged. Discussion The “bilateral mesh graft” technique was performed on the pediatric patients with a median age of 2.5 months (range 3 days to 6 months). The median diameter of the abdominal wall defect was 9 cm (range 7-10 cm). Moreover, the median was increased in bladder pressure after closure was 6.4 cm H2O (range 3-10 cm H2O). One of the patients who underwent secondary closure was diagnosed with a congenital heart condition and died postoperatively due to heart failure and respiratory insufficiency. The median hospital staying duration of the four surviving cases was 4.5 days with minimal complications. During the follow-up appointments, all four surviving patients exhibited normal weight gain and a soft abdomen with no infections or erosions detected at the site of surgery. The “bilateral mesh graft” technique yielded good clinical outcomes in both the primary and secondary closure cases. However, prior to surgery, particularly in the primary closure cases, the patients must be evaluated for respiratory function and additional congenital anomalies, such as heart conditions, in order to minimize potential complications. Nevertheless, further research is still needed in order to determine the long-term effects of the functional aspects on the abdominal wall muscles and viscera.

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Symptomatic muscle herniations are an unusual cause of upper extremity pain in the athlete that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion. This article describes a successful repair of a 21-year-old rock climber’s ventral forearm herniation with polypropylene mesh. [ABSTRACT FROM PUBLISHER]