Defect engineering synergistically boosts the catalytic activity of Fe-MoOv for highly efficient breast mesh antitumor therapy.

The demand for breast mesh with antitumor properties is critical in post-mastectomy breast reconstruction to prevent local tumor recurrence. Molybdenum-based oxide (MoOx) exhibits enzyme-like activities by catalyzing endogenous hydrogen peroxide to produce reactive oxygen species for inducing tumor cell apoptosis. However, its catalytic activity is limited by insufficient active sites. Herein, a defect engineering strategy is proposed to create redox nanozymes with multiple enzymatic activities by incorporating Fe into MoOx (Fe-MoOv). Fe-MoOv is subsequently integrated into polycaprolactone (PCL) to fabricate breast meshes for establishing an enzyme-catalyzed antitumor platform. The doping of Fe into MoOx formed numerous defect sites, including oxygen vacancies (OV) and Fe substitution sites, synergistically boosting the binding capacity and catalytic activity of Fe-MoOv. Density functional theory calculations demonstrated that the outstanding peroxidase-like catalytic activity of Fe-MoOv resulted from the synergy between OV and Fe sites. Additionally, OV contributes to the localized surface plasmon resonance effect, enhancing the photothermal capability of the PCL/Fe-MoOv mesh. Upon near-infrared laser exposure, the catalytic activity of the PCL/Fe-MoOv mesh is further improved, leading to increased generation of reactive oxygen species and enhanced antitumor efficacy, achieving 86.7% tumor cell mortality, a 264% enhancement compared to the PCL/MoOx mesh.

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

OBJECTIVE: Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. METHODS: We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). RESULTS: We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. CONCLUSIONS: Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

[Complicated right Bochdalek hernia]. / Hernia de Bochdalek derecha complicada.

The clinical case of a 53-year-old woman diagnosed with a right Bochdalek hernia complicated by intestinal obstruction is presented. This type of diaphragmatic hernia is rare, especially those located on the right side, but is the most common non-hiatal hernia. Her diagnosis focused on the computed tomography of the chest and abdomen and the repair was performed using a laparoscopic approach. A primary closure was carried out associated with the placement of polypropylene mesh. Her evolution was favorable, with no complications associated with the procedure.

Se presenta el caso clínico de una mujer de 53 años diagnosticada con una hernia de Bochdalek derecha complicada con oclusión intestinal. Este tipo de hernias diafragmáticas son raras, especialmente las localizadas en lado derecho, pero constituyen aquellas no hiatales más frecuentes. El diagnóstico se centró en la tomografía computarizada de tórax y abdomen, y la reparación se realizó mediante una malla de polipropileno. La evolución fue favorable, sin complicaciones asociadas al procedimiento.

Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis.

OBJECTIVE: This meta-analysis aims to compare the clinical efficacy of mesh non-fixation and fixation in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair, systematically evaluating the application value of the mesh non-fixation technique in clinical settings. METHODS: A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases was conducted to identify randomized controlled trials (RCTs) comparing mesh non-fixation and fixation in TAPP inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence grading system was employed for outcome quality assessment. Publication bias analysis was performed using Begg's test. A trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software. RESULTS: A total of nine RCTs involving 1,879 inguinal hernia patients were included. Meta-analysis results demonstrated that, compared to the fixation group, the non-fixation group exhibited significantly lower seroma occurrence rate [RR = 0.43, 95% CI (0.20, 0.89), P = 0.02, heterogeneity P = 0.28, I²=22%], Visual Analog Scale (VAS) pain score at 6 months postoperatively [MD=-0.21, 95% CI (-0.29, -0.12), P < 0.00001, heterogeneity P = 0.34, I²=0%], and cost [MD=-3.23 thousand yuan, 95% CI (-4.26, -2.19), P < 0.00001, heterogeneity P = 0.0003, I²=92%]. There were no statistically significant differences in overall complication rate [RR = 0.88, 95% CI (0.62, 1.23), P = 0.45, heterogeneity P = 0.11, I²=44%], overall infection event rate [RR = 0.96, 95% CI (0.36, 2.56), P = 0.93, heterogeneity P = 0.62, I²=0%] and recurrence rate [RR = 0.75, 95% CI (0.28, 1.99), P = 0.56, heterogeneity P = 0.44, I²=0%] between the two groups. The results of the TSA indicated that the observed lower seroma occurrence rate in the non-fixation group compared to the fixation group requires further validation through the inclusion of additional RCTs. CONCLUSION: Mesh non-fixation in TAPP inguinal hernia repair is deemed safe and does not elevate the risk of hernia recurrence. However, given certain limitations in this study, future comprehensive and reliable validation will require further multicenter, high-quality, large-sample double-blind RCTs.

The efficacy of wrapping with polyglycolic acid mesh and fibrin glue in preventing clinically relevant pancreatic fistula after minimally invasive distal pancreatectomy (WRAP Study): study protocol for a multicenter randomized controlled trial in Japan.

BACKGROUND: Postoperative pancreatic fistula (POPF) continues to be the most common complication after distal pancreatectomy (DP). Recent advancements in surgical techniques have established minimally invasive distal pancreatectomy (MIDP) as the standard treatment for various conditions, including pancreatic cancer. However, MIDP has not demonstrated a clear advantage over open DP in terms of POPF rates, indicating the need for additional strategies to prevent POPF in MIDP. This trial (WRAP study) aims to evaluate the efficacy of wrapping the pancreatic stump with polyglycolic acid (PGA) mesh and fibrin glue in preventing clinically relevant (CR-) POPF following MIDP. METHODS: This multicenter, randomized controlled trial will include patients scheduled for laparoscopic or robotic DP for tumors in the pancreatic body and/or tail. Eligible participants will be centrally randomized into either the control group (Group A) or the intervention group (Group B), where the pancreatic stump will be reinforced by PGA mesh and fibrin glue. In both groups, pancreatic transection will be performed using a bioabsorbable reinforcement-attached stapler. A total of 172 patients will be enrolled across 14 high-volume centers in Japan. The primary endpoint is the incidence of CR-POPF (International Study Group of Pancreatic Surgery grade B/C). DISCUSSION: The WRAP study will determine whether the reinforcement of the pancreatic stump with PGA mesh and fibrin glue, a technique whose utility has been previously debated, could become the best practice in the era of MIDP, thereby enhancing its safety. TRIAL REGISTRATION: This trial was registered with the Japan Registry of Clinical Trials on June 15, 2024 (jRCTs032240120).

Modification of transvaginal polypropylene mesh with co-axis electrospun nanofibrous membrane to alleviate complications following surgical implantation.

BACKGROUND: Surgeries for treating pelvic organ prolapse involving the utilization of synthetic mesh have been associated with complications such as mesh erosion, postoperative pain, and dyspareunia. This work aimed to reduce the surgical implantation-associated complications by nanofibrous membranes on the surface of the polypropylene mesh. The nanofiber of the nanofibrous membrane, which was fabricated by co-axial electrospinning, was composed of polyurethane as fiber core and gelatin as the fiber out layer. The biocompatibility of the modified mesh was evaluated in vitro by cell proliferation assay, immunofluorescence stain, hematoxylin-eosin (HE) staining, and mRNA sequencing. Polypropylene mesh and modified mesh were implanted in a rat pelvic organ prolapse model. Mesh-associated complications were documented. HE and Picro-Sirius red staining, immunohistochemistry, and western blotting were conducted to assess the interactions between the modified mesh and vaginal tissues. RESULTS: The modified mesh significantly enhanced the proliferation of fibroblasts and exerted a positive regulatory effect on the extracellular matrix anabolism in vitro. When evaluated in vivo, no instances of mesh exposure were observed in the modified mesh group. The modified mesh maintained a relatively stable histological position without penetrating the muscle layer or breaching the epidermis. The collagen content in the vaginal wall of rats with modified mesh was significantly higher, and the collagen I/III ratio was lower, indicating better tissue elasticity. The expression of metalloproteinase was decreased while the expression levels of tissue inhibitor of metalloproteinase were increased in the modified mesh group, suggesting an inhibition of collagen catabolism. The expression of TGF-ß1 and the phosphorylation levels of Smad3, p38 and ERK1/2 were significantly increased in the modified mesh group. NM significantly improved the biocompatibility of PP mesh, as evidenced by a reduction in macrophage count, decreased expression levels of TNF-α, and an increase in microvascular density. CONCLUSIONS: The nanofibrous membrane-coated PP mesh effectively reduced the surgical implantation complications by inhibiting the catabolism of collagen in tissues and improving the biocampibility of PP mesh. The incorporation of co-axial fibers composed of polyurethane and gelatin with polypropylene mesh holds promise for the development of enhanced surgical materials for pelvic organ prolapse in clinical applications.

The influence of simultaneous posterior colporrhaphy and perineoplasty on the efficiency and safety of mesh-augmented sacrospinal fixation (apical sling) in advanced POP repair.

BACKGROUND: Pelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40-60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation. METHODS: It is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge. DISCUSSION: The aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence. TRIAL REGISTRATION: NCT05422209. Registered on 18 May 2022.

Polyvinylidene fluoride prosthetic reinforcement in abdominal wall hernia surgery.

INTRODUCTION: Surgical repair of the anterior abdominal wall hernia is the most common intervention in general surgery practice. The introduction of synthetic prostheses reduces the frequency of recurrences, but in many cases, they are associated with complications that could seriously impair the quality of life of patients. To reduce perioperative complications, we introduced in our practice innovative prostheses made of a highly inert polymer, polyvinylidene fluoride (PVDF), and conducted an observational study.

[Mediastinal Dedifferentiated Liposarcoma Reconstructing Defected Chest Wall Using Prosthetic Materials:Report of a Case].

Present case is a 74-year-old man, given a diagnosis of huge mediastinal dedifferentiated liposarcoma. Surgical complete resection of the tumor and involved anterior chest wall( all body of sternum and bilateral 3rd~5th rib) followed by reconstruction of the defected chest wall using three artificial prosthetic materials of putting titanium mesh plate between ePTFE mesh seat at inner (mediastinal) site and polypropylene mesh seat at outer site was perfomed. The patient is doing well without respirately failure and disease free even 6 years after surgery. This surgical procedure could be thought of effective treatment method in sense of preventing postoperative complication and preserving respiratory function.

[Research Status and Safety Considerations of Animal-Derived Mesh Products].

With the development of the economy and technological progress, more and more animal-derived mesh products are being utilized in the medical field for tissue and organ repair and replacement. Owing to the complexity of their structure and production process, these animal-derived meshes still face several challenges in practical applications, such as insufficient mechanical strength, rapid degradation rates, and the detection of harmful leachable substances. Among these challenges, the production process is a key factor affecting product quality. This paper reviews the key aspects of the production process and quality control for animal-derived meshes in China, offering new insights for the quality control and regulatory oversight of such products.

Biomechanical Study on the Comparison of Synthetic Materials for Cranio-Orbital Fracture Repair.

OBJECTIVE: For analyzing the mechanical properties of 2 cranio-orbital repair materials under distinct external impacts by finite element analysis and evaluating the stability of various repair materials. METHODS: Based on the computed tomography images of the patients with cranio-orbital fractures, three-dimensional models of the normal craniomaxillofacial models were established by segmenting them with Mimics 19.0, Geomagic Studio 12.0, and UG 12.0, respectively, to build the finite element models of titanium repair fixation and the poly-ether-ether-ketone repair fixation. The models were then simulated by Ansys 19.2, with divergent impact forces to analyze the stresses and displacements of the repair materials, as well as the internal fixation system, and to make a comparison on the stability of the distinct repair materials. RESULTS: The titanium mesh is stable at impact forces ≤1500 N. Furthermore, the poly-ether-ether-ketone mesh and the internal fixation system are resistant to fracture and displacement at impact forces of up to 3000 N. CONCLUSION: By simulating distinct mechanical environments, the biomechanical finite element analysis method can digitally assess the mechanical properties of cranio-orbital repair materials and objectively evaluate the stability of the repair materials and the internal fixation system.

Biologic grafts for pelvic organ prolapse repairs: what have we learned in the last 20 years?

PURPOSE OF REVIEW: The ideal graft material for the augmentation of pelvic organ prolapse (POP) has yet to be discovered. While synthetic mesh offers durable repairs this can be at the expense of mesh complications. Biologic grafts have been considered an alternative. This chapter reviews biologic graft materials as applied to POP surgery. RECENT FINDINGS: The heterogeneity of available graft materials and definitions of success in POP literature make comparisons difficult. There may be utility in the augmentation of apical prolapse with autologous grafts. There is also modest evidence to support anterior wall augmentation with biologic grafts. However, a 2024 Cochrane review concluded there is not enough evidence to support routine use of grafts for transvaginal repairs. SUMMARY: Biologic grafts can be considered in certain cases. There continues to be a need for finding the ideal "graft-patient" combination. The field particularly needs more robust research in the recurrent POP patient population.

Management of Persistent Diplopia and Epiphora in Mismanaged Orbital Blowout Fracture - A Case Report.

ABSTRACT: A 31-year-old male with a history of right zygomaticomaxillary complex (ZMC) fracture presented with aesthetic concerns, continuous tearing, and double vision. The patient had undergone multiple surgeries post accident, resulting in an asymmetrical cheek bulge, persistent diplopia, and epiphora. Investigations revealed abnormal placement of an orbital mesh and damage to the lacrimal sac. A surgical plan was devised to remove the plates, reposition the muscles, secure the floor, correct the epiphora, and provide the desired aesthetics. The surgery involved removal of the mesh and a long plate, refracturing of the zygoma, approximation and securing of the fractured zygoma with plates, and creation of an osteum on the lateral wall of the nose. Post-operatively, the patient's healing was uneventful and he was satisfied with the outcome. This case underscores the importance of a proper surgical technique and patient-centered care in managing complex facial fractures.

[Experimental study on repairing rat abdominal wall defect with chitosan hydrogel/polypropylene mesh composite].

Objective: To investigate the improvement effects and mechanisms of composite chitosan (CS) hydrogel on traditional polypropylene (PP) mesh for repairing abdominal wall defects. Methods: CS hydrogel was prepared via physical cross-linking and then combined with PP mesh to create a CS hydrogel/PP mesh composite. The internal structure and hydrophilicity of the composite were characterized using macroscopic observation, upright metallographic microscope, scanning electron microscopy, and water contact angle measurements. The performance of the composite (experimental group) in resisting cell adhesion and supporting cell infiltration was assessed through fibroblast (NIH-3T3) infiltration experiments and human umbilical vein endothelial cells (HUVECs) tube formation assays, and simple cells were used as control group. Finally, a bilateral abdominal wall defect model (1.5 cm×1.0 cm) was established in 18 Sprague Dawley rats aged 8-10 weeks, with the composite used on one side (experimental group) and PP mesh on the other side (control group). The effects on promoting wound healing, preventing adhesion, angiogenesis, and anti-inflammation were investigated through macroscopic observation, histological staining (HE and Masson staining), and immunohistochemical staining (CD31, CD68). Results: The composite appeared as a pale yellow, transparent solid with a thickness of 2-3 mm, with the PP mesh securely encapsulated within the hydrogel. Scanning electron microscopy revealed that the hydrogel contained interconnected pores measuring 100-300 µm, forming a porous structure. Contact angle measurements indicated that CS hydrogel exhibited good hydrophilicity, while PP mesh was highly hydrophobic. In vitro cell culture experiments showed that DAPI staining indicated fewer positive cells in the experimental group after 1 day of culture, while the cells in control group covered the entire well plate. After 3 days of culture, the cells in experimental group were spherical and displayed uneven fluorescence, suggesting that the material could reduce cell adhesion while supporting cell infiltration. HUVECs tube formation experiments demonstrated an increase in cell numbers in experimental group with a trend towards tube formation, while cells in control group were sparsely distributed and showed no migration. In the rat abdominal wall defect repair experiment, results showed that after 1 week post-surgery, the experimental group had tissue and blood vessels infiltrating, and by 4 weeks, the integrity was well restored with significant regeneration of muscle and blood vessels, while the control group exhibited adhesions and incomplete healing. HE staining results indicated weaker cell infiltration in the experimental group, with cell density significantly higher than that of the control group at 2 and 4 weeks post-surgery ( P<0.05). Masson staining revealed that collagen fibers in the experimental group were arranged neatly, with significantly increased collagen content at 2 weeks post-surgery ( P<0.05), while collagen content was similar in both groups at 4 weeks ( P>0.05). Immunohistochemical staining showed that CD31-positive cells were evenly distributed between muscle layers in the experimental group, whereas the control group exhibited notable defects. At 2 weeks after operation, the CD31-positive cell ratio was significantly higher than that in the control group ( P<0.05); at 2 and 4 weeks after operation, the CD68-positive cell ratio in the experimental group was significantly lower than that in the control group ( P<0.05). Conclusion: CS hydrogel has a positive effect on preventing adhesions and promoting wound healing, exhibiting anti-inflammatory and pro-angiogenic properties during the healing process. This provides a promising strategy to address challenges related to abdominal adhesions and reconstruction.

Static reanimation of the paralyzed face using non-absorbable polypropylene mesh.

<br><b>Introduction:</b> There are 2 methods for correcting facial deformities resulting from facial nerve paralysis - dynamic and static. Although dynamic methods are the standard approach in selected patient groups, static facial suspension using synthetic material provides a minimally invasive alternative for those who do not qualify for them.</br> <br><b>Aim:<b> Presenting experiences with the use of non-absorbable polypropylene mesh in the Department of Plastic Surgery in Polanica-Zdrój and reviewing the literature related to static facial reanimation methods.</br> <br><b>Materials and methods:</b> Fourteen patients underwent static facial tissue suspension using non-absorbable polypropylene mesh and 12 patients underwent surgery using classical autologous tissue techniques between 2019 and 2023. Indications for surgical treatment were analyzed, and preliminary results of treatment using both methods were compared.</br> <br><b>Results:</b> Compared to autologous tissue methods, surgeries using synthetic mesh were associated with shorter hospitalization times. No long-term postoperative complications were observed in any patient. There were no differences in treatment outcomes between autologous tissue and synthetic mesh techniques, and all patients assessed the outcome as favorable.</br> <br><b>Discussion:</b> Treatment of facial nerve paralysis sequelae using static techniques should be considered for patients not qualifying for surgery with dynamic methods and/or not consenting to such procedures. Using synthetic material as an alternative to autologous material reduces surgical time and avoids donor-site injuries and prolonged recovery.</br> <br><b>Conclusions:</b> Facial suspension with synthetic material is an effective, low-risk procedure for static correction of facial nerve paralysis sequelae.</br> <br><b>Study significance:</b> Emphasizing the importance of static methods in facial reanimation.</br>.

A comparative quantitative assessment of 3D-printed PEKK and PEEK thin meshes in customized alveolar bone augmentation.

OBJECTIVE: Customized nonabsorbable membranes are widely used in severe alveolar bone defects and provide sufficient and precise regenerated bone tissue for subsequent dental implant placement. Although 3D-printed polyetheretherketone (PEEK) meshes have confirmed successful use in clinical cases, the performance of a PEEK mesh is not satisfactory. Compared with PEEK, polyetherketoneketone (PEKK) has better mechanical and processing properties. However, whether PEKK is suitable for making customized membranes remains unclear. The objectives of this study were (1) to evaluate the printing precision, surface characteristics, mechanical characteristics and biocompatibility of the PEKK mesh and (2) to compare the properties of the PEKK and PEEK meshes. MATERIALS AND METHODS: Both PEKK and PEEK meshes were designed and manufactured via additive manufacturing technology combined with computer-aided design (CAD). The printing precision was evaluated with a high-resolution extraoral scanner. The surface characteristics were evaluated with a contact angle system and three-dimensional optical microscopy. The mechanical characteristics were evaluated via three-point bending tests and tensile tests. The biocompatibility was evaluated with a CCK-8 assay, live/dead viability assay and qRT-PCT. RESULTS: Compared with the PEEK mesh, the PEKK mesh exhibited better control in terms of the thickness and aperture area. Both the PEKK mesh and the PEEK mesh had a hydrophobic surface, but the PEKK mesh had a smoother surface. Compared with the PEEK mesh, the PEKK mesh has better compression and tensile properties. Both the PEKK mesh and the PEEK mesh had good biocompatibility. The proliferation of cells on the PEKK mesh was slightly lower than that on the PEEK mesh. CONCLUSIONS: Compared with PEEK mesh, PEKK mesh has greater printing accuracy, smoother surfaces, better mechanical properties and similar biocompatibility and is expected to be used in the production of customized barrier membranes for the augmentation of severe bone defects. To ensure the stability of the mesh for clinical application, it is best to control the aperture diameter of the PEKK mesh to less than 2 mm with a thickness of 0.2 µm.

Ergonomic differences in mesh placement and mesh fixation between laparoscopic and robotic inguinal hernia repair with mesh.

PURPOSE: General differences in surgeon ergonomics between laparoscopic and robotic-assisted inguinal hernia repairs (LIHR vs. RIHR) have been previously studied. However, specific differences in the ergonomics of mesh placement (MP) and mesh fixation (MF) are undetermined. Our aim was to determine if there are differences in the ergonomics of MP and MF between the surgical approaches. We hypothesize that we will identify differences, with the potential for worse ergonomics during LIHR. METHODS: Data was collected from fifteen LIHR and fifteen RIHR. All cases were elective, primary inguinal hernias completed by a fellowship-trained minimally invasive surgeon. Surface electromyography (EMG) of four upper extremity muscle groups, including the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR) and extensor digitorum (ED), was recorded bilaterally during MP and MF. Muscle activation as a percent of maximum voluntary contraction (%MVCRMS) and muscle fatigue denoted as the median frequency of muscle activations (Fmed) were calculated for each muscle. RESULTS: EMG analysis showed increased %MVCRMS in LIHR compared to RIHR cases, with significant findings in the left UT, right UT, ED, and FCR for MP and MF and the left FCR during MP. Muscle fatigue was decreased in LIHR compared to RIHR cases, with significant differences in left FCR and right ED and AD. CONCLUSION: Despite greater muscle activations during LIHR, RIHR had greater muscle fatigue. It is possible that short periods of high muscle activation are ergonomically protective during minimally invasive inguinal hernia repair. Identifying these differences may aid in development of procedure-specific interventions to improve ergonomics.

Bone augmentation using bioresorbable mesh domes containing bone graft granules.

Bone graft granules are valuable tools for ridge area bone grafting owing to their ease of manipulation and interconnected porous structure. Guided bone regeneration (GBR) using barrier membranes is commonly used for alveolar ridge augmentation; however, the surgical procedures are technically complicated. In this study, we fabricated bioresorbable mesh domes (BMDs) using two types of Vicryl mesh (woven and knitted types) containing carbonate apatite granules. BMD samples were prepared in three groups: upper sides made from the woven type (UW) and lower sides made from the woven type (LW) (the UW/LW group), upper sides made from the woven type (UW) and lower sides made from the knitted type (LK) (the UW/LK group), and upper sides made from the knitted type (UK) and lower sides made from the knitted type (LK) (the UK/LK group). The samples were subsequently implanted into rabbit calvaria, and radiomorphometric and histological analyses were conducted. The UK/LK group exhibited enhanced appositional bone formation because the knitted mesh on the skin side prevented the infiltration of a substantial amount of fibrous tissue. This increase in bone formation could be attributed to the interaction between granules and osteoprogenitors that pass through the mesh from the host bone. Conversely, the UW/LW and UW/LK groups presented limited appositional bone formation. Compared with knitted mesh, woven mesh might tend to be absorbed over a short span, allowing fibrous tissue invasion and inhibiting new bone formation. Additionally, BMDs could retain granules in a targeted location and avoid displacement of the granules to unintended locations.

Outcomes of Abductor Repair Using Mesh Augmentation in Oncologic Proximal Femur Replacement.

Reconstruction of the abductor mechanism remains a primary challenge with contemporary proximal femoral replacement (PFR) surgery. Previously, techniques such as trochanteric preservation or direct repair to the implant have been described; however, these strategies are limited in their ability to tension the repair and reattach other muscles of the hip girdle. The aim of this study was to evaluate the outcomes of patients undergoing oncologic PFR using a novel technique of mesh augmentation for soft tissue repair. METHODS: We reviewed 18 (mean age 64 years; 8 female: 10 male) consecutive patients undergoing PFR with Marlex mesh augmentation between 2018 and 2023 at a single institution. The most common indication was metastatic disease (n = 13). The mean follow-up in the 14 surviving patients was 27 months (range 12-34). RESULTS: All patients were ambulatory at final follow-up. There were no post-operative dislocations, infections, or wound issues. At the final follow-up, the mean total MSTS score was 77%. CONCLUSION: Mesh augmentation of PFRs allowed for adequate soft tissue tensioning and muscular attachment to the body of the implant. In our series, this technique was durable, with no dislocations and no mesh-related complications. In summary, mesh augmentation of PFRs may be considered during reconstruction for oncologic indications.