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The next-generation flexible wearable electronics are among the most rapidly growing industries due to their extended use in everyday applications resulting in an increased demand for cheaper, safer, and flexible energy storage devices. This study aims to investigate and enhance the overall performance of a Zn-MnO2 alkaline battery and make it suitable for safe and flexible wearable applications. To achieve high cyclability and performance of the cathode, issues of low active-material availability for redox reactions and inactive-phase formations are overcome by fabricating a binder-free hierarchical (increased surface area) additives (enabled reversible compound formation) based MnO2 cathode. Furthermore, zinc/stainless steel composite anode (to reduce anode shape changes) and calcium hydroxide coated polymer electrolyte (to stop zincate ion transfer) are used to improve cyclability. By assembling the above mentioned layers, excellent rate capabilities, high-capacity utilization (487 mAh g-1 ), long cycling stabilities (1000 cycles with 70% retention), and high energy density (400 Wh kg-1 ) are achieved. Moreover, bending, hammering, puncturing, and lighting up an light emitting diode are conducted (under flat, bent, and cut) to demonstrate the cells' safety, flexibility, and robustness. The successful findings in this study can chart new pathways to the development of safe, flexible, and cost-effective next-generation energy storage sources for wearables.
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Dispositivos Eletrônicos Vestíveis , Zinco , Íons , Compostos de Manganês , Óxidos , PolímerosRESUMO
Desmoid tumours are rare and locally invasive neoplasms that originate from the muscles and their aponeurosis. Incomplete excision causes recurrences; therefore, patients require aggressive resection that essentially entails tumour excision with a clear surgical margin. After radical resection, the resultant wide defect may lead to difficulty in closure of the anterior abdominal wall. Here, we report a case having surgery for large desmoid tumour of the anterior abdominal wall through an abdominoplasty incision followed by an abdominal wall reconstruction with a dual-sided composite mesh.
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Parede Abdominal , Abdominoplastia , Fibromatose Agressiva , Parede Abdominal/cirurgia , Fibromatose Agressiva/cirurgia , Humanos , Recidiva Local de Neoplasia , Próteses e ImplantesRESUMO
STUDY OBJECTIVE: To demonstrate laparoscopic mesh repair of perineal hernia (PH) by a modified sacral colpopexy technique. DESIGN: Step-by-step demonstration of the technique used for the surgical repair of PH after gynecologic surgery. SETTING: PH is defined as a pelvic floor defect through which the intra-abdominal viscera may protrude [1]. The reported incidence of PH ranges from 0.6% to 3%, and it generally occurs after rectal or prostate surgery [2]. Owing to its low incidence, there is no standard procedure to treat PH [3]. Herein, we demonstrate a successful case of PH treatment with a composite mesh (Dual Mesh; W. L. Gore & Associates, Newark, DE) after gynecologic surgery by a modified laparoscopic sacral colpopexy technique, which was approved by our institutional review board. INTERVENTIONS: The patient had undergone extralevator abdominoperineal excision for an aggressive angiomyxoma and developed a sigmoid colon-protrudent PH after the surgery [4]. The patient suffered from defecatory dysfunction and dysmenorrhea. A total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and mesh repair of the PH were performed at 2 years after the primary surgery, and they were successful without any intra- or postoperative complications. Because the pelvic floor defect was too large to secure the mesh by a simple placement, we applied the modified sacral colpopexy technique using 2-0 proline (ETHICON, Tokyo, Japan) to cover and support this defect. At 12 months after the second surgery, there was no sign of recurrence of PH and aggressive angiomyxoma, and the preoperative symptoms had diminished. CONCLUSION: Laparoscopic mesh repair by the modified sacral colpopexy technique is safe and effective to manage PH.
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Procedimentos Cirúrgicos em Ginecologia/métodos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Neoplasias Abdominais/patologia , Neoplasias Abdominais/cirurgia , Feminino , Hérnia Abdominal/etiologia , Hérnia Abdominal/cirurgia , Humanos , Japão , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Distúrbios do Assoalho Pélvico/patologia , Distúrbios do Assoalho Pélvico/cirurgia , Períneo/patologia , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reto/cirurgia , Sacro/cirurgiaRESUMO
INTRODUCTION: Laparoscopic repair is now the treatment of choice for most cases of ventral/incisional hernia. Although the technique has undergone many refinements, there is no standard technique for difficult or complicated hernias. AIM: The aim of this study was to show the different innovative methods used to treat difficult ventral hernia through hybrid techniques. MATERIALS AND METHODS: A total of 75 (n = 75) patients underwent Laparoscopic Ventral Hernia Hybrid Mesh Repair (LVHHMR) by our surgical unit between January 2014 and December 2016. Three different techniques of repairing the defects were used. Mesh fixation time, post-operative pain score (visual analogue score) and follow-up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analysed. RESULTS: Out of 75 patients (20 men and 55 women), the median age was 45 years and body mass index of the patients was 25-35. Types of hernias operated were paraumbilical hernias, incisional and recurrent hernias. The techniques used were (1) laparoscopic adhesiolysis, open sac excision with closure of defect and laparoscopic mesh placement, (2) laparoscopic adhesiolysis, omphalectomy with closure of defect and laparoscopic mesh placement and (3) open adhesiolysis, sac excision with closure of defect and laparoscopic mesh placement. Five patients required analgesics for 48 h. No patients complained of pain at follow-ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay postoperatively was 2-3 days. CONCLUSION: LVHHMR is safe and feasible approach for complicated/difficult ventral hernias. However, further larger studies are required to establish these methods as gold standard.
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Background: The treatment of incisional and ventral hernias is associated with significant complications and recurrences, especially in severely obese patients. Recent studies have shown a reduced rate of surgical site infections and length of hospital stay in severely obese patients undergoing a laparoscopic ventral hernia repair.Aim: This study aims to describe the clinical experience in terms of efficacy and safety with laparoscopic ventral hernia repair using the ParietexTM Composite mesh (Covidien Sofradim Production, Trevoux, France) in severely obese patients (body mass index ≥35) compared with non-severe obese patients in a seven-year single-center cohort.Material and methods: All patients with a primary ventral or incisional hernia admitted to our hospital from 2006 until December 2012 who underwent a laparoscopic repair with the Parietex Composite mesh were included in this study. Pain scores using a numeric rating were collected prospectively 24-48 hours postoperatively. Patient data were retrospectively collected.Results: A total number of 210 patients were included; 173 with a BMI <35 and 37 with a BMI ≥35. Mean follow-up was 31 months. No statistically significant differences were found with regard to operation time, hospital stay, use of analgesics and postoperative complications. The long-term follow up recurrence rate in non-severely obese patients was 13% compared to 16% in severely obese patients (p = .60).Conclusion: Laparoscopic ventral and incisional hernia repair using the Parietex Composite mesh is feasible and safe in severely obese patients compared to non-severely obese patients.
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Hérnia Ventral/cirurgia , Herniorrafia/métodos , Herniorrafia/normas , Laparoscopia/métodos , Laparoscopia/normas , Obesidade/complicações , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Colágeno , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Minimally invasive incisional hernia repair has been established as a safe and efficient surgical option in most centres worldwide. Laparoscopic technique includes the placement of an intraperitoneal onlay mesh with fixation achieved using spiral tacks or sutures. An additional step is the closure of the fascial defect depending upon its size. Key outcomes in the evaluation of ventral abdominal hernia surgery include postoperative pain, the presence of infection, seroma formation and hernia recurrence. TACKoMESH is a randomised controlled trial that will provide important information on the laparoscopic repair of an incisional hernia; 1) with fascial closure, 2) with an IPOM mesh and 3) comparing the use of an articulating mesh-fixation device that deploys absorbable tacks with a straight-arm mesh-fixation device that deploys non-absorbable tacks. METHODS: A prospective, single-centre, double-blinded randomised trial, TACKoMESH, will establish whether the use of absorbable compared to non-absorbable tacks in adult patients undergoing elective incisional hernia repair produces a lower rate of pain both immediately and long-term. Eligible and consenting patients will be randomized to surgery with one of two tack-fixation devices and followed up for a minimum one year. Secondary outcomes to be explored include wound infection, seroma formation, hernia recurrence, length of postoperative hospital stay, reoperation rate, operation time, health related quality of life and time to return to normal daily activity. DISCUSSION: With ongoing debate around the best management of incisional hernia, continued trials that will add substance are both necessary and important. Laparoscopic techniques have become established in reducing hospital stay and rates of infection and report improvement in some patient centered outcomes whilst achieving similarly low rates of recurrence as open surgical techniques. The laparoscopic method with tack fixation has developed a reputation for its tendency to cause post-operative pain. Novel additions to technique, such as intraoperative-sutured closure of a fascial defect, and developments in surgical technology, such as the evolution of composite mesh design and mesh-fixation devices, have brought about new considerations for patient and surgeon. This study will evaluate the efficacy of several new technical considerations in the setting of elective laparoscopic incisional hernia repair. TRIAL REGISTRATION: Name of registry - ClinicalTrials.gov Registration number: NCT03434301 . Retrospectively registered on 15th February 2018.
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Herniorrafia/métodos , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Hérnia Ventral/cirurgia , Humanos , Laparoscopia/métodos , Tempo de Internação , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Próteses e Implantes , Qualidade de Vida , Recidiva , SuturasRESUMO
PURPOSE: The feasibility of noninvasive visualization of composite meshes used in ventral hernia repair by amide-proton transfer magnetic resonance imaging (APT-MRI) was explored. METHODS: Magnetization transfer asymmetry ratio images of composite meshes were obtained in vitro and in vivo from fast-spin echo acquisitions with frequency saturation offsets of ±3.5 ppm with respect to water frequency and no saturation. Three rats were assessed with APT-MRI each week for 1 month after the intraperitoneal implantation of two meshes, one on each side of the incision. One mesh was coated with collagen and the other was not. RESULTS: In vitro, meshes were delineated with APT-MRI as a thin continuous linear hypersignal located on one side of the mesh. Unlike collagen-free meshes, collagen-coated meshes were easily identified in vivo with APT-MRI during the first 3 weeks postimplantation. The composite meshes magnetization transfer asymmetry ratio (8.7 ± 2.8%) were significantly different from the muscle magnetization transfer asymmetry ratio value (-0.9 ± 1.6%). After a month, the mesh value dropped down to 1.1 ± 3.9%. Muscle and mesh magnetization transfer asymmetry ratio values were not significantly different and mesh conspicuity was no longer possible. CONCLUSION: The results suggest that APT-MRI is a promising technique for noninvasive, early postsurgical visualization of composite meshes used in ventral hernia repair.
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Hérnia Ventral/diagnóstico , Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Imageamento por Ressonância Magnética/métodos , Telas Cirúrgicas , Amidas/análise , Animais , Materiais Revestidos Biocompatíveis/análise , Feminino , Aumento da Imagem/métodos , Masculino , Prótons , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
BACKGROUND: Chest wall chondrosarcomas, although common, pose unique challenges due to their aggressive nature, rarity of abdominal wall involvement, and propensity for recurrence. We highlight the critical role of meticulous surgical planning, multidisciplinary collaboration, and innovative reconstruction techniques in achieving optimal outcomes for patients with composite giant chest and abdominal wall chondrosarcoma. CASE PRESENTATION: A 38-year-old female patient presented with progressive left chest and abdominal wall swelling for two years; on evaluation had a large lobulated lytic lesion arising from the left ninth rib, scalloping eighth and tenth ribs measuring 13.34 × 8.92 × 10.71 cm (anteroposterior/transverse/craniocaudal diameter) diagnosed with chondrosarcoma grade 2. A three-dimensional (3D) composite mesh was designed based on computed tomography using virtual surgical planning and computer-assisted design and manufacturing technology. She underwent wide local excision and reconstruction of the chest and abdominal wall with 3D-composite mesh under general anesthesia. The postoperative condition was uneventful, with no recurrence at 12 months follow-up. CONCLUSION: A 3D-composite mesh facilitates patient-specific, durable, and cost-effective chest and abdominal wall reconstruction.
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Parede Abdominal , Neoplasias Ósseas , Condrossarcoma , Procedimentos de Cirurgia Plástica , Parede Torácica , Feminino , Humanos , Adulto , Parede Abdominal/cirurgia , Parede Abdominal/patologia , Telas Cirúrgicas , Parede Torácica/cirurgia , Parede Torácica/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/patologiaRESUMO
Ultra-thin vapor chambers (UTVCs) are widely used to cool high-power electronics due to their excellent thermal conductivity. In this study, a UTVC of 82 mm × 58 mm × 0.39 mm with composite wick was prepared. The composite wick is composed of two layers of copper mesh and multiple spiral-woven meshes (SWMs), and the composite wick was applied in UTVC to improve liquid replenishment performance and temperature uniformity. Furthermore, the thermal performance of UTVCs with different support column diameters, filling ratios (FRs), and SWM structures was experimentally studied. The results found that the equivalent thermal conductivity (ETC) decreases as the diameter of the support column increases; the UTVC with 0.5 mm support column diameter has the highest ETC, at 3473 W/(m·K). Then, the effect of FR on the heat transfer performance of UTVCs with SWM numbers of 0, 1, 2, and 3 (0 SWMs, 1 SWM, 2 SWMs, 3 SWMs) is consistent, the 30% FR UTVC with 3 SWMs having the highest ETC, at 3837 W/(m·K). Finally, the increased number of SWMs can significantly improve the ultimate power of the UTVCs, the UTVC with 3 SWMs having the highest ultimate power, at 26 W. The above experimental studies indicate that the designed and manufactured UTVCs have great potential advantages in thermal dissipation for electronics.
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This review describes the evolution of hiatal hernia repair for the past several decades: From the use of a primary tissue repair only, the subsequent inclusion of synthetic mesh and its complications, to current day indications for mesh use. We will highlight the recent research in biologic and composite meshes as well as the ongoing limitations in studying their efficacy. Finally, we will describe our institutional indications and surgical technique practices in the utilization of biologic mesh.
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Produtos Biológicos , Hérnia Hiatal , Laparoscopia , Humanos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Laparoscopia/métodos , RecidivaRESUMO
Introduction Composite meshes coated with anti-adhesive barriers have been developed by taking advantage of the robustness of polypropylene meshes for use in hernia repair. We aimed to evaluate the effects of composite meshes containing polyglactin, polycaprolactone, oxidized regenerated cellulose and chitosan on the adhesion formation. Methods Forty-two Sprague Dawley male rats were divided into six groups of seven rats according to the content of the meshes used. A defect was created on the right abdominal wall of the rats and an oval composite mesh of 2 cm in diameter was placed over the defect and fixed. The rats were sacrificed under anesthesia on the 7th postoperative day. Macroscopic and histopathological examination was performed and the incorporation of the mesh with the abdominal wall and the presence of intraabdominal adhesions were evaluated. Results When the macroscopic findings of the rats were evaluated, there was a statistically significant difference between the rat groups in terms of the distribution of peritoneal adhesion scores (p<0.05). There was no statistically significant difference between the rat groups in terms of the distribution of inflammation, fibrosis and macrophage levels (p>0.05). Conclusion It was evaluated that the development of intraabdominal adhesion and the strength of adhesion decreased when biocompatible adhesion barriers with anti-adhesive properties such as oxidized regenerated cellulose and chitosan were used in the structure of composite meshes used in hernia repair. Hemostatic and antibacterial properties of these substances are promising to create the ideal mesh.
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INTRODUCTION AND IMPORTANCE: An incisional hernia is one of the most frequent complications after abdominal surgery, with an estimated incidence of 2-20% after midline laparotomy. They are often caused by poor wound healing. We present the case of a complex giant incisional hernia that was repaired by implanting an intraperitoneal mesh. CASE PRESENTATION: A 63-year-old man with obesity, hypertension, and multiple previous laparotomies, who developed a complex giant incisional hernia (xipho-pubic > 10 cm wide). An open technique repair was decided with the introduction of a large mesh (Parietex ™ Composite) in an intraperitoneal position, covering a 25 × 16 cm hernial ring. After two years, the patient continues to be followed due to a low-output distal enterocutaneous fistula. CLINICAL DISCUSSION: Currently, there is no technique or approach that has become a gold standard for ventral incisional hernia repair. The introduction of an intraperitoneal mesh with two surfaces by laparotomy is recommended when there are contraindications for laparoscopic surgery, for example in obese patients, and patients with multiple previous laparotomies. However, it has been reported to be a complex technique with an enterocutaneous fistula rate of 0.3-4%. CONCLUSION: The introduction of a composite mesh represents an alternative surgical technique for the repair of giant incisional hernias.
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Transvaginal mesh/grafts have been popularized over the past 20 years in an attempt to improve the longevity of traditional vaginal pelvic organ prolapse (POP) surgery. Several national bodies have concluded that the proposed benefits of mesh/graft implantation are outweighed by the significant increase in surgery complications related to these products. As a consequence mesh products for vaginal POP surgery have been withdrawn from use in many countries. This article is a narrative review of newer mesh and graft products including lightweight polypropylene mesh products, biological grafts, hybrid grafts, and tissue engineered grafts.
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Produtos Biológicos , Prolapso de Órgão Pélvico , Prolapso Uterino , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Telas Cirúrgicas , Vagina/cirurgiaRESUMO
BACKGROUND: Composite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient. CASE PRESENTATION: Our patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation. CONCLUSION: To our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient.
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Hérnia Ventral , Telas Cirúrgicas , Idoso , Colectomia , Hérnia Ventral/cirurgia , Humanos , Intestino Delgado , Laparotomia , Masculino , Telas Cirúrgicas/efeitos adversosRESUMO
INTRODUCTION: Traumatic rupture of the diaphragm with herniation of abdominal viscera into the pericardium is a rare injury. We present a case of intrapericardial diaphragmatic hernia after one year of thoracoabdominal trauma. This case is the 106th in the literature and only the fifth treated by the laparoscopic approach including this case. After case presentation, we will discuss post-traumatic intrapericardial diaphragmatic hernias by reviewing the literature. CASE PRESENTATION: A 48-year-old male presented to our outpatient clinic with a history of thoracoabdominal trauma due to a motor vehicle accident one year ago. The patient complained from abdominal pain and constipation over the last year. After a thorough history and physical examination, thoracoabdominal computed tomography (CT) was performed. The CT scan revealed herniation of the transverse colon and omentum through a large anterior diaphragmatic defect into the pericardial sac. Laparoscopic composite mesh repair was done. The patient had an uneventful postoperative course and was discharged home on the second postoperative day. The patient was asymptomatic at regular follow-up six months postoperatively. CONCLUSION: Late presentation of intrapericardial diaphragmatic hernia is rare. Chest computed tomography is the most useful diagnostic tool. Delayed diagnosis of Intrapericardial diaphragmatic hernia does not preclude laparoscopic repair by primary closure or with mesh according to the size of the defect.
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One of the most frequently applied polymers in regenerative medicine is polystyrene (PS), which is commonly used as a flat surface and requires surface modifications for cell culture study. Here, hierarchical composite meshes were fabricated via electrospinning PS with nylon 6 (PA6) to obtain enhanced cell proliferation, development, and integration with nondegradable polymer fibers. The biomimetic approach of designed meshes was verified with a scanning electron microscope (SEM) and MTS assay up to 7 days of cell culture. In particular, adding PA6 nanofibers changes the fibroblast attachment to meshes and their development, which can be observed by cell flattening, filopodia formation, and spreading. The proposed single-step manufacturing of meshes controlled the surface properties and roughness of produced composites, allowing governing cell behavior. Within this study, we show the alternative engineering of nondegradable meshes without post-treatment steps, which can be used in various applications in regenerative medicine.
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PURPOSE: To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh. MATERIALS AND METHODS: This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B). RESULTS: Group A (30 patients) had a mean BMI of 37.8 ± 5.7 kg/m2 (range: 34.0-74.2 kg/m2); group B (170 patients) had a mean BMI of 24.6 ± 4.5 kg/m2 (range 19.0-29.8 kg/m2) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6 min (range 30-120); group B 38.9 ± 21.5 min (range 25-110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7 days (range 1-5) versus group B, 2.8 ± 1.9 days (range 1-4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23). CONCLUSION: The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2-W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable.
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Hérnia Ventral , Laparoscopia , Obesidade Mórbida , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Telas CirúrgicasRESUMO
Purpose: Although the modified Sugarbaker technique gives good results for the treatment of parastomal hernia (PH), there are other valid options for the treatment of this frequent complication. In our practice, the laparoscopic keyhole (KH) technique, with some specific modifications, can give similar results. Materials and Methods: We collected data on all the patients with symptomatic PHs who underwent surgical repair between January 2002 and December 2017 in our surgical department. The primary endpoint was to evaluate the recurrence rate after at least 1 year, determined on the basis of physical examination during follow-up and on postprocedure radiological results. Results: Ninety patients were treated with the KH technique. The stomas that were treated were 83 end colostomies and 7 ileal ureterostomies. Eighty-eight patients were treated with polyester mesh (Parietex™, Medtronic, Ireland) and 2 with a composite mesh (Physiomesh™, Ethicon). Patients had median follow-up period of 1 year. Seroma occurred in 4 patients, who were treated conservatively by clinical monitoring. Four patients had a recurrence: 1 occurred on the seventh postoperative day, due to a technical error; 1 after 6 months, due to the partial shrinkage of the mesh into the defect; the third after 1 year, but it occurred at the beginning of our experience, and the last recurrence was after 3 years in a patient who gained 15 kg after the procedure. Conclusions: If a few precautionary steps are added to the original technique, laparoscopic KH repair is feasible and safe, giving good results in terms of complications and recurrence rates.
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Colostomia/efeitos adversos , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Poliésteres/química , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Seroma/etiologia , Resultado do Tratamento , Derivação UrináriaRESUMO
Biomaterials-centered infection or implant-associated infection plays critical roles in all areas of medicine with implantable devices. The widespread over use of antibiotics has caused severe bacterial resistance and even super bugs. Therefore, the development of anti-infection implantable devices with non-antibiotic-based new antimicrobial agents is indeed a priority for all of us. In this study, antimicrobial composite meshes were fabricated with broad-spectrum antimicrobial peptides (AMPs). Macroporous polypropylene meshes with poly-caprolactone electrospun nanosheets were utilized as a substrate to load AMPs and gellan gum presented as a media to gel with AMPs. Different amounts of AMPs were loaded onto gellan gum to determine the appropriate dose. The surface morphologies, Fourier-transform infrared spectroscopy spectra, in vitro release profiles, mechanical performances, in vitro antimicrobial properties, and cytocompatibility of composite scaffolds were evaluated. Results showed that AMPs were loaded into the meshes successfully, the in vitro release of AMPs in phosphate-buffered saline was prolonged, and less than 60% peptides were released in 10 days. The mechanical properties of composite meshes were also within the scope of several commercial surgical meshes. Composite meshes with the AMP loading amount of over 3 mg/cm2 showed inhibition against both Gram-negative and Gram-positive bacteria effectively, while they presented no toxicity to mammalian cells even at a loading amount of 10 mg/cm2. These results demonstrate a new simple and practicable method to offer antimicrobial properties to medical devices for hernia repair.
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Antibacterianos , Peptídeos Catiônicos Antimicrobianos , Bactérias Gram-Positivas/crescimento & desenvolvimento , Teste de Materiais , Polipropilenos , Telas Cirúrgicas/microbiologia , Antibacterianos/química , Antibacterianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/farmacologia , Linhagem Celular , Humanos , Polipropilenos/química , Polipropilenos/farmacologiaRESUMO
Purpose: Parastomal hernia is a common complication of an enterostoma. Current methods of repair have high recurrence rates and are associated with severe complications. Autologous full-thickness skin as reinforcement may reduce the recurrence and complication rates. This study aims to investigates the tensile strength of full-thickness skin; information that is essential if we are to proceed with clinical trials on humans. Methods: Full-thickness skin samples from 12 donors were tested for tensile strength, as well as the load tolerated by a suture through the skin. Strips of skin were cut out and stretched until breaking point. Sutures were made through skin samples and traction applied until either the tissue or the suture gave way. All done while recording the forces applied using a dynamometer. Identical tests were carried out on commercially available synthetic and biologic graft material for comparison. Results: The full-thickness skin strips had a median tensile strength of 604 N/cm. This tensile strength was significantly higher than that of the compared materials evaluated in this study. In full-thickness skin, the suture, or tissue endured a median force of 67 N before giving way, which was as high as, or higher than similar sutures through the compared materials. Conclusions: The tensile strength of full-thickness skin vastly exceeds the physiological forces affecting the abdominal wall, and sutures through skin endure high loads before giving way. The tensile strength of a full-thickness skin graft and the strength of sutures through this material will not limit its use for reinforcement in parastomal hernia repair.