Repair of a Pulmonary Hernia after Thoracotomy with an Intrapleural Mesh: a Case Report.

Pulmonary hernias are rare. They can be congenital, but mostly are acquired. Usually asymptomatic, they are diagnosed on physical examination or, incidentally, on imaging exams. Surgical treatment is required for large, increasing, or symptomatic hernias, and incarcerated or strangulated ones. This is a clinical case of a symptomatic postoperative pulmonary hernia. It occurred two years after a posterolateral thoracotomy for the resection of an intercostal myxolipoma. The tumor was resected en bloc with a partial segment of the 10th left rib and immediate reconstruction was made with an onlay polypropylene mesh. The postoperative hernia was successfully treated with a double-faced mesh of polypropylene and ePTFE. This surgery provided a functional and aesthetic enhancement for the patient, greatly improving his quality of life. This approach is, therefore, considered safe and effective.

Impact of Infusion Set Materials and Designs on the Subcutaneous Response in People With Diabetes: A Rapid Review of the Literature.

Insulin infusion sets (IISs) are an integral and intricate part of continuous subcutaneous insulin infusion for subjects with type 1 diabetes, infusing insulin from pump to the subcutaneous space. Insulin infusion sets interface with the skin surface, the dermis, and the subcutaneous space and may be the cause of infusion failure due to biological events or mechanical problems. Novel IISs with extended wear time and anti-inflammatory properties to mitigate these issues are described in the literature although material-tissue interactions are poorly understood. This rapid review focuses on the impact of IIS materials and designs on the subcutaneous response in people with diabetes and includes literature identified in PubMed, Embase, and Cochrane databases. Twenty-one studies were identified for qualitative synthesis that encompassed a limited and heterogenic body of evidence including 10 clinical reports, six reviews, one case report, two abstracts, and two communications. Two clinical reports were randomized crossover studies. Reports on materials mostly compared steel versus polytetrafluoroethylene (Teflon) cannulas and suggested no substantial difference in tissue response to these materials. Reports on designs focused mostly on the angle of cannula insertion. To drive and improve research on extended wear and nonimmunogenic IISs, future studies should focus on material-tissue interaction as dedicated outcome measures, quantified with punch biopsy and imaging techniques such as ultrasound, optical coherence tomography, and confocal reflectance microscopy. Original studies are required to further a field too young for a systematic meta-analysis.

Transvaginal polytetrafluoroethylene mesh surgery for pelvic organ prolapse: 1-year clinical outcomes.

OBJECTIVES: To evaluate the safety and efficacy of transvaginal mesh surgery using a polytetrafluoroethylene mesh to treat pelvic organ prolapse. METHODS: This prospective observational study included women undergoing transvaginal mesh surgery for pelvic organ prolapse that used new polytetrafluoroethylene mesh cut into a shape similar to that of Elevate. We evaluated the subjective and objective outcomes at 3 and 12 months, as well as postoperative complication rates. RESULTS: This study included 55 patients. The pelvic organ prolapse quantification scores improved significantly at 3 and 12 months after surgery compared with scores before surgery. In four patients (7.3%), a pelvic examination showed stage 2 objective recurrence without subjective symptoms. Clavien-Dindo grades 2 and 3 perioperative complications were observed in 9.1% and 1.8% of the patients, respectively. Vaginal mesh exposure occurred in one patient (1.8%) at the time of the 3-month follow-up evaluation. The mesh was exposed at the proximal midline of the anterior vaginal wall. CONCLUSIONS: These findings show the safe and effective use of the polytetrafluoroethylene mesh for transvaginal mesh surgery.

Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits.

Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged < 18 years who underwent primary RVOT reconstruction with a BJV or ePTFE conduit between 2013 and 2017 were retrospectively investigated. 44 patients (20 and 24 with BJV and ePTFE conduits, respectively) met the inclusion criteria. The mean follow-up time was 4.5 ± 1.5 years. No significant differences in peak RVOT velocity (1.8 ± 0.9 m/s vs 2.1 ± 0.9 m/s, P = 0.27), branch pulmonary stenosis (P = 0.50), or pulmonary regurgitation (P = 0.44) were found between the BJV and ePTFE conduit groups, respectively. Aneurysmal dilatation of the conduit was observed in 25.0% of the patients in the BJV conduit group but not in the ePTFE conduit group (P = 0.011). All the cases with aneurysmal dilatation of the BJV conduit were complicated with branch pulmonary stenosis up to 3.0 m/s (P = 0.004). No conduit infections occurred during the follow-up period, and no significant difference in conduit replacement (20.0% vs 8.3%, P = 0.43) was found between the BJV and ePTFE conduit groups, respectively. The outcomes of the RVOT reconstructions with BJV and ePTFE conduits were clinically satisfactory. Aneurysmal dilatation was found in the BJV conduit cases, with branch pulmonary stenosis as the risk factor.

Experimental comparative study of arterial implants made of silicone reinforced with polyester fabric and expanded polytetrafluoroethylene (PTFE) in rabbits aorta / Estudo experimental comparativo de implantes arteriais em silicone com reforço de poliéster e politetrafluoretileno expandido (PTFE) em aorta de coelhos

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.

RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.

Comparación de recidiva posterior a hernioplastía diafragmática con cierre directo versus colocación de parche / Comparison of recurrence after diaphragmatic hernioplasties with direct closure versus patch placement

Resumen Objetivo: Investigar con cuál técnica quirúrgica, cierre directo o con parche de Goretex, las hernias diafragmáticas congénitas operadas tienen más recidiva. Metodología: Los datos de los pacientes sometidos a reparación por hernia diafragmática congénita en el Hospital Nacional de Niños, entre enero 2008 y el 31 diciembre de 2017, fueron revisados retrospectivamente. De los 94 pacientes, solo 59 cumplen con los criterios de inclusión. Para la comparación de las variables cuantitativas se empleó pruebas de T de Student e intervalos de confianza al 95 %; las variables cualitativas se analizaron por la prueba de Fisher con un nivel de significancia de 0,05. Resultados: La mayoría de las hernias diafragmáticas operadas fueron izquierdas (78 %) y posterolaterales (91 %). La técnica de reparación más frecuente utilizada fue el cierre directo (68%). Hubo más recidivas posteriores a cierre con parche de Goretex. Se presentaron entre 1 y 12 meses postoperatorio. No hubo diferencia estadísticamente significativa entre recidivas con técnica de cierre directo versus cierre con parche de Goretex. Conclusión: Realizar un cierre directo del diafragma es una buena opción quirúrgica para reparación de hernia diafragmática congénita. No hubo en este estudio diferencias estadísticamente significativas en cuanto a recidiva entre utilizar técnica con cierre directo o con parche.

Abstract Objective: To investigate with which surgical technique, direct closure or use of a Goretex patch, congenital diaphragmatic hernias recurre more. Methodology: The data of the patients who underwent repair of congenital diaphragmatic hernia at the National Children's Hospital from January 2008 to December 31, 2017, were reviewed retrospectively. Of the 94 patients, only 59 met the inclusion criteria. For the comparison of the quantitative variables, Student's t-test and 95% confidence intervals were used, the qualitative variables were analyzed by the Fisher's test with a significance level of 0.05. Results: Most of the operated diaphragmatic hernias were left 78% and posterolateral 91%. The most frequent repair technique used was direct closure, 68%. There were more recurrences after closing when a Goretex patch was used. They occurred between 1 and 12 months post-operatively. There was no statistically significant difference between recurrences with the direct closure technique versus closure with the Goretexpatch. Conclusion: Performing a direct closure of the diaphragm is a good surgical option for surgical repair of congenital diaphragmatic hernias. There were no statistically significant differences in relapse in this study between using the direct closure or patch technique.

Permanent Compared With Absorbable Suture for Vaginal Mesh Fixation During Total Hysterectomy and Sacrocolpopexy: A Randomized Controlled Trial.

OBJECTIVE: To compare mesh and permanent suture exposure rates in the first year after minimally invasive total hysterectomy and sacrocolpopexy with a light-weight polypropylene mesh using permanent or delayed absorbable sutures. METHODS: Across five centers in the United States, women were randomized to permanent or delayed absorbable suture for vaginal attachment of a Y-mesh during hysterectomy and sacrocolpopexy for stage II prolapse and worse. The primary outcome was mesh or permanent suture exposure in the first year after surgery. The secondary outcome was to compare a composite measure for success defined as leading edge of prolapse not beyond the hymen and apex not descended more than one third vaginal length, and no subjective bulge and no prolapse retreatment. Patients completed a pelvic examination including the pelvic organ prolapse quantification system and questionnaires at baseline, 6 weeks and 1 year postsurgery. A sample size of 80 per group was planned to compare the rate of mesh or permanent suture exposure in the permanent compared with delayed absorbable groups. RESULTS: From April 2015 to May 2019, 204 patients (n=102 permanent; n=102 delayed absorbable) were randomized. One hundred ninety-eight women had follow-up data, with 182 (93%) completing 1-year follow-up: 95 of 99 (96%) permanent, 87 of 101 (86%) delayed absorbable. The total rate of mesh or permanent suture exposure was 12 of 198 (6.1%): 5.1% for permanent compared with 7.0% for delayed absorbable (risk ratio 0.73, 95% CI 0.24-2.22). The majority (9/12) were asymptomatic. Composite success was 93% for permanent compared with 95% for delayed absorbable suture, P=.43). Six (3.0%) women had a serious adverse event. CONCLUSION: Suture type used for vaginal graft attachment did not influence mesh or permanent suture exposure rates. FUNDING SOURCE: Boston Scientific Corporation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02277925.

Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study.

Background and objectives: Non-resorbable dense polytetrafluoroethylene (dPTFE) membranes are widely used for regeneration procedures, alone or in combination with particulate materials. The aim of this work was to examine the efficacy of a newly developed dPTFE membrane in the management of extraction socket healing. Materials and Methods: The extraction premolar sockets of 44 patients (20 men and 24 women) were preserved. One group received prosthetic rehabilitation with a fixed partial denture (FPD) (PROS group, N = 19) and a second group received immediate implant placement (IMPL group, N = 25). The PROS group sockets were augmented with a bovine derived xenograft and covered with a newly developed dPTFE membrane prior to FPD rehabilitation. Results: In the IMPL group, socket preservation was combined with immediate implant placement. Before (T0) and 6 months after surgery (T1), horizontal and vertical dimensions were measured with customized stents. No significant differences in alveolar bone loss from T0 to T1 were observed between the PROS and IMPL groups in the horizontal dimension for any tooth type. There was a significant difference in alveolar bone loss from T0 to T1 between the two groups for only single-rooted maxillary premolars in the vertical dimension. Conclusions: The use of the examined new dPTFE membrane consistently led to the preservation of hard tissue in the extraction sites.

Handmade trileaflet valved ePTFE right ventricle to pulmonary artery conduit - How do we do it?

Right ventricle to pulmonary artery conduits such as homografts and pre-manufactured synthetic conduits are widely employed in the present era of complex congenital cardiac surgeries for disorders involving right ventricle - pulmonary artery discontinuity and major coronary artery crossing the right ventricular outflow tract. The key drawback of homograft conduits is the need for reoperation to replace them as a result of degeneration over time or in cases where a child has outgrown the conduit and cost is a major drawback to using commercially available conduits. The advantages of expanded polytetrafluoroethylene are its long-term durability in terms of conduit calcification/degeneration and valve stenosis/regurgitation and its cost-effectiveness.  In this video presentation, we demonstrate the preparation and intraoperative usage of a handmade, trileaflet, valved polytetrafluoroethylene conduit in a case of double outlet right ventricle with valvular and subvalvular pulmonary stenosis and the left anterior descending artery crossing the right ventricular outflow tract. Our experience with this handmade conduit is close to 120 cases and we have seen excellent postoperative recovery and results. Our medium-term follow-up echocardiographic evidence shows conduit patency and preserved valve function.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair / 15 anos de experiência em suspensão frontal com fio de politetrafluoretileno (Gore-Tex®) na correção de ptose palpebral

ABSTRACT Purpose: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. Methods: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. Results: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. Conclusion: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

RESUMO Objetivo: Revisar os resultados de cirurgias de sus pensão ao músculo frontal com o uso de fio de politetrafluoretileno em pacientes com blefaroptose. Métodos: Em um estudo observacional retrospectivo, foram analisados os resultados das cirurgias de músculo frontal de uma instituição, realizadas entre 2003 e 2018. Todos os procedimentos foram realizados com incisão fechada e técnica de pentágono. Os desfechos foram classificados como satisfatórios ou insatisfatórios com definição satisfatória definida como distância margem-reflexo >3mm e <1mm entre as pálpebras e insatisfatória como hipocorreção, complicações cirúrgicas e assimetria. Resultados: Incluímos um total de 76 pálpebras de 52 pacientes em nosso estudo. Com um tempo médio de seguimento pós-operatório de 16,8 ± 18,5 meses (intervalo 3-95), 59 (77,6%) pálpebras apresentaram desfecho satisfatório e 17 (22,4%) insatisfatórios (8 casos de assimetria, 3 granulomas, 3 extrusões de sutura, 2 abscessos e 1 caso de celulite). Nove pálpebras do grupo insatisfatório necessitaram de reoperação. Entre os pacientes com seguimento ³12 meses (38 cirurgias), resultados duradouros foram observados na maioria dos casos, exceto por 2 extrusões de sutura de surgimento tardio. Conclusão: O uso de politetrafluoretileno na cirurgia de músculo frontal mostrou ser previsível, seguro e duradouro, Nossos achados corroboram com estudos prévios que mostraram resultados funcionais adequados e baixos índices de complicação.

Fifteen years of experience with frontalis suspension using polytetrafluoroethylene (Gore-Tex®) suture in blepharoptosis repair.

PURPOSE: To review the outcomes of frontalis suspension surgeries with the use of polytetrafluoroethylene in patients with blepharoptosis. METHODS: A retrospective observational study analyzed the outcomes of frontalis suspension surgeries performed in a single institution from 2003 to 2018. All procedures were performed with closed incision and single pentagon techniques. Outcomes were classified as satisfactory or unsatisfactory, with satisfactory defined as a margin reflex distance of >3 mm and <1 mm between eyelids and unsatisfactory as hypocorrection, surgical complications, and asymmetry. RESULTS: We included a total of 76 eyelids from 52 patients in our study. Within a mean postoperative follow-up of 16.8 ± 18.5 months (range, 3-95), 59 (77.6%) eyelids had a satisfactory outcome, and 17 (22.4%) were unsatisfactory (8 cases of asymmetry, 3 granulomas, 3 suture extrusions, 2 abscesses, and 1 case of cellulitis). Nine eyelids from the unsatisfactory group required reoperation. Among the patients with a follow-up of ³12 months (38 surgeries), lasting results were observed in most eyelids, except for 2 late-onset suture extrusions. CONCLUSION: The use of polytetrafluoroethylene in frontalis suspension surgery was shown to be predictable, safe, and lasting. Our findings support previous studies that have shown adequate functional results and low complication rates.

Digital Pulley Reconstruction Using Pulley Allografts: A Comparison With Traditional Tendon-Based Techniques.

BACKGROUND: The safety and feasibility of sterile, acellular pulley allografts in reconstruction has been previously demonstrated. Comparisons with tendon-based techniques for pulley reconstruction have not been reported. We hypothesized that the use of allograft pulleys would result in reduced procedural time and equivalent clinical outcomes as compared with traditional tendon-based reconstructive techniques. METHODS: All cases of pulley reconstruction using either allograft pulleys or tendon-based pulley reconstruction between November 2013 and November 2015 were reviewed. Patients who underwent concomitant procedures were excluded. Patient demographics, comorbidities, operative details (tourniquet and total operative times, number of pulleys repaired), postoperative complications (surgical site infection, reoperation, stiffness, and persistent pain), disability of the arm, shoulder and hand scores, and follow-up data were recorded. A P value of <0.05 was considered significant. RESULTS: Fifteen pulleys in 10 patients were reconstructed: 5 tendon-based and 5 with allograft. Average length of follow-up was 12.5 ± 2.9 months. There was no difference in patient demographic factors or comorbidities between groups. The most common indication for surgery was trauma. Four of 5 patients in the allograft group had multiple pulleys reconstructed versus 1 in the tendon-based group. One patient in the tendon-based group required reoperation versus 0 in the allograft group. Total operative and tourniquet times were significantly reduced in the allograft group (46 ± 5.5 vs 89 ± 12.9 minutes and 34 ± 6.8 vs 63 ± 5.3 minutes; P = 0.015 and 0.014). Postoperative disability of the arm, shoulder and hand scores were lower in the allograft group (56.8 vs 3.6, P = 0.11). There was no significant difference in postoperative range of motion between groups. CONCLUSION: Pulley reconstruction with allograft is an efficient, technically feasible, reconstructive technique that adheres to the principle of replacing like with like, while eliminating donor site morbidity. Overall operative and tourniquet times were significantly shorter using allograft pulleys for pulley reconstruction.

New Flexible Internal Annular Fixation Rings for Tricuspid Aortic Valves.

OBJECTIVES: Although aortic annulus repair has a long history, there are still no ideal devices to control an aortic annulus. We have developed a new method involving the use of an expanded polytetrafluoroethylene graft with the support of a metallic ring holder during implantation from inside an aorta, with no dissection of the surrounding aortic annulus. METHODS: We used aortic annular rings of 18 to 24 mm made of Gore-Tex tubed grafts (W.L. Gore & Associates, Flagstaff, AZ, USA) and metallic ring holder. After cutting the graft circumferentially to a 5-mm thickness, it was compressed manually to decrease the thickness. Then, a metallic ring holder corresponding to the graft size was inserted into the graft. The metallic ring holder was fixed to the graft with one 4-0 monofilament suture using 6 holes and the side trench on the metallic ring holder. The proper size for the graft was determined, and the appropriate annuloplasty ring was selected. A row of 4-0 double-needle braided sutures with expanded polytetrafluoroethylene spaghettis was sewn from the aortic side into the left ventricular outflow tract with a horizontal mattress stitch. After all sutures around the annulus were placed, they were tied down and the metallic ring holder was removed. The leaflets were repaired if necessary. RESULTS: A total of 9 patients with tricuspid aortic valve have undergone this procedure since January 2015. The sizes of the aortic annular rings were 20 mm ( n = 3), 22 mm ( n = 5), and 24 mm ( n = 2). Aortic leaflets were repaired in 6 patients (6 central plications). Concomitant procedures were total aortic arch replacement ( n = 2), mitral valve repair ( n = 2), tricuspid valve repair ( n = 1), and coronary artery bypass grafting ( n = 2). There were no hospital deaths and no major morbidities. All patients were checked for mild or less than mild aortic regurgitation during the mean follow-up period of 13 months. Postoperative echocardiograms showed excellent peak pressure gradients compared with preoperative echocardiograms. Postoperative cardiac computed tomography scans were performed in 6 patients. The discrepancies between the ring size used and postoperative annular size were <1-mm diameter in all patients. CONCLUSIONS: This new flexible ring is easy to use to fix an aortic annulus from the inside. Early results reveal excellent control of aortic regurgitation with the projected annular size. Further investigations are needed to ensure the effectiveness of the ring.

Flexor tendon repair with a polytetrafluoroethylene (PTFE) suture material.

BACKGROUND: There is a consensus that after a flexor tendon repair an aggressive rehabilitation protocol with early active motion can improve functional outcome, provided that the combination of material and suturing technique can meet the higher biomechanic demands. Bearing this in mind we evaluated a polytetrafluoroethylene (PTFE) suture (SERAMON®, Serag-Wiessner) as a possible material for flexor tendon repair. MATERIALS AND METHODS: 40 flexor tendons were harvested from fresh cadaveric upper extremities. 3-0 and 5-0 strands were used both in the polypropylene (PPL) as well as in the PTFE group. In the first phase of the study, we evaluated knotting properties and mechanical characteristics of the suture materials themselves. In the second phase, a 2-strand Kirchmayr-Kessler suture technique was applied for a core suture of a flexor tendon (n = 16). In the third phase, we performed a tendon repair including an epitendinous running suture with 5-0 PPL or 5-0 PTFE material (n = 22). One way ANOVA tests were performed. RESULTS: The linear loading strength of single strand knotted PPL 3-0 was 19.87 ± 0.59 N. The linear loading strength of knotted PTFE 3-0 was 32.47 ± 1.67 N. For PPL 3-0 maximum linear strength was achieved with five knots, for PTFE 3-0 with eight knots. When a Kirchmayr-Kessler core-only repair was performed, then in the PPL group the loading strength of the repaired tendon was 30.74 ± 9.77 N. In the PTFE group the loading strength was 23.74 ± 5.6 N (p = 0.10). However, all repairs in the PTFE group failed due to cheese wiring. When a Kirchmayr-Kessler core and epitendinous repair technique was used, then in the PPL group the loading strength of the repaired tendon was 49.90 ± 16.05 N. In the PTFE group the loading strength was 73.41 ± 19.81 N (p = 0.006). CONCLUSION: PTFE demonstrates superior strength properties in comparison to PPL for flexor tendon repairs. However, standard 2 strand techniques have proved inadequate to bear the higher biomechanic demands.

[Effectiveness of biological prosthesis for femoro-femoral bypass in high risk patients]. / Éffektivnost' biologicheskogo proteza pri bedrenno-bedrennom shuntirovanii u lits s vysokim operatsionnym riskom.

AIM: To compare synthetic and biological prostheses for femoral bypass surgery. MATERIAL AND METHODS: There were 40 patients with critical ischemia of lower extremities due to atherosclerotic lesion of aorto-iliac segment and severe comorbidities. They were divided into 2 groups by 20 patients. C-shaped femoro-femoral bypass with synthetic polytetrafluoroethylene and lavsan prostheses was performed in the first group and S-shaped bypass procedure with biological prosthesis from the internal thoracic arteries of the bull - in the second group. RESULTS: Biological prosthesis is associated with reduced early postoperative morbidity by 10%, late graft thrombosis incidence by 20% and increased physical and psychological health by 7.1%. CONCLUSION: S-shaped femoro-femoral bypass with a biological prosthesis from the internal thoracic arteries of the bull is pathogenetically substantiated and effective.

The Use of Expanded Polytetrafluoroethylene in Short Nose Elongation: Fourteen Years of Clinical Experience.

BACKGROUND: Short nose elongation is a relatively common rhinoplasty procedure, especially in Asia. The selection of the adequate graft material is challenging. Previous reports have described the application of expanded polytetrafluoroethylene (ePTFE) for dorsal augmentation rhinoplasty, but studies using ePTFE for nose elongation are lacking. We propose ePTFE as an alternative treatment for short noses, describe the technique, and discuss outcomes, patient selection, and complications based on our 14-year experience. METHODS: From February 2003 to December 2016, 206 patients with varying degrees of short noses were included in this retrospective study. All patients underwent nose elongation surgery using an ePTFE implant. Nasal lengths before and after surgery were measured using a 3-dimensional simulation technology. Outcomes and complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey. RESULTS: Nasal elongation was successfully achieved using ePTFE. Mean increase in nasal length was 4.36 ± 0.85 mm. The mean follow-up period was 13.3 months, ranging from 6 months to 8 years. Follow-up examinations demonstrated stable results. The overall complication rate was 6.8%. Complications included infection, implant extrusion, migration, deviation, visibility, and/or prominence, tissue reaction, and reddening of the nasal skin. Most patients (93.6%) rated their outcome as improved and much improved. CONCLUSIONS: Nasal elongation using ePTFE implantation is a feasible therapeutic approach for patients with short noses. Reliable outcomes and the absence of donor site morbidity contribute to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.

Height Changes of Tutoplast-Processed Fascia Lata Over Time After Dorsal Augmentation During Rhinoplasty.

PURPOSE: Tutoplast (Tutogen Medical, Neunkirchen am Brand, Germany)-processed fascia lata (TPFL) has been used for dorsal augmentation in rhinoplasty in the Republic of Korea for approximately 10 years, but few studies have described changes in TPFL in terms of dorsal height over time. We investigated changes in dorsal height after TPFL use as a dorsal implant material during rhinoplasty. MATERIALS AND METHODS: The records of 18 rhinoplasty patients who had undergone dorsal augmentation with TPFL were examined retrospectively. The patients had undergone rhinoplasty from March 2008 to June 2012. Two different ear, nose, and throat doctors analyzed the first follow-up photographs (2 lateral views and 2 oblique views) taken at approximately 1 month postoperatively and the last follow-up photographs taken from 18 to 75 months after surgery. The last follow-up photographs were classified as showing no nasal dorsal height change, slight change, and marked change compared with the first follow-up photographs. RESULTS: Of the 18 patients enrolled, 50% (n = 9) showed no change in the nasal dorsum whereas 33% (n = 6) showed mild depression and 17% (n = 3) showed marked depression of the nasal dorsum at last follow-up. CONCLUSIONS: About half of the patients who had undergone dorsal augmentation using TPFL during rhinoplasty showed mild or marked dorsal depression over time. It is recommended that TPFL be used with another implant during augmentation rhinoplasty or TPFL be used only for a slightly depressed nose. In addition, patients should be informed that TPFL could be resorbed over time.

Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients.

OBJECTIVES: The type of conduit used for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure remains problematic because of the limited availability of pulmonary allografts and the unsatisfactory long-term results associated with the use of xenografts. Polytetrafluoroethylene (PTFE) conduits have been proposed as an alternative. This study evaluated the results of RVOT reconstruction using a PTFE conduit during the Ross procedure. METHODS: Between 2007 and 2015, 28 patients underwent RVOT reconstruction using PTFE conduits. The mean age of the patients was 35.9 ± 18.1 (range 4-58) years. The total root replacement technique was used in all patients. The mean PTFE conduit size was 25.3 ± 2.3 mm. RESULTS: The early mortality rate was 3.6% (1 patient). The mean follow-up duration was 48.5 ± 31.2 months; there were no late deaths. The transprosthetic gradients increased significantly over time. The conduit size was the only independent predictor of peak RVOT gradient progression (P = 0.02). None of the patients demonstrated significant RVOT regurgitation. One patient required an RVOT reoperation. CONCLUSIONS: The PTFE conduit demonstrates acceptable haemodynamic results at the mid-term follow-up and could be considered as an alternative substitute for RVOT reconstruction during the Ross procedure.

Long-term outcomes of expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction.

OBJECTIVE: Various types of conduits are available for right ventricular outflow tract (RVOT) reconstruction. We have developed an expanded polytetrafluoroethylene (ePTFE) conduit with bulging sinuses and a fan-shaped ePTFE valve. This study summarized the results of a multicenter study evaluating the valved ePTFE conduit. METHODS: The valve functions of 902 patients (median age, 3.9 years; median weight, 12.6 kg) who underwent RVOT reconstruction using valved ePTFE conduits (9 different sizes, 8-24 mm in diameter) at 65 hospitals between 2001 and 2015 were retrospectively investigated. Median follow-up time was 5.5 years. The valve functions were assessed using echocardiography, cardiac catheterization, and magnetic resonance angiography. RESULTS: There were no deaths related to the ePTFE conduit. The peak RVOT gradient was 16.5 ± 13.1 mm Hg, and pulmonary insufficiency graded better than mild was 95.9% at the latest follow-up. Conduit replacement was performed in 55 patients, and in only 3 patients because of conduit infection. Freedom from intervention at 5 years and 10 years was 92.3% and 76.1%, respectively, with small conduits (8-16 mm in diameter) and 99.6% and 95.1%, respectively, with large conduits (18-24 mm in diameter). CONCLUSIONS: The long-term outcomes of the ePTFE conduit with a fan-shaped valve and bulging sinuses appear clinically satisfactory. We believe that the longevity of small-sized conduits can yield sufficient time to exchange them to larger-sized conduits without any loss of their valve functions. Regarding longevity and resistance to infections, this ePTFE valved conduit can be one of the best ways to reconstruct the RVOT.