Pure tissue repairs: a timely and critical revival.

"The majority of hernias can be satisfactorily repaired by using the tissues at hand. The use of mesh prosthesis should be restricted to those few hernias in which tension or lack of good fascial structures prevents a secure primary repair. This group includes large direct inguinal hernias and incisional hernias in which the defect is too large to close primarily without undue tension. Most recurrent hernias, because of this factor are best repaired with mesh prosthesis". These words, penned in 1960 by Francis Usher have reconfirmed what had been a mantra of the Shouldice Hospital (Usher in 81:847-854, 1960). The Shouldice Hospital has specialized in the treatment of abdominal wall hernias since 1945. It has, since its beginning, insisted on the fact that a thorough knowledge of anatomy coupled with large volumes of surgical cases would lead to unparalleled expertise. It was Cicero who taught us that "Practice, not intelligence or dexterity, will win the day"! Since the seminal contribution of Bassini (1844-1924), there have been no less than 80 procedures imitating his inguinal herniorrhaphy and much more since the introduction of mesh and mesh devices (Iason in Hernia. The Blakiston Company, Philadelphia, pp 475-604, 1940). All have failed to some extent and it appears that the common denominator for these failures was the inability to understand the importance of entering the preperitoneal space. Only Shouldice and McVay (Lotheissen, Narath) realized the shortcoming and have continued to thrive as a successful procedure. Entering the preperitoneal space eliminates any temptation to plicate the posterior inguinal wall, a layer normally deficient in direct inguinal hernias, but it also allows the identification of muscle layers rectus, transversus and internal oblique muscles which will go to reconstruct the posterior inguinal wall, without tension as reported by Schumpelick (Junge in 7(1):17-20, 2003).

[In search of a cultural-technological history of genital prosthetics]. / Auf der Suche nach einer Kultur- und Technikgeschichte der männlichen Genitalprothetik.

Within the field of the history of technology, much has been written about the so-called "prosthesis boom" of the First World War. Most of these studies claim that the main motive of the mass supply of artificial limbs to amputee soldiers was primarily aimed at restoring the work force. However, because these studies often lack a gender perspective, it stays unmentioned to what extent this also served to reconstruct a hegemonic masculinity that had become fragile, if not destroyed by the consequences of the war. Especially genital injuries-prevalent during World War I and II as well as today-and their treatment and rehabilitation were (and still are) often largely taboo. Because of this silence, there have been no comprehensive studies or artifact collections on the cultural and technical history of male genital prosthetics. By presenting different examples of potential artifacts for such a history, the article suggests an object-based approach to fill this academic void. These thoughts are based on the assumption of a "doing gender through technology", hence that gender and sex are constantly constructed and modeled through (medical) technological practices.

Bone anchored hearing aids in children.

Bone-anchored hearing devices have evolved over recent years. This article provides an overview of the device history, indications, evolution of surgical technique, evidence for benefit and focuses on the challenges that are faced in the pediatric population.

Historical development of active middle ear implants.

Active middle ear implants (AMEIs) are sophisticated technologies designed to overcome many of the shortcomings of conventional hearing aids, including feedback, distortion, and occlusion effect. Three AMEIs are currently approved by the US Food and Drug Administration for implantation in patients with sensorineural hearing loss. In this article, the history of AMEI technologies is reviewed, individual component development is outlined, past and current implant systems are described, and design and implementation successes and dead ends are highlighted. Past and ongoing challenges facing AMEI development are reviewed.

World War II, tantalum, and the evolution of modern cranioplasty technique.

Cranioplasty is a unique procedure with a rich history. Since ancient times, a diverse array of materials from coconut shells to gold plates has been used for the repair of cranial defects. More recently, World War II greatly increased the demand for cranioplasty procedures and renewed interest in the search for a suitable synthetic material for cranioprostheses. Experimental evidence revealed that tantalum was biologically inert to acid and oxidative stresses. In fact, the observation that tantalum did not absorb acid resulted in the metal being named after Tantalus, the Greek mythological figure who was condemned to a pool of water in the Underworld that would recede when he tried to take a drink. In clinical use, malleability facilitated a single-stage cosmetic repair of cranial defects. Tantalum became the preferred cranioplasty material for more than 1000 procedures performed during World War II. In fact, its use was rapidly adopted in the civilian population. During World War II and the heyday of tantalum cranioplasty, there was a rapid evolution in prosthesis implantation and fixation techniques significantly shaping how cranioplasties are performed today. Several years after the war, acrylic emerged as the cranioplasty material of choice. It had several clear advantages over its metallic counterparts. Titanium, which was less radiopaque and had a more optimal thermal conductivity profile (less thermally conductive), eventually supplanted tantalum as the most common metallic cranioplasty material. While tantalum cranioplasty was popular for only a decade, it represented a significant breakthrough in synthetic cranioplasty. The experiences of wartime neurosurgeons with tantalum cranioplasty played a pivotal role in the evolution of modern cranioplasty techniques and ultimately led to a heightened understanding of the necessary attributes of an ideal synthetic cranioplasty material. Indeed, the history of tantalum cranioplasty serves as a model for innovative thinking and adaptive technology development.

Overview of disc arthroplasty-past, present and future.

Degenerative disc disease is one of the most frequent spinal disorders. The anatomy and the biomechanics of the intervertebral disc are very complex, and the pathomechanics of its degeneration are poorly understood. Despite this complexity and uncertainty, great advances have been made in the field of disc replacement technology, with promising results. Difficulties are continuously being encountered, but careful analysis of the results and intensive research and development will assist in countering these problems. There are approximately 40 clinical reports in the literature describing various aspects of randomised controlled trials involving intervertebral disc arthroplasty. However, the majority of these publications do not provide reliable information, in that they give only interim results and/or the results from just one of the many centres in multicentre studies. Such publications must be interpreted with caution, since they do not always represent the results of the whole study population and may hence be underpowered. We identified six randomised controlled trials that compared the final clinical outcomes of disc arthroplasty and spinal fusion. The present systematic review attempts to give an overview of the current status of disc arthroplasty.

Tracheal replacements: part 1.

In this review, we summarize the history of tracheal reconstruction and replacement as well as progress in current tracheal substitutes. In Part 1, we cover the historical highlights of grafts, flaps, tube construction, and tissue transplants and address the progress made in tracheal stenting as a means of temporary tracheal support. This is followed in Part 2 by an analysis of solid and porous tracheal prostheses in experimental and clinical trials. We conclude Part 2 with a summary of recent efforts toward generating a bioengineered trachea. Finally, we provide an algorithm on the spectrum of options available for tracheal replacement.

The history and future of implantation therapy for gastroesophageal reflux disease.

The initial development of endoscopic implantation techniques for the treatment of gastroesophageal reflux disease in the 1980s helped set the stage for current implantation techniques and studies, which now include more than 500 patients. The relative simplicity of these techniques adds to their attraction. Ultimately, multiple factors, including therapeutic efficacy durability, safety, simplicity, and cost-effectiveness, will determine clinical application of these techniques. This article focuses on transoral endoscopic implantation, although surgical, transcutaneous, and other endoscopic routes have been used as well.

Wrapping the visceral sac into a bilateral mesh prosthesis in groin hernia repair.

Almost 40 years of lucky existence is enough time for questioning and/or updating the Stoppa method for hernia repair. In this paper, the author reports the circumstances of the birth of this method more than 30 years ago, recalls its innovative principles, describes its technical aspects, and exposes its good results. Not simply approving old concepts, the author concludes with critical remarks with regard to a so-called political correctness of today's groin hernia repair, which gives great importance to reducing patient trauma arising from surgery. For belief without doubt can be wrong belief!