Conventional Closure Research Articles

Randomized Trial of Sternal Closure for Low Risk Patients: Rigid Fixation versus Wire Closure.

A previous retrospective analysis of our cardiac surgery patients showed shortened ventilation time and hospital stay among patients receiving rigid sternal fixation compared to sternal wire fixation. We performed a prospective randomized study to further investigate these outcomes and determine if rigid closure can provide reduced pain after cardiac surgery. Patients undergoing cardiac surgery between July 2011 and May 2014 were prospectively randomized into wire closure (Group C) or rigid fixation using sternal plates (Group R) groups. Age above 80, emergency surgery, redo sternotomy, and immunosuppression were among major exclusion criteria precluding randomization. Intubation time was recorded for all patients. Pain scores were determined daily from postoperative day 1 until day 5 at 6 a.m. using a numeric rating scale. Narcotic pain medication requirements from day 1 to 5 were collected and converted into intravenous morphine equivalents. Of 80 patients, 39 patients were in Group R (average age 65 ± 8; 31 male and 8 female) and 41 patients were in Group C (average age 66 ± 9; 34 male and 7 female). Group R patients had a higher body mass index than patients in Group C (Group R: 31 ± 5; Group C: 29 ± 5; P = .04). No significant differences in the end points of intubation time and postoperative pain were observed.Conclusion: This randomized study of cardiac surgery patients showed no significant benefits of rigid fixation over conventional sternal wire closure with regard to intubation time, postoperative pain, or length of hospital stay.

Comparison of conventional closure versus “re-modified Smead Jones” technique of single layer mass closure with Polypropylene (prolene) loop suture after midline laparotomy in emergency cases

Background: The occurrence of sudden disruption of the abdominal laparotomy wound is a major disaster in the life of a patient who has undergone an abdominal operation and a major psychological blow to the patient as well as the surgeon.Methods: 100 consecutively enrolled patients who underwent emergency midline laparotomies were enrolled in the study who were admitted in Department of Surgery, JSS University, Mysore and intra-operatively randomized into two groups in 1:1 pattern.Results: The total number of patients who underwent laparotomy for generalized peritonitis in 2 years was 100. The post-operative wound infection rate in Group A was 32.4% and in Group B was 12.3% (p = 0.03) and 95% CI (1.083-7.326).Conclusions: Present study concluded that the modified version of Smead-Jones techniques of laparotomy closure with prolene loop had very low incidence of early and may reduce the late complications. It was superior to other conventional methods of closure.

Reynolds stress modelling of wake interference of two cylinders in tandem: Conventional vs. eddy-resolving closure

A differential, near-wall Reynolds stress model (RSM) employed in Unsteady RANS (Reynolds-Averaged Navier–Stokes) framework, coupled with the equation governing the inverse turbulent time scale relying on the so-called 'homogeneous dissipation' rate (ωh=ɛh/k), was applied to two in-line tandem-cylinder flow configurations. The configurations differ with respect to the distance between cylinders, with the consequence of a differently characterized wake structure. The reference experimental database has been provided by Jenkins et al. (2005, 2006) and Neuhart et al. (2009). Complementary to the ‘conventional’ Reynolds stress model based on the Jakirlic and Hanjalic's (2002) formulation, its version sensitized appropriately to account for the turbulent unsteadiness by a selective enhancement of its production in line with the SAS (Scale-adaptive Simulation) proposal (Menter and Egorov, 2010), formulated recently by Jakirlic and Maduta (2015), was also applied. This eddy-resolving RSM formulation has been shown to be capable of returning all important mean flow and turbulence features of the configurations considered, including also the intermittent shedding behaviour of the flow in the gap between cylinders related to the long-distance case. The model's inherent capability of capturing the turbulence unsteadiness resulted consequently in the correctly predicted mean flow and turbulence fields, unlike the conventional URANS RSM model which could reasonably well return only the mean surface pressure distribution.

A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

English

BACKGROUND: Seroma formation and its sequelae including infection, flap necrosis, delayed wound healing and patient discomfort form one of most commonly encountered complication following mastectomy and axillary dissection. Mechanical closure of dead space by flap fixation is a simple surgical procedure that eliminates dead space after mastectomy, by decreasing the movement of flap over chest wall and thereby reducing the exudate. OBJECTIVE: The objective of this study is to evaluate the effect of mechanical closure of dead space after mastectomy in prevention of seroma formation. METHOD: A total of 80 patients of Carcinoma Breast who underwent Modified Radical Mastectomy in Department of general surgery, Government Rajaji Hospital, Madurai during the period from March 2016 to August 2016, were included in this prospective study, and randomized into two groups based on in-patient number. 42 patients with odd IP no in conventional simple wound closure (Group A) and 38 patients with even IP no in Flap fixation (Group B). Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma, and wound complications. RESULT: Of the 80 women, 42 women with mean age 48±8 years belongs to group A and 38 women with mean age 46±7 years belongs to group B. Average size of the tumor at presentation was 3.4cm. 36 (45%) women presented with stage IIA disease and 44 (55%) with stage IIB disease. Drain volume in first post-operative day varied from 100 to 200ml with average of 170ml in group A and 163ml in group B. There was no statistically significant difference in the drain volume in first post-operative day (p > 0.05). The average total drain volume in the post-operative period in group A was 1426ml and 932ml in group B. p value was found to be significant (< 0.001). The average day of drain removal in group A was 13 days and 8 days in group B. p value was found to be significant (< 0.001). 8 patients developed seroma in Group A Vs none in group B. p value was found to be significant (> 0.05). One patient developed wound complication (cellulitis) Vs none in group B. There was no statistically significant difference in the incidence of wound complications in both groups. CONCLUSION: The present prospective study demonstrated that the mechanical obliteration of dead space by flap fixation significantly decreases the incidence of seroma formation. So when performing modified radical mastectomy, the flap-fixation technique is a valuable technique for reducing seroma formation allowing early drain removal and increased patient satisfaction.

Double-blind randomized controlled trial of collagen mesh for the prevention of abdominal incisional hernia in patients having a vertical rectus abdominis myocutaneus flap during surgery for advanced pelvic malignancy.

The study investigated the effect of collagen mesh-assisted closure at the donor site in preventing the formation of incisional hernia following construction of a vertical rectus abdominis myocutaneus (VRAM) flap as part of pelvic surgery for recurrent colorectal cancer. The study was a double-blinded randomized controlled superiority trial that was designed and performed according to the Consolidated Standards of Reporting Trials (CONSORT) Statement. Eligible patients undergoing surgery that included a VRAM flap for advanced colorectal pelvic malignancy were prospectively randomized to conventional abdominal wound closure or collagen mesh-assisted closure. The primary end-point was incisional herniation at 1year confirmed by CT. Secondary end-points were CT-verified incisional herniation at 3 and 36months, clinically recognizable incisional herniation, donor-site and reconstructive-site complications, surgical mortality, postoperative morbidity, postoperative recovery and survival. In total, 58 (29 conventional closure; 29 mesh-assisted closure) patients were included. At 1year, incisional herniation on the CT scan was found in 12 (50%) of 24 patients in the conventional closure group, and in 8 (33%) of 24 in the mesh-assisted closure group (P=0.38). No significant difference between the groups was found in surgical mortality, early or late complications or survival. Donor-site morbidity was comparable between the two groups. No preventative effect of collagen mesh-assisted closure was observed following VRAM flap reconstruction.

Lumbodorsal flap for repair of meningomyelocele- a procedure matched controlled study

Background: Open neural tube defects have been approached by innumerable surgical techniques. Hitherto, excision of the exposed neural tube component, water tight closure of dura, approximation of paraspinal soft tissue and skin closure repair was stressed. Support of vertebral defect was not adequately addressed. Objectives were to introduce lumbodorsal/thoraco dorsal fascial flap as an effective answer to the vertebral defect component of MMC. To compare conventional paraspinal soft tissue closure with lumbodorsal/ thoracodorsal fascial flap.Methods: This was a procedure matched controlled study conducted from 1984-2015. A total of 121 procedures were performed by the same team formed the cohort of the study. Conventional muscle mobilization group A (n=50) and lumbodorsal flap group B (n=71) were the two groups. Demographic data, CSF leak, CSF collection, wound dehiscence, duration of drain and duration of surgery were the parameters evaluated with statistically blinded method.Results: The series mostly constituted lumbar (28%) and lumbo-sacral meningomyelocele (56%). Most of the children in both the groups are either at birth or &lt;1 month. Only few patients in group B with lipo-meningocele presented beyond the age of 5 years (7%). 12% in group A had hydrocephalus, whereas 15.4% had in group B. The patients underwent similar technique at all sites of MMC. Grossly it appears that there is less wound dehiscence, less CSF leak, less hygroma formation in group B cases. Duration of surgery is similar in both the groups, most of them requiring 60 to 120 minutes. The duration of drainage was more than 7 days in group A (34%) as compared to group B (20%).Conclusions: Lumbodorsal/thoraco dorsal fascial flap adequately supports the vertebral defect and skin flaps. They seem to be superior in addressing the vertebral defect component.

Prediction of Turbulent Flow Around a Square Cylinder With Rounded Corners

Predictions are reported of the two-dimensional turbulent flow around a square cylinder with rounded corners at high Reynolds numbers. The effects of rounded corners have proved difficult to predict with conventional turbulence closures, and hence, the adoption in this study of a two-equation closure that has been specifically adapted to account for the interactions between the organized mean-flow motions due to vortex shedding and the random motions due to turbulence. The computations were performed using openfoam and were validated against the data from flows past cylinders with sharp corners. For the case of rounded corners, only the modified turbulence closure succeeded in capturing the consequences of the delayed flow separation manifested mainly in the reduction of the magnitude of the lift and drag forces relative to the sharp-edged case. These and other results presented here argue in favor of the use of the computationally more efficient unsteady Reynolds-averaged Navier-Stokes approach to this important class of flows provided that the effects of vortex shedding are properly accounted for in the turbulence closure.

Outcomes of perventricular off-pump versus conventional closure of ventricular septal defects: a prospective randomized study.

Perventricular device closure (PVDC) of ventricular septal defects (VSDs) has demonstrated excellent clinical results. However, no prospective studies have compared PVDC with the conventional approach (CA). Between June 2012 and August 2014, 640 consecutive patients with isolated VSD were enrolled in the study, and randomized into the PVDC group ( n = 320) and the CA group ( n = 320). The mean ages were 36.2 (10; 36) months and 36.2 (10; 36) months, respectively. The average weights were 13.9 (8.1; 15.0) kg and 14.5 (6.9; 13.8) kg, respectively. The mean follow-up was 24.9 (standard deviation 1.8) months. No early or late deaths occurred in either group. The procedural success rate reached 96.6% in the PVDC group, with a 3.4% conversion rate to CA. Mean procedure time was 56.9 (30; 70) min in the PVDC group and 162 (120; 180) min in the CA group ( P = 0.000). Thirteen (3.9%) patients in the CA group and only 4 (1.3%) in the PVDC group required postoperative blood transfusion in the intensive care unit ( P = 0.040). At the final follow-up, significantly more residual shunts were found in the CA group. No rhythm or conduction disorders occurred in any patient of either group. According to the mid-term follow-up results, PVDC has similar efficacy to CA for VSD closure. The off-pump PVDC technique reduces blood product transfusion and the procedural time and minimizes surgical trauma while providing excellent cosmetic results.

Flap Fixation Using Tissue Glue or Sutures Appears to Reduce Seroma Aspiration After Mastectomy for Breast Cancer

BackgroundUp to 90% of patients undergoing breast cancer surgery suffer from seroma formation, which can cause discomfort and various complications after mastectomy. This retrospective observational cohort study aimed to elucidate whether flap fixation with fibrin sealant (ARTISS) tissue glue reduces seroma formation and seroma aspiration after mastectomy when compared with flap fixation using Vicryl sutures and when compared with a conventional wound closure technique. MethodsAll patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in 2 large breast cancer centers were treated using flap fixation with Vicryl sutures. From September 2013 to March 2014, all patients undergoing mastectomy were treated with flap fixation using ARTISS tissue glue. The data were retrospectively analyzed and compared with a “drain-only” group that was not treated with flap fixation (May 2011-March 2012). ResultsA total of 230 women who underwent mastectomy were retrospectively analyzed in this trial; 88 patients were included in the drain-only group (DO), 92 patients were included in the flap fixation group using Vicryl sutures (FF-1), and 50 patients were included in the flap fixation group using ARTISS tissue glue (FF-2). There was significantly less seroma formation in the group after flap fixation using sutures (P = .006). There were significantly fewer patients who required seroma aspiration in the FF-1 group (P = .001) and the FF-2 group (P = .001) after undergoing mastectomy and sentinel node biopsy or modified radical mastectomy. ConclusionThis study suggests that flap fixation after mastectomy using ARTISS tissue glue or sutures reduces postoperative seroma aspiration. As a result, flap fixation might lead to less patient discomfort. A randomized, prospective trial should be performed to verify these results.

Características del carcinoma epidermoide cutáneo y riesgo para el desarrollo de recidivas con cirugía convencional y cirugía con transoperatorio tardío

BackgroundNon-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis ObjectiveTo identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population. Materials and methodWe reviewed clinical records from the last 10 years, and included those with a diagnosis of SCC. ResultsOne hundred and fourteen tumours in 103 patients were included. The mean new tumour diagnosis was 32.2 per year; there were 46.6% men and 53.4% women. Age range 19-91, with mean 71.94 years (SD=13.34). The evolution time was from 1-112 months (mean=12 months, SD=2.65). The most affected site was the cheek. In addition, an invasive tumour was reported in 54% in the histopathological study. At 10-year follow-up we found a second SCC in 14 patients and only 4 recurrences, between the 1st and 4th year and 3were treated with delayed closure until margins were tumour-free. ConclusionIn this study we demonstrated that delayed closure technique is easy and adaptable in our population in the treatment of SCC, achieving good results with very low recurrences at 10- year follow -up.

PROSPECTIVE CLINICAL STUDY: MASS CLOSURE VERSUS LAYER CLOSURE OF ABDOMINAL WALL

Background: Most common abdominal wall incisions are midline or paramedian and its closure technique should be efficient to provide strength for prevention of incisional hernia and should be a barrier to infection. Incisional hernia is commonest complication as high as 39.9 % after abdominal surgery. Integrity of sutured abdominal wound rests on balance between suture holding capacity of tissues and tissue holding capacity of sutures (1). Objective: objective of study is evaluate comparison between mass closure and layered closure of midline and paramedian incisions for operative time and postoperative complications after performing single layered closure and conventional layered closure of laparotomy wounds like seroma ,wound infection ,wound gaping ,burst abdomen and incisional hernia. Results : Meantime for closure of laparotomy wound through midline or Para median incision by single layered closure technique was 14 minutes and by layered closure technique was 23 minutes . There was difference of 9 minutes statistically significant (p=0.001). In postoperative period patients closed by mass closure technique 8 patients(16%) had postoperative complications in the form of seroma in 2 patients(4%), infection in 3 patients(6%), wound gaping in 2 patients(4%) and incisional hernia in 1 patient(2%)and no patient had burst abdomen where as in layered closure total 16(32%) patients had complications as seroma in 5 patients(10%) ,wound infection in 4 patients(8%)., gaping in 4 patients(8%) burst abdomen in 1 patient (2%) and incisional hernia in 2 patients(4%). Conclusion: Single layered closure technique is better than layered closure in term of operation time and postoperative complications like seroma, infection, wound gaping, burst abdomen and incisional hernia.

Peratrial Device Closure of Atrial Septal Defect Under Transesophageal Echocardiographic Guidance without Fluoroscopy Compared to Conventional On-Pump Surgical Closure.

ObjectiveThis study is designed to evaluate the advantages between peratrial device closure under transesophageal echocardiographic guidance and open heart surgery in atrial septal defect.MethodsFrom November 2011 to September 2014, 28 patients with atrial septal defect were treated. Fourteen patients received peratrial device closure under transesophageal echocardiographic guidance (TEE group) and 14 patients received cardiopulmonary bypass (CPB group). Clinical parameters during intraoperative and postoperative periods were examined.ResultsAll patients recovered after surgery without serious complications. Compared with that in CPB group, clinical observations in TEE group showed significant decreases in the operation time (193.6±35.5 vs. 77.4±22.7 min, P<0.05), periods in intensive care unit (31.6±23.3 vs. 17.5±8.1 hours, P<0.05), fluid volume after operation (502.5±439.3 vs. 32.5±7.3 ml, P<0.05), postoperative length of hospital stay (8.9±2.8 vs. 6.8±2.4 days, P<0.05) and total hospitalization cost (7205.9±1617.6 vs. 5882.3±441.2 $, P<0.05).ConclusionThe peratrial device closure of atrial septal defect under transesophageal echocardiographic guidance is a mini-invasive, simple, safe and effective intervention. Its use in the clinical practice should be encouraged.

Comparison of glues, sutures, and other commercially available methods of skin closure: A review of literature

Objectives: Octyl-2-cyanoacrylate (Dermabond) is a soft tissue adhesive that has been approved for topical use to close traumatic lacerations and surgical incisions. We review paediatric and adult human studies that compared octyl-2-cyanoacrylate with conventional closure techniques in a variety of wounds.Methods: Medline were searched using a combination of ‘tissue adhesives’, ‘cyanoacrylates’, ‘sutures’, ‘surgical staplers’ and ‘surgical tape’ for paediatric and adult studies comparing skin adhesives with other methods of wound closure. A review was performed using search results screened using predetermined inclusion and exclusion criteria.Results: We found and summarized 17 studies comparing octyl-2-cyanoacrylate skin glue to conventional methods of skin closure.Conclusions: Octyl-2-cyanoacrylate skin adhesive produces similar cosmetic results to sutures and other current wound closure techniques while being cost effective, quick and easy to use. Studies suggest that it may be a preferable alternative to sutures.

Right Ventricular Isovolumic Acceleration in Children with Patent Ductus Arteriosus: Short and Mid-term Follow-up after Percutaneous Device Closure

Objective: We aimed to assess the association of right ventricular acceleration during isovolumic contraction (RVIVA) to functional recovery after device closure of patent ductus arteriosus (PDA). Methods: 84(7.5+6.8 year; 49 female ) patients who underwent device closure of PDA were evaluated with conventional and tissue Doppler echocardiography pre closure, at 24 hours and at 6 months post closure to assess RVIVA, myocardial performance index (MPI). Brain natreuretic peptide (BNP) was assessed pre closure and 6 months post closure Results: RVIVA was significantly decreased in children with PDA, while other conventional Echo Doppler parameters were comparable to controls. Following closure of PDA, RVIVA was significantly increased (P 2.4 m/s was the best cutoff value in predicting functional recovery after percutaneous closure of PDA. Conclusion: Measurement of RVIVA in patients with PDA specially those presented late are important to differentiate high- and low-risk groups in terms of prognosis.. RVIVA might be considered a useful indicator for functional recovery after device closure of PDA

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI). Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure.Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant. Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

Incidence of wound complications in cesarean deliveries following closure with absorbable subcuticular staples versus conventional skin closure techniques

ObjectiveTo determine if there is a significant difference in composite wound complications among traditional closure techniques versus absorbable subcuticular staple closure. Study designThis study is a retrospective cohort study of cesarean sections performed from January through September of 2014. Composite wound complications included surgical site infection, separation, and fluid collection. Medical records were reviewed and data including the patient demographics, comorbidities, closure type and wound complications were recorded. Patients with incomplete data were excluded. Data were analyzed with ANOVA or Fisher exact test, according to data type. ResultsOf the 186 patients identified, 176 patients were included in the data analysis (n=83 suture, n=49 traditional staple, n=44 the absorbable subcuticular staple). The groups were similar in all demographic categories; labor prior to delivery, estimated blood loss, and medical and pregnancy related comorbidities. The overall incidence of wound complications at our institution during this study was 5.7%. The incidence of complications among the suture and subcuticular staple closure was not significantly different (3.6% versus 0%, p=0.3), however there were significantly less complications in the suture and subcuticular staple closure groups when compared to traditional staple closure (14.3%) (p=0.03 and p=0.01, respectively). ConclusionHerein, we report a decreased incidence of composite wound complications with subcuticular staple closure versus traditional staple closure in patients undergoing cesarean section. Absorbable subcuticular staple closure represents a convenient, safe and cost-effective closure technique.

GRADIENT-DIFFUSION CLOSURE AND THE EJECTION-SWEEP CYCLE IN CONVECTIVE BOUNDARY LAYERS

The inadequacy of conventional gradient-diffusion closure in modeling turbulent heat flux within the convective atmospheric boundary-layer is often alleviated by accounting for nonlocal transport. Such nonlocal effects are a manifestation of the inherent asymmetry in vertical transport in the convective boundary layer, which is in turn associated with third-order moments (skewness and fluxes of fluxes). In this work, the role of these third-order moments in second-order turbulence closure of the sensible heat flux is examined with the goal of reconciling the models to various closure assumptions. Surface layer similarity theory and mixed-layer parametrizations are used here, complemented by LES results when needed. The turbulent heat flux with various closure assumptions of the flux transport term is solved, including both local and nonlocal approaches. We connect to ejection-sweep cycles in the flow field using the GramCharlier cumulant expansion of the joint probability distribution of vertical velocity and potential temperature. In this nonlocal closure, the transport asymmetry models that include the vertical velocity skewness as a correction term to H originate from ejection-sweep events. Vertical inhomogeneity results in a modified-skewness correction to the nonlocal contribution to the heat flux associated with the relative intensity of ejections and sweeps.

Prophylactic mesh can be used safely in the prevention of incisional hernia after bilateral subcostal laparotomies

The use of prophylactic mesh to prevent incisional hernia is becoming increasingly common in midline laparotomies and colostomies. The incidence of incisional hernia after subcostal laparotomies is lower than after midline incisions. Nevertheless, the treatment of subcostal incisional hernia is considered to be more complex. Currently, there are no published data about mesh augmentation procedures to close these laparotomies. This was a longitudinal, prospective, cohort study of patients undergoing a bilateral subcostal laparotomy in elective operations. The mesh group was a group of patients operated consecutively between 2011 and 2013 with a prophylactic self-fixation mesh. The control group was selected from a retrospective analysis of patients operated between 2009 and 2010 and closed with a conventional protocol of 2-layer closure. The incidence of incisional hernia was recorded both clinically and radiologically for 2years. A total of 57 patients were included in the control group and 58 in the mesh group. Most patients underwent gastric, hepatic, and pancreatic operations. Both groups were homogeneous in terms of their clinical and demographic characteristics. Operative time and hospital stay were similar in both groups. Both groups had a comparable rate of local and systemic complications. Ten patients (17.5%) in the control group developed an incisional hernia, and only 1 patient (1.7%) in the mesh group developed an incisional hernia (P=.0006). The incidence of incisional hernia after a conventional closure of bilateral subcostal laparotomy is significant. The use of a mesh augmentation procedure for closing bilateral subcostal laparotomies is safe and may reduce the incidence of incisional hernia.

Zipfix versus Conventional Sternal Closure: One-year follow-up

Purpose: The present study aimed to compare postoperative complications commonly revealed after sternotomy closure by new sternal ZipFixTM and conventional steel wire.