Defect Diameter Research Articles

SP7.11 Preliminary results from the TACKoMesh RCT; comparing the patient experience of pain following elective laparoscopic incisional hernia repair with ‘Protack™ versus Reliatack™’, IPOM and sutured fascial closure

AimsProvide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.MethodsTrial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74–136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome.Surgery was performed with spiral-tack mesh-fixation devices (Protack™ (permanent) or Reliatack™ (absorbable)), Symbotex™ IPOM mesh, and sutured fascial closure using extracorporeal knot ties.Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106.ResultsPatients were aged 36–80 and 57.1% male. Mean preoperative BMI was 30.91.Mean operating time was 81minutes. In 20.6% patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median 3 knots.Median mesh-fixation time was 286seconds and a mean of 25 tacks/patient were used. Median length of hospital stay was 3.5days.Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively.At one year, 11% patients had experienced hernia recurrence and 52% a post-operative seroma.ConclusionsTarget recruitment was not possible owing to COVID-19. This technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.

Proximate and mineral composition of Japanese quail egg and its possible role in bone healing

Quail eggs are known to be highly nutritious. In the first study, the nutritional and mineral composition of quail eggs was evaluated by determining the proportion of moisture, total ash, lipids, nitrogen, crude protein and carbohydrate in the egg. The second phase was to determine the role of quail eggs in bone healing. Freshly laid Japanese quail eggs were purchased from a research institute in Plateau state, Nigeria. Five eggs were randomly selected and used for the evaluation of the nutritional and mineral composition of eggs. They were subjected to different methods to obtain the proximate and nutritive content. The moisture content in the egg was 65.5 %, total ash was 8.5 %, lipid was 1.5 %, nitrogen was 0.75 %, crude protein was 4.72 %, and carbohydrate was 19.78 %. For the mineral content, sodium was 42.5 mg, potassium was 80 mg, phosphorus was 6.49 mg, calcium was 0.9 mg, and magnesium was 1.3 mg. In the second study, 12 male New Zealand white rabbits with an average age of 7–8 months were used. They were separated into 2 groups comprising 6 rabbits per group. Rabbits in group A had a cylindrical trephine drill to create a 3.5 mm diameter defect on the lateral distal epicondyle of the left femur and were monitored for 12 weeks. Faster healing was observed in the group administered quail egg. At week 10, the radiographic score of the quail egg treated group [4(3-4)] was significantly (P < 0.05) higher compared to the control group with 2(2-3). At week 12, complete healing was observed in the quail egg group [4(4-4)]; this was different from the control group that had 2 rabbits yet to be healed. The study shows that Japanese quail egg is nutritious and rich in essential nutrients including calcium and phosphorus and as such it can serve as a nutritional supplement to enhance bone healing.

Repairing Small Facial Soft Tissue Defects by Tissue Regeneration in Asians.

A variety of options are available to repair the small facial soft tissue defects after surgical removal of cutaneous tumor, including direct suture, skin grafts, local, regional or free flaps. However, tissue regeneration is another option for repairing facial defects. This study proposes the clinical application of the principle of tissue regeneration priority in small defects (diameter <1.3cm) of facial soft tissue. A retrospective study of 33 patients whose facial defects were repaired by tissue regeneration healing in situ from January 2019 to January 2022. In this group, the facial soft tissue defects were treated with wound moist theory in order to promote wound regeneration. All patients underwent 1 month follow-up at least and the longest follow-up time was 6 months. Hundred percent of the patients were satisfied with their cosmetic outcome. Only some patients formed small depression scars after surgery, the appearance of which were similar to acne scar. In this situation, re-resection and laser treatment could be used as complementary procedures. However, no patient underwent the secondary treatments including laser and re-resection. Healing by tissue regeneration is an effective option for the facial defects in Asians. For most of the small soft tissue defects of the face, tissue regeneration in situ can achieve satisfactory effects. More importantly, it has the advantages of simple operation and fewer complications.

Giant Incisional Hernia Repair Using Open Intraperitoneal Dual Mesh.

AimGiant incisional herniae are larger than 15 cm and are typically treated with an open approach. Our aim was to highlight the outcomes of treating giant incisional hernia using open intraperitoneal dual mesh.MethodsBetween January 2015 and December 2021, 25 patients with giant incisional hernias, where fascial defects were 15-30 cm, were evaluated retrospectively. Intraperitoneal dual mesh was used in all patients. The patients were evaluated in terms of age, gender, body mass index (BMI), previous abdominal surgeries, defect diameter, anesthesia method, length of hospital stay, drain application, complications, and recurrence.ResultsEleven of the patients were male and 14 were female. The mean age was 62±13.5 years (29-82 years). The average BMI was 32 kg/m2 (20-52 kg/m2). The mean size of the fascial defect was 22±5.5 cm (15-30). The mean operation time was 90 minutes (70-130 minutes). Six patients had type I and II complications according to the Clavien-Dindo classification, specifically superficial skin infections, skin erosion, subcutaneous bleeding, and temporary ileus due to intestinal adhesion. During the average follow-up period of 36 months (6-70 months), no major complications were observed related to the recurrence and use of dual mesh.ConclusionIn the treatment of giant incisional hernia, open intraperitoneal dual mesh application should be kept in mind as an effective treatment option with low complication and recurrence rates.

Transcatheter Closure of Atrial Septal Defect in Children: Single-Center Experience, Mid-Term Follow-up Results.

Objective:Atrial septal defect is a congenital heart disease usually diagnosed in childhood. This study aimed to evaluate the mid-term follow-up results of patients who underwent transcatheter closure of atrial septal defect by comparing the devices and methods used in the procedure and investigating the complications of this procedure in children.Materials and Methods:This study evaluated 232 patient files retrospectively. Of the 232 patients, 24 were excluded from the study due to missing files or data. Also, patients with multi-fenestrated atrial septal defect and aneurismatic septal tissue were excluded from the study. The following data were evaluated: follow-up time, patient complaints, symptoms, transthoracic echocardiography, and transesophageal echocardiography findings (if performed), the size of the defect as measured by balloon-sizing, the size of the device used in the procedure, and major and minor complications.Results:The study included 208 children who were diagnosed with atrial septal defect. The mean age of the patients was 88.0 ± 56.5 months. Of the patients, 170 (81.7%) had no complaints. The success rate of the procedure was found to be 95.7%. While device embolization was the most common major complication, arrhythmia was the most common minor complication. The complication rate was statistically different according to the device type used in the procedure.Conclusion:Transcatheter closure of atrial septal defect is a safe method for atrial septal defect closure in pediatric patients. The study found that defect diameters measured by different methods were not correlated with each other. The procedure complication rates differed according to device type.

Minimally invasive transabdominal preperitoneal repair of incisional lumbar hernia

Introduction: A lumbar hernia is a rare type of abdominal wall defect by anatomic location. It can be primary in origin over the lumbar triangles that can be categorized into superior (Grynfeltt) and inferior (Petit), or secondary as a result of trauma or surgery. Lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. Anatomical location makes challenging diagnosis and repair. Individual approach for every patient is a key for successful surgical treatment. In this paper, we present a minimally invasive approach to the treatment of incisional lumbar hernia. Case presentation: A 75-year-old patient from Pazardzhik town, admitted to our unit at the Military Medical Academy for swelling in the left lumbar region at the site of an old surgical scar from a previous nephrectomy (2020) caused by nephropathy. The swelling has a one-year history and causes periodic local pain and discomfort during physical exercise. CT-scan show us incisional left site lumbar hernia, 10cm defect diameter with descending colon and spleen as a hernia contents. We conducted preoperative preparation and consultations with an anesthesiologist, cardiologist and nephrologist. The patient underwent minimally invasive transabdominal preperitoneal lumbar hernia repair with a prosthesis. The postoperative period went smoothly and the patient was discharged on the fourth day. Three months later, he feels well and there is no evidence of recurrence. Conclusions: Preoperative CT-scan of the abdomen with contrast in lumbar hernia patients is a mandatory requirement for proper diagnosis and selection of an appropriate surgical approach. Minimally invasive transabdominal preperitoneal incisional lumbar hernia repair provides optimal view in operative field, minimal tissue trauma, fast recovery and good cosmetic results. This is a new method, but a feasible, useful and safe alternative to conventional surgical techniques for incisional lumbar hernia repair. Keywords: Incisional lumbar hernia, Preperitoneal repair, Hernia with rare location

Paper 40: Improved Cartilage Healing with Microfracture Augmented with Fisetin &amp; Bone Marrow Aspirate Concentrate in Acute Osteochondral Defect

Paper 40: Improved Cartilage Healing with Microfracture Augmented with Fisetin &amp; Bone Marrow Aspirate Concentrate in Acute Osteochondral Defect

Powder recycling effects on porosity development and mechanical properties of Hastelloy X alloy during laser powder bed fusion process

This study compares and analyzes the morphology, size, oxygen content, and microstructure of virgin and recycled powders after six iterations to assess the mechanical properties of the Hastelloy X alloys fabricated via laser powder bed fusion (LPBF). Compared to the virgin powder, the average particle size and oxygen content for the recycled powder are increased by 22% and 48%, respectively, which promotes the laser absorptivity of the powder bed from 0.45 to 0.64, resulting in the rapid transitioning of the keyhole to a precarious state. The porosity of the LPBF Hastelloy X alloy manufactured using the recycled powder was 1.47%, which was significantly higher than that of the parts prepared using the virgin powder. However, only a slight difference in the grain size was observed in the LPBF Hastelloy X alloys manufactured from the virgin and recycled powders. A 20.8% reduction in the plasticity of the LPBF Hastelloy X manufactured from the recycled powder was observed after six iterations. The evolution of the printed defects evolution during the recycling process was revealed. Importantly, a printed defect diameter larger than 40 µm can significantly affect crack initiation and propagation in LPBF products.

Comparison of renal parenchymal trauma after standard, mini and ultra-mini percutaneous tract dilation in porcine models.

To evaluate whether reducing tract dilation diameter in PCNL (percutaneous nephrolithotomy) procedures results in minimizing of renal trauma of the percutaneous tract. A percutaneous renal access tract was established bilaterally to 11 pigs. Two pigs were euthanized immediately after the experiment, while nine pigs were sacrificed 1 month later. The percutaneous accesses were dilated up to 30Fr, 22Fr or 12Fr. The animals underwent a contrast-enhanced computer tomography immediately after the procedure and 30days later. DMSA-scintigraphy with SPECT-CT was also performed. The kidneys of all animals were harvested for histological evaluation. The volume of scar tissue and the percentage of renal volume replaced by scar tissue were calculated. Immediate post-procedural CT-scans revealed a significant difference in defect diameter among the three modalities. However, the scar volume calculated on CT-images and histopathology showed a significant difference only when 30Fr dilation was compared to 12Fr dilation. The percentage of scar volume was negligible in all cases, but there was still a statistical difference between 30 and 12Fr dilation. Dilation up to 22Fr revealed no statistical differences compared to the other two modalities. DMSA-scintigraphy showed no scar tissue in any case. Dilation up to 30Fr may cause a significantly larger scar tissue on renal parenchyma compared to 12Fr dilation as it was shown on CT-images and microscopic evaluation, but based on the DMSA/SPECT-CT this difference seems to be insignificant to the renal function. The scar tissue caused by 22Fr dilation seemed to have no significant difference from the other modalities.

One-sized bilobed flap does not fit all standing cones: a mathematical analysis of the standing cone in bilobed flap dynamics.

The bilobed flap (BLF) is a workhorse for nasal repair. Alterations to the length and orientation of the BLF's standing cutaneous deformity (SCD) have been suggested as a means of preventing Z-plasty-induced flap lengthening and consequent ipsilateral alar depression. To investigate the effect of design variations of the SCD on bilobed flap mechanics. Geometric analysis of the BLF was performed using commercially available graphing software. BLFs were designed with a SCD equal to one radius (rBLF) and one diameter (dBLF) of the primary defect as well as with a more superiorly-oriented one diameter SCD (soBLF). Lengths from the pivot point to the distal edges of the primary defect and primary lobe were measured and compared. Elongation or a more superior orientation of the SCD without changes to the rest of the flap design forms a primary lobe along a shorter arc resulting in insufficient flap length to resurface the primary defect. The insufficient length requires secondary motion to complete the repair and possible unintended alar displacement. Modification of the size and orientation of the SCD alters the location of the pivot point, which is a key determinant of BLF mechanics. Therefore, changes to the SCD require alterations to the remainder of the flap design to ensure aesthetic and functional success.

Characterization of Nano-Scale Parallel Lamellar Defects in RDX and HMX Single Crystals by Two-Dimension Small Angle X-ray Scattering.

Nano-scale crystal defects extremely affect the security and reliability of explosive charges of weapons. In this work, the nano-scale crystal defects of 1,3,5-trinitro-1,3,5-triazacyclohexane (RDX) and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) single crystals were characterized by two-dimension SAXS. Deducing from the changes of SAXS pattern with sample stage rotating, we firstly found the parallel lamellar nano-scale defects in both RDX and HMX single crystals. Further analysis shows that the average diameter and thickness of nano-scale lamellar defects for RDX single crystal are 66.4 nm and 19.3 nm, respectively. The results of X-ray diffraction (XRD) indicate that the lamellar nano-scale defects distribute along the (001) in RDX and the (011) in HMX, which are verified to be the crystal planes with the lowest binding energy by the theoretical calculation.

Medium-long-term outcomes of saphenous vein graft in Peyronie surgery: Is there a need for new graft material?

AimWe present our results of tunical incision and saphenous graft surgery for men with short penis and who cannot have sexual relations due to curvature linked to chronic Peyronie plaques. IntroductionPeyronie disease is a chronic process where fibrotic plaques form in the tunica albuginea. The plaques cause pain in the acute period and cause the penis to bend after inflammation ends. Surgical procedures are required for curvature>30°. Saphenous vein graft (SVG) replacement is an alternative method for tunical plaque incision defect. Material-methodThe outcomes for 71 patients with TI+SVG surgery were retrospectively assessed. Plaque features (curvature angle, location, direction of curve and tunical defect diameter), operative and postoperative properties (surgery duration, recurrent curvature, penis shortening, glans hypoesthesia, satisfaction score, follow-up duration), preoperative–postoperative penis length and IIEF-5 score differences were assessed. ResultsMean age was 61.12±7.9 (45–75) years, mean curvature angle was 62.0±14.7 (50–90), location was mid-penile for 46 (65%), with angulation direction toward the dorsal for 37 (52%), and the defect area after tunical incision was 15.5±3.9 (10–23) cm2. With mean follow-up duration of 37±9.4 months, 9 patients had re-curvature (13.2%), 8 had short penis (11.3%) and 7 had ED identified (9.4%). Total penis straightening was present for 86.8%, with patient satisfaction score of 21.1±4.4 (8–25). ConclusionThe TI+SVG method is an effective method for Peyronie surgery in the medium-long term.

Revisiting Defect-Induced Light Field Enhancement in Optical Thin Films.

Based on a finite-difference time-domain method, we revisited the light field intensification in optical films due to defects with different geometries. It was found that defect can induce the local light intensification in optical films and the spherical defects resulted in the highest light intensification among the defect types investigated. Light intensification can increase with defect diameter and the relative refractive index between the defect and the film layer. The shallow defects tended to have the highest light intensification. Finally, the extinction coefficient of the defect had a significant effect on light intensification. Our investigations revealed that the light field intensification induced by a nano-defect is mainly attributed to the interference enhancement of incident light and diffracted or reflected light by defects when the size of the defect is in the subwavelength range.

Evaluation of Modified Dorsonasal Flap for Reconstruction of Dorsonasal Defect in Erbil

Background and objectives: nasal reconstruction is challenging for plastic surgeons mainly because its midfacial location and the relationship between convexities and concavities of nasal subunits that make it difficult to hide any contour deformity; as a result, proper planning of final scar location is crucial for successful aesthetic outcome. The modified dorsal nasal flap is used for resurfacing nasal tip defects with respecting of these nasal subunits. This paper evaluates the outcome of modified dorsonasal flap for reconstruction of the dorsal nasal defects. Method: in our department twenty nasal defects were reconstructed with modified dorsal nasal flap between years (2016-2019); Charts of these patients were analyzed in relation to their age, cause and size of the defect, complications and appearance. Results: half of patients who underwent nasal reconstruction by dorsal nasal flap were males (n=10) and the other half were females (n=10), mean age 39.5 months, median defect diameter was (21mm), follow up period ranged from (7-42 months), all patients were satisfied with results with no significant complications including: hematoma, infection, flap loss or wound dehiscence. Conclusion: Dorsal nasal flap is reproducible one stage flap for reconstruction of nasal defects with minimal complication and good aesthetic outcome.

Human acellular amniotic membrane scaffolds encapsulating juvenile cartilage fragments accelerate the repair of rabbit osteochondral defects.

AimsThe purpose of this study was to explore a simple and effective method of preparing human acellular amniotic membrane (HAAM) scaffolds, and explore the effect of HAAM scaffolds with juvenile cartilage fragments (JCFs) on osteochondral defects.MethodsHAAM scaffolds were constructed via trypsinization from fresh human amniotic membrane (HAM). The characteristics of the HAAM scaffolds were evaluated by haematoxylin and eosin (H&E) staining, picrosirius red staining, type II collagen immunostaining, Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). Human amniotic mesenchymal stem cells (hAMSCs) were isolated, and stemness was verified by multilineage differentiation. Then, third-generation (P3) hAMSCs were seeded on the HAAM scaffolds, and phalloidin staining and SEM were used to detect the growth of hAMSCs on the HAAM scaffolds. Osteochondral defects (diameter: 3.5 mm; depth: 3 mm) were created in the right patellar grooves of 20 New Zealand White rabbits. The rabbits were randomly divided into four groups: the control group (n = 5), the HAAM scaffolds group (n = 5), the JCFs group (n = 5), and the HAAM + JCFs group (n = 5). Macroscopic and histological assessments of the regenerated tissue were evaluated to validate the treatment results at 12 weeks.ResultsIn vitro, the HAAM scaffolds had a network structure and possessed abundant collagen. The HAAM scaffolds had good cytocompatibility, and hAMSCs grew well on the HAAM scaffolds. In vivo, the macroscopic scores of the HAAM + JCFs group were significantly higher than those of the other groups. In addition, histological assessments demonstrated that large amounts of hyaline-like cartilage formed in the osteochondral defects in the HAAM + JCFs group. Integration with surrounding normal cartilage and regeneration of subchondral bone in the HAAM + JCFs group were better than those in the other groups.ConclusionHAAM scaffolds combined with JCFs promote the regenerative repair of osteochondral defects.Cite this article: Bone Joint Res 2022;11(6):349–361.

Waiting time for Mohs Micrographic Surgery and the associated increase in lesion size of basal cell carcinoma

The first-line treatment for basal cell carcinoma (BCC) involved either surgical excision (SE) or Mohs micrographic surgery (MMS). The current waiting time for MMS and whether this is associated with worsening of outcome is unknown. We aim to look at the waiting time for MMS upon review at the Outpatient Specialist Dermatology Clinic and the increase in lesion size during this time period. A retrospective analysis of all patients who underwent MMS for biopsy-proven BCC over a duration of 5 years was performed. Variables analysed included patient age, sex, location, histologic subtype, lesion size at initial presentation, lesion size during MMS, defect size following MMS, waiting time for MMS, and projected defect size if lesions were treated with SE at earlier time point. A total of 233 patients were included in the final analysis. The mean wait time between referral to MMS was 215.8±125.7 days. The mean maximum diameter of lesions was 9.34±5.23 mm at referral for MMS and 11.91±6.60 mm at presentation for MMS, hence an increase of 3.01±3.03 mm (p=0.001, paired t-test), which equates to 1.41±0.42 times increase. The mean maximum diameter of the actual defect size post-MMS was 18.03±9.45mm, while the projected diameter of defect post SE was 15.29±5.71 mm, hence, smaller by 3.27±5.51 mm (p=0.001, paired t-test) compared with actual defect size post-MMS. This study highlights that the lesion grows significantly during the long wait for MMS. Hence, an increase in capacity for MMS is essential to reduce the waiting time for surgery which could lead to a defect which is easier to reconstruct with better outcome for patients.

Модифицированный метод инвертированного клапана внутренней пограничной мембраны в хирургии макулярных отверстий большого диаметра

Purpose. To evaluate the anatomical and functional results of surgical treatment of patients with large macular holes using the developed modification of the method of inverted internal limiting membrane flap. Material and мethods. The study included 72 patients (72 eyes) with a diagnosis of “full thickness macular hole” with a macular defect diameter of more than 400µm. The patients underwent a complete ophthalmological examination, including optical coherence tomography and microperimetry. The average age of patients was 67.8 ± 4.7 years The average diameter of macular holes according to OCT was 561.6 ± 123.6µm, the best-corrected visual acuity 0.12 ± 0.08. Results. All patients underwent endovitreal intervention by one surgeon according to the developed method. According to optical coherence tomography, in 98.6 % of cases (71 out of 72 patients), macular holes closure was observed 2 weeks after surgery. All patients noted an improvement in visual functions in the postoperative period. The best corrected visual acuity 2 weeks after the operation was 0.4 ± 0.08, as a rule, the maximum visual acuity was achieved after 6 months (0.5 ± 0.08). Conclusions. The proposed method showed high efficiency in the treatment of patients with large macular holes, which was confirmed by the data of optical coherence tomography, visometry and microperimetry. Keywords: large macular hole, internal limiting membrane peeling, inverted in-ternal limiting membrane flap.

The influence of functional pinealectomy and exogenous melatonin application on healing of a burr hole in adult rat calvaria: a histological and immunohistochemical study.

Even today, repair of the cranial defects still represents a significant challenge in neurosurgery and various options have been used for their reconstruction to date. However, there are very few studies investigating the effects of exogenous administration of melatonin (MEL) as an agent that promotes bone regeneration. The goal of this study was to investigate the effects of functional pinealectomy (Px) and exogenous MEL administration on the bone repair properties and surrounding connective tissue alterations in a rat calvaria model. The total of 30 adult female Wistar-Albino rats was randomly divided into three groups (n = 10): control group (CO; 12 h light/12 h dark exposure), functional Px group (24 h light exposure, light-induced functional Px), and Px+MEL group (light-induced Px + MEL, 20 mg/kg/day for 12 weeks). Critical-sized burr-hole defects (diameter: 3.0 mm) were surgically created by a single operator in the calvarium of all rats, using an electric drill. Animals in Px+MEL group received MEL 20 mg/kg/day for 12 weeks. At the end of the study, bone healing and connective tissue alterations surrounding drilled defect area in the rat calvaria were determined in haematoxylin-eosin-stained and Mallory Azan slices applied in anti-bone sialoprotein. Image Pro Express 4.5 programme was used for histomorphometric calculation of areas of new bone and fibrotic tissue. Normality control was performed by Shapiro-Wilk test. Variance homogeneities were examined by Shapiro-Wilk and Levene tests; Tukey HSD test was used as a post hoc method since there was no homogeneity problem. All hypothesis tests were performed at the 0.05 significance level. Histological analysis showed that the bone repair process in the Px+MEL group was similar to that of the CO group, whereas the functional Px group showed a delay. Histomorphometrically, it was found that the Px group had the largest hole diameter and the most fibrotic scar area, although no binary statistical significance was found between the CO and Px+MEL groups (p = 0.910). In terms of vascularisation, it was observed that the most vascular structure was found in the Px+MEL group among the scar tissue and ossification areas, while the vascularisation was the least in the Px group (p < 0.001). Our findings revealed that bone repair process was impaired in functional Px group, but exogenous MEL replacement was able to restore this response. Thus, it is concluded that utilisation of MEL may improve the bone repair in calvarial defects.

Benefits and Risks of Delayed Surgery for Ventricular Septal Rupture after Acute Myocardial Infarction.

The timing of surgery for ventricular septal rupture (VSR) after acute myocardial infarction (AMI) remains controversial. This study investigated the benefits and risks of delayed surgery for post-AMI VSR and examined differences in echocardiographic findings between early and delay groups.A total of 38 consecutive patients with post-AMI VSR who underwent surgery at our hospital between May 2003 and November 2020 were retrospectively analyzed. Our strategy was to delay surgery until 2 weeks after AMI. If patients demonstrated organ dysfunction, we considered early surgery. Patients were divided into early (n = 20; 53%) and delay (n = 18; 47%) groups. Risks and benefits were investigated based on echocardiographic findings during the waiting period. The delay group had more preoperative intravenous catheter infections (P = 0.008) but fewer reoperations (P = 0.02) and lower operative mortality (P = 0.04) than the early group. The VSR defect diameter and total pulmonary blood flow to total systemic blood flow (Qp/Qs) increased in both groups while waiting. Nevertheless, the early group had a significantly higher Qp/Qs change rate than the delay group (P = 0.05). The 30 day and hospital mortality rates were 5.3% and 13.2%, respectively.The VSR defect diameter and Qp/Qs in both groups increased with time and can therefore become risk factors. Nonetheless, the benefit of waiting exceeded the risk because our outcomes were better than those previously reported.

Relationship to drill bit diameter and residual fracture resistance of the distal tibia

BackgroundThe etiology of bone refractures after screw removal can be attributed to residual drill hole defects. This biomechanical study compared the torsional strength of bones containing various sized cortical drill defects in a tibia model. MethodsBicortical drill hole defects of 3 mm, 4 mm, and 5 mm diameters were tested in 26 composite tibias versus intact controls without a drill defect. Each tibia was secured in alignment with the rotational axis of a materials testing system and the proximal end rotated internally at a rate of 1 deg./s until mechanical failure. FindingsAll defect test groups were significantly lower (P < 0.01) in torque-to-failure than the intact group (82.80 ± 3.70 Nm). The 4 mm drill hole group was characterized by a significantly lower (P = 0.021) torque-to-failure (51.00 ± 3.27 Nm) when compared to the 3 mm drill hole (59.00 ± 5.48 Nm) group, but not different than the 5 mm hole group (55.71 ± 5.71 Nm). All bones failed through spiral fractures, bones with defects also exhibited posterior butterfly fragments. InterpretationAll the tested drill hole sizes in this study significantly reduced the torque-to-failure from intact by a range of 28.4% to 38.4%, in agreement with previous similar studies. The 5 mm drill hole represented a 22.7% diameter defect, the 4 mm drill hole a 18.2% diameter defect, and the 3 mm drill hole a 13.6% diameter defect. Clinicians should be cognizant of this diminution of long bone strength after a residual bone defect in their creation and management of patient rehabilitation programs.