Emergency Repair Research Articles

098. Report in Emergency repair for Duodenum Part 1 Perforation in Referral Hospital Banyumas

Introduction: Duodenal perforation was frequent cause of hollow viscus perforation beside to gastric perforation. Immediate source control properties, reproducibility, simplicity and applicability was the prefer method in emergency setting to repair this perforation. Case: We present one case of female, 46 years old patient with duodenal part 1 perforation with Boey Score 1, where we performed repair with primary suturing, gastrojejunal – braun anastomosis and omental patch. We found part 1 duodenal perforation 1.5cm in diameter. Patient was in hospital for 5 days before being discharged. Conclusions: Primary suturing, gastrojejunal – braun anastomosis and omental patch applicable in referral hospital, were preferable method that has best result and easy repair technique based on this report.

Power consumption state evaluation of important power customers based on AHP‐TOPSIS algorithm

AbstractIn the construction of a new power system, the identification and evaluation of power consumption status of power customers will become an important basis for them to participate in the emerging businesses such as demand response and virtual power plants. In order to ensure the power safety of important power customers, a new evaluation of power consumption status of important power customers based on the AHP (analytic hierarchy process)‐TOPSIS (technique for order preference by similarity to an ideal solution) algorithm is proposed by fully mining and applying the power big data. Firstly, a power consumption big data analysis platform based on the Hadoop architecture is built to provide a high‐performance platform support for big data analysis. Secondly, nine evaluation indexes are constructed from the three dimensions of voltage, load and synthesis, which objectively and scientifically describes the power consumption status of important power customers. Finally, the AHP‐TOPSIS algorithm is used to evaluate and analyse the voltage, load and comprehensive indicators respectively, thus, obtaining the evaluation values of three kinds of indicators. The power consumption status scores of important power customers are determined by the variable weight weighted summation. The rationality and feasibility of the method and algorithm are proved by example analysis and field verification. This method helps to promote the transformation from post fault emergency repair to warning beforehand. It has the multiple effects of ensuring safe power consumption, supporting accurate patrolling and active emergency repair serving.

Prediction of Power Equipment Emergency Repair Based on Adaptive Neural Network Fuzzy Inference Method

If the emergency repair prediction of power equipment is only made from the perspective of historical spare parts inventory data, it cannot reflect the impact of disaster-causing elements and disaster evolution on the demand for emergency repair spare parts in the future. Therefore, this paper aims to propose a reliable power equipment emergency repair prediction method, and constructs a demand prediction method for emergency repair spare parts of power equipment based on scenario analysis. Constructing a power equipment repair system through intelligent reasoning methods to improve the efficiency of power equipment repair. This article comprehensively uses methods such as literature analysis, model inference, and case simulation verification, this paper innovatively combines the adaptive neural network fuzzy inference system with expert experience. This paper validates the superiority of the prediction method constructed in this paper through comparative analysis. The results show that with the increase of the amount of data, the prediction accuracy of the method proposed in this paper will be improved, which can provide a reference for the subsequent emergency repair prediction of power equipment.

Local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures

This study aimed to investigate the clinical outcomes of local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures. This retrospective case series study included patients with Gustilo IIIB open tibiofibular fractures treated by local muscle or myocutaneous flap transfer in Weifang People’s Hospital between May 2016 and April 2021. Fifteenpatients (11 males aged 19–72 years) were included. The follow-up ranged from 8 to 24 months. The ranges of bone healing time and wound healing time were 6–17 months and 1–3 weeks, respectively. The length of hospital stay was 26 days (11–50 days). All patients reported acceptable functional recovery and satisfactory leg appearance, with Johner-Wruhs scores of excellent, good, and fair in 10, four, and one patients, respectively. The excellent-good rate was 93.3%. The complications included one case of infection and one case of nonunion. In conclusion, local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures may be useful in providing adequate soft tissue coverage and fracture healing with low complication and infection rates.

Outcomes after revisional surgery for paraesophageal hernias at a high-volume tertiary care center.

Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery. A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II-IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012-2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts. A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11years; p = 0.01). Median time between primary and rPEH was 40[17-121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%); p = 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%); p < 0.01), with the most common reasons being adhesions and gastric fundus injury. Intra-operative complications occurred in 12(26%) revisional cases, of which 58% were gastric fundus injuries. Median length of stay was longer for rPEH than pPEH (2[1-5] vs. 1[1-2] day; p = 0.02). Incidence of severe complications (rPEH: 5(11%), pPEH: 11(6%); p = 0.23) and reoperations (rPEH: 2(4%), pPEH: 7(4%); p = 0.84) were similar between groups. There were no peri-operative deaths. In a high-volume tertiary care center, repair of recurrent giant paraesophageal hernias can be performed successfully laparoscopically in the majority of cases with acceptable morbidity and peri-operative outcomes in comparison to primary surgery.

Transprosthetic Fenestration With Electrified Wires. Experimental Evaluation of Three Multifilament Endografts.

In situ fenestration of aortic endografts is an alternative endovascular technique for treatment of complex aortic aneurysms. While this technique has been carried out also to pass stent-grafts in individual cases, its feasibility and safety using different stent-grafts needs to be evaluated. In a saline bath at water temperature of 37°C, a 0.018" Astato 30 guidewire was advanced through 3 different stent-grafts (RelayPro, Zenith and Endurant II) by applying external current of 180 W via an electrosurgery pencil. Puncture efficacy and quality of the fenestration after ballooning with a 6 mm percutaneous transluminal angioplasty (PTA) catheter were assessed. Then, balloon-expandable covered stents were deployed in the fenestrations and evaluated for stenosis, using microscopy and radiography. Crossing of the electrified guidewire was instantaneous in the Zenith (n:10) and RelayPro (n:10) groups but not in 3 of 10 punctures in the Endurant group (p<.05). The fenestration area created after PTA was significantly larger in the RelayPro (5.3 mm2 ± 1.8, interquartile range [IQR] 1.6) and Zenith group (6.7 mm2 ± 0.7, IQR 0.5) compared to Endurant (2.3 mm2 ± 0.4, IQR 0.5, p<.001). Fraying was observed in all groups while graft shredding was found in 8 cases after PTA of the Zenith and Endurant endografts and in 5 of the RelayPro group, but the difference was not significant. Vertical tearing was detected after RelayPro (2 out of 10) and Zenith (6 out of 10) fenestrations, no damage was found in the Endurant group (p<.01). Residual stenosis at the level of the fenestration after implantation of a 6 × 79 mm VBX stent had to be corrected in all Endurant cases with a high-pressure PTA catheter. No stenosis was found in the RelayPro and Zenith groups before and after flaring. The "electrified wire" technique is a feasible tool that can be used to perform in situ fenestration by perforation of the endograft fabric. Based on this experimental evaluation the "ideal graft" for this technique could not be identified. Long-term fatigue tests and comparison with other fenestration techniques are required. In situ endograft fenestration can be a useful technique in emergent aortic repair. Recently, the electrified wire technique has been proposed as alternative option to laser, radiofrequency and needle-based techniques. In comparison to these methods, the use of electrified wires can be performed without modifications of routine equipment. Additionally, the material costs can be substantially reduced. However, the effectiveness of this approach for fenestration of different prosthetic grafts is unknown. Based on our experimental studies, the electrified wire technique is feasible but the Endurant endograft requires more attempts, and the placement of a bridging stent should be completed with high-pressure balloons.

Research on Emergency Repair of Distribution Network Considering Cooperative Scheduling of Power Supply Vehicles

Research on Emergency Repair of Distribution Network Considering Cooperative Scheduling of Power Supply Vehicles

Urgent hybrid repair of a symptomatic dissection-related type ii thoracoabdominal aortic aneurysms.

Emergency repair of type II thoraco-abdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoraco-abdominal aortic aneurysm that was treated by mean of a hybrid technique. The repair was carried out through two stages. In the first stage, we deployed two imbricated stent grafts in the descending thoracic aorta. A left carotid to left subclavian artery by-pass was preemptively performed in order to obtain a proper proximal landing zone and as part of the spinal cord protective maneuvers. The endovascular first stage was effective in obtaining proximal sealing but, as expected, did not prevent distal reperfusion of the aneurysmatic false lumen. Few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by mean of a multibranched synthetic graft. The repair was carried out through a left thoracophrenolaparotomy in the VII intercostal space. A left passive arterial by-pass and selective cold renal and warm visceral perfusion were adopted in order to provide organ protection. Technical success was achieved and radiologically confirmed. The patient experienced a mild postoperative paraplegia, which almost completely regressed after a neuro-motor rehabilitation program.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Primary and incisional hernias should be considered separately in clinical decisions and research: A nationwide register-based cohort study

BackgroundVentral hernias of umbilical, epigastric, and incisional types pose varied surgical challenges. Recent debates and research suggest that treatment strategies and outcomes may vary significantly based on hernia type and width. This study investigated whether differences in the risk of surgical outcomes among primary and incisional hernias are solely due to the hernia type. The primary outcome was reoperation for recurrence, and the secondary outcome was 90-day postoperative readmission. MethodsThis study was based on prospectively collected data from the Danish Ventral Hernia Database linked with the Danish Civil Registration system and the National Patient Register. Data spanned from 2007 to 2022 and included patients with umbilical, epigastric, or incisional hernias. The 3 hernia types were analyzed for the risk of reoperation for recurrence, adjusted for sex, age, emergency repair, width, use of mesh, and Charlson comorbidity index. ResultsWe included 57,312 hernias: 34,147 umbilical, 9,433 epigastric, and 13,722 incisional hernias. Compared with patients with umbilical hernias, patients with epigastric hernias had a lower risk of reoperation (hazard ratio: 0.88, 95% confidence interval: 0.79–0.99) and those with incisional hernias had an increased risk (hazard ratio: 2.93, 95% confidence interval: 2.57–3.33). Postoperative 90-day readmission rates were also higher for patients with incisional hernias than for patients with umbilical and epigastric hernias. ConclusionIncisional hernias exhibited a higher risk of reoperation for recurrence and 90-day postoperative readmission, underscoring their unique nature in terms of both origin and clinical behavior. The findings suggest that primary and incisional hernias should be separate entities in medical practice and research.

The Relationship Between Peri-Operative Systemic Inflammation and Survival in Patients With Abdominal Aortic Aneurysm

An association between pre-operative markers of systemic inflammation and inferior mortality following AAA repair has been observed. The prognostic value of the post-operative inflammatory response remains unreported in patients with AAA. The present study aimed to describe the association between the peri-operative inflammatory response & mortality in patients undergoing endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for infrarenal AAA. Consecutive patients undergoing either emergency (EVAR or OSR) or elective (OSR) intervention for infrarenal AAA were retrospectively recruited from 3 centres. Pre-operative systemic inflammation was assessed using the modified Glasgow Prognostic Score (mGPS). Post-operative day 3 CRP (≤ 300mg/L, > 300mg/L) was chosen as the covariate of interest. The primary outcome was thirty-day mortality in the emergency cohort and twelve-month mortality in the elective cohort. There were 167 emergency cases (120 (72%) OSR) and 207 elective (207 (100%) OSR) cases, with a median (IQR) follow-up of 85 (52) months in the emergency cohort and 63 (57) months in the elective cohort. There were 56% vs. 44% of patients in the emergency cohort day 3 CRP ≤300mg/l vs. >300mg/L compared with 82% vs. 18% of patients in the elective cohort (p < 0.001). On univariate binary logistic regression analyses in the emergency cohort, open repair (p < 0.05), pre-operative mGPS 2 (p < 0.05), post-operative mesenteric ischaemia (p < 0.01), and day 3 post-operative CRP > 300mg/L (p < 0.05) were associated with increased odds of thirty-day mortality. On multivariate binary logistic regression analyses, only pre-operative mGPS 2 (OR 2.11, 95% CI 1.12 - 3.98, p < 0.05) retained independent association with thirty-day mortality. In the elective cohort, mean (95% CI) survival in the day 3 CRP ≤300mg/l vs. >300mg/L was 112.0 (101.8 - 122.2) months vs. 67.2 (54.1 - 80.2) months (p < 0.001). On univariate binary logistic regression analyses in the elective cohort, age ≥ 75 (p < 0.05), ischaemic heart disease (p < 0.05), and day 3 post-operative CRP > 300mg/L (p < 0.001) were associated with increased odds of twelve-month mortality. On multivariate binary logistic regression analyses, both age ≥ 75 (OR 5.15, 95% CI 1.25 - 21.30, p < 0.05) and day 3 post-operative CRP > 300mg/L (OR 15.68, 95% CI 3.61 - 68.15, p < 0.001) retained independent association with twelve-month mortality. Pre- and post-operative markers of systemic inflammation were independently associated with inferior survival following emergency and elective repair of AAA respectively. Further investigation of the peri-operative systemic inflammatory response is warranted in this patient group, with a particular focus on identifying targets for intervention.

RATE OF ASCENDING AORTIC ENLARGEMENT IN A LARGE ECHOCARDIOGRAPHIC COHORT: ASSOCIATED RISK FACTORS AND ADVERSE AORTIC EVENTS

BackgroundUnderstanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. This study aimed to identify aortic aneurysm growth rate on serial echocardiograms as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth. MethodsPatients identified with ascending aortic aneurysm and undergoing serial echocardiograms within five years were evaluated. Ascending aortic size was measured as part of routine echocardiogram exams. Clinical and demographic variables including aortic valve type (trileaflet, bicuspid or prosthetic) were evaluated for association with baseline aortic size as well as with aortic progression rate. Clinical events including aortic dissection, elective or emergent surgical repair were recorded. Results3639 patients were identified, (78% males, median age of 69 years, 175 (4.8%) with bicuspid valve, and 206 (5.6%) with prior aortic valve replacement (AVR). Patients with larger aorta at baseline were older with higher tobacco use and prior prosthetic valves. Over a mean of 2.4 years, aortic growth was observed and differed by valve type (trileaflet valve: 0.08 mm/year , bicuspid valve: 0.4 mm/year , p<0.001). In six patients who developed aortic dissection the estimated average annual growth rate was 0.98 mm/year. ConclusionsIn a large echo cohort, aortic aneurysm growth rate was 0.08 mm/year though higher in those with bicuspid valves ( 0.4 mm/ year), but initial aortic size did not correlate with change in the aortic progression rate. This data may help inform recommended echocardiographic surveillance intervals.

Rapid design method for composite emergency steel piers with thin-walled steel tube framework and discussion on "temporary-permanent" transition

To address the conflict between the reserve of repair materials for existing bridge piers and the demands for emergency repairs, as well as the challenge of converting temporary emergency structures into permanent ones without significant disassembly, a novel composite emergency steel pier has been developed. This pier utilizes commonly available thin-walled steel tube sections as the framework, I-beams as the connecting elements, and incorporates a "temporary-permanent" transition function. Taking the emergency steel pier for medium-height bridge piers in high-speed rail systems as an example, this study introduces three evaluation metrics—security coefficient (n), stability coefficient k), and variation coefficient (V)—analyzing the factors influencing the design and application thresholds of the emergency steel piers from perspectives of strength, stability, and load distribution uniformity. Based on this, a rapid design method for composite emergency steel piers with thin-walled steel tube frameworks that does not require numerical simulation has been developed and experimentally validated. Research findings indicate that when used for the emergency repair of medium-height or lower bridge piers in high-speed railways, the column line stiffness of the thin-walled steel tube framework composite emergency steel piers should range between 0.34 × 10 exp7 kN/mm to 4.15 × 10 exp7 kN/mm. The transverse and longitudinal spacing of the columns should be 1 m to 3 m and 1.5 m to 3 m respectively. The line stiffness of the plinth beams I and II should be greater than 0.69 kN/mm and 1.01 kN/mm respectively. Within these parameter ranges, the emergency steel pier will not experience strength failure or instability, and the load distribution among the columns remains uniformly favorable. In applications to other scenarios, the rapid generation of composite emergency steel piers with thin-walled steel tube frameworks can be achieved by following three steps: parameter selection and structural configuration determination, calculation of the pier-beam linear stiffness ratio, and criterion-based result verification. The rapid design and implementation of composite emergency steel piers help alleviate the contradiction between material stockpiling and repair demands. Furthermore, the pre-designed "temporary-permanent" transition functionality facilitates integrated operations for emergency repairs and permanent restorations.

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery.A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items forSystematic Reviewsand Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software.Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Successful management of a combined penile and urethral fracture.

This case highlights a rare occurrence of combined penile fracture and urethral injury in a 35-year-old male, emphasizing the critical need for accurate diagnosis and precise surgical intervention in such cases. After a mishap during sexual intercourse, the patient faced intense penile pain, swelling, and urethrorrhagia. Advanced diagnostic methods, particularly MRI, confirmed a disruption in the tunica albuginea within the left corpora cavernosa. The patient underwent emergent surgical repair, addressing both urethral and corpora cavernosa injuries, leading to a successful postoperative course. This case report underscores the paramount importance of comprehending and effectively managing complex urological traumas. Timely and appropriate surgical intervention is crucial for ensuring optimal patient recovery and well-being in instances of combined penile and urethral injuries.

Spontaneous avulsion of left internal mammary artery graft a complication of coronary artery bypass surgery: case report and review of the literature

BackgroundCoronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade.Case presentationWe hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient’s critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection.ConclusionAvulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.

Pre-disaster allocation and post-disaster dispatch strategies of power emergency resources for resilience enhancement of distribution networks

With the frequent occurrence of large-scale power outages caused by extreme disasters, coordinated dispatch of power emergency resources (PERs) and repair crews (RCs) has gradually become an essential method to enhance the resilience of distribution networks (DNs). Previous works solve this coordinated dispatch problem in a risk-neutral approach with the assumption that the supply of power repair materials (PRMs) is still fully available after the disaster. However, growing evidence indicates that certain extreme disasters may lead to limited availability of PERs in the DN, rendering risk-neutral decision making impractical. To fill this gap, this paper proposes a resilience-oriented PERs pre-disaster allocation and post-disaster dispatch strategy in a risk-averse manner. In the pre-disaster prevention process, a two-stage distributionally robust optimization (DRO) model based on mean-CVaR is developed, considering the uncertainties of both system damage and PERs demands, along with the decision maker's preference for risk. In the post-disaster restoration process, a collaborative spatio-temporal dispatching model for PERs and RCs with the goal of minimizing outage losses is established. To tackle the computational challenges associated with PRMs allocation based on DRO, robust counterpart transformation and dual theory are utilized. Case studies are conducted using a real world modified 118-bus distribution network. In comparative analysis, five control groups are established to validate the necessity to consider the limited supply of PRMs and the risk-averse attitude of decision makers in enhancing DNs resilience.

Trends and predictors of laparoscopic compared with open emergent inguinal hernia repair

BackgroundLaparoscopic emergent inguinal hernia repair remains controversial despite studies suggesting it is safe and feasible. Variables associated with laparoscopic compared with open emergent inguinal hernia repair are currently not well described. This study aims to investigate patient characteristics and risk factors associated with laparoscopic emergent inguinal hernia repair. MethodsThe American College of Surgeons National Surgical Quality Improvement database was queried for adult patients (age ≥18 years) who had undergone emergent inguinal hernia repair between 2015 and 2021. The relationships between demographic variables and laparoscopic compared with open emergent inguinal hernia repair were evaluated using univariate and multivariate analyses. ResultsA total of 8,215 patients were included in this analysis. Use of laparoscopic emergent inguinal hernia repair increased from 9% in 2015 to 23% in 2021. Female patients (odds ratio, 1.84, P < .001) and patients aged ≤65 years (odds ratio, 1.25, P = .005) were more likely to undergo laparoscopic repair. Black (odds ratio, 0.73, P = .003) and Hispanic (odds ratio, 0.72, P = .006) patients and patients with greater American Society of Anesthesiologists classification (odds ratio, 0.86, P = .037), ascites (odds ratio, 0.39, P = .039), and preoperative dialysis requirement (odds ratio, 0.45, P = .017) were less likely to undergo laparoscopic repair. Aside from a decreased likelihood of readmission in patients who underwent laparoscopic surgery (odds ratio, 0.696, P = .024), there was no difference in other postoperative outcomes, despite a laparoscopic approach being associated with greater rates of concomitant procedures compared with an open approach (24% vs 18%, P < .001). ConclusionsFemale sex, younger age, and lower American Society of Anesthesiologists class were associated with a greater likelihood of laparoscopic surgery. Black and Hispanic patients and patients with ascites and dialysis requirements were less likely to undergo laparoscopic repair. Laparoscopic inguinal hernia repair can be safely performed in an emergent setting.

Numerical Study of Discharge Coefficients for Side-Damaged Compartments

Accurately evaluating the buoyancy and stability of damaged ships, particularly the flow rate of the water inflow through damaged openings, is of great significance for ship rescue and emergency repair. A three-dimensional simplified model of inflow for a ship’s damaged side bulkheads is established using the shear stress transport k-epsilon and volume of fluid (VOF) models by STAR-CCM+. Moreover, the flow rates of water inflow through damaged openings with different shapes, characteristic sizes, and central depths are calculated. Furthermore, the corresponding discharge coefficients are obtained, and the relevant rules are summarized. It was found that the influence of water depth on the coefficient is minimal in these work conditions, but from the perspective of the damaged opening’s characteristic dimensions and shape, the variation in the coefficient is more pronounced. Overall, the triangular opening has a higher coefficient than the circular opening, which in turn is higher than that of the square-damaged opening, and the coefficient decreases as the size of the opening increases. Lastly, empirical formulas for two different methods are provided. The research provides a reference for the rescue repair and buoyancy stability assessment of damaged ships.

Clinical application of perforator-based propeller flaps in repair of hand wound

To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.