Gore-Tex Research Articles

P47 MITRAL VALVE RE–REPAIR THROUGH A RIGHT MINITHORACOTOMY

Abstract Objective Recurrent mitral valve regurgitation after prior repair is usually treated with re–repair or replacement through a median sternotomy. We report our small initial experience with mitral valve re–repair through a repeated minimally invasive approach. Methods From July 2018 to November 2021, 10 patients (median age 52 years IQR 49–68; male 90%) underwent isolated mitral valve re–repair with a right mini–thoracotomy approach with peripheral arterial and venous cannulation. Median Euroscore II was 2.05 (IQR 2.03–2.54). Results The median time from the original operation to redo surgery was 4.7 (3.5–8.1) years. Median cardiopulmonary bypass and cross–clamp times were 128 (IQR 109–134) and 99.5 (IQR 81–112) minutes, respectively. Failure of previous mitral valve repair was mainly due to Gore–Tex chordal rupture (3 patients), annular detachment (3 patients), native chordal rupture (2 patients), and posterior leaflet prolapse (2 patients). Concerning the surgical terchnique, a complete mitral valve ring Corcym Memo 3D or 4D was used in 8 patients while additional repair techniques were needed 5 patients (PTFE neochords implantation, cleft or commissure closure). No conversion to full sternotomy and no reoperation for bleeding was necessary. Median ICU and hospital stay were 2.0 (IQR 2.0–2.0) and 7.5 (7.0–9.0) days respectively. Median follow up time was 3.5 (2.8–3.9) years. Neither deaths nor major postoperative complications occurred in the follow–up period. Conclusions In our experience, mitral valve re–repair can be an attractive option for patients with failure of previous mitral valve surgery and can be safely performed through a minimally invasive approach with good outcomes. Main advantages seem to be the avoidance of extensive surgical dissection, optimal valve exposure, and low risk of surgical complications.

Cardiac herniation presenting as superior vena cava obstruction syndrome after intrapericardial pnemonectomy for locally advanced lung cancer---case report

IntroductionCardiac herniation is a rare complication after pulmonary surgery, and there are only a few reports about it. We now report a case of cardiac herniation presenting as superior vena cava obstruction after pneumonectomy.Case presentationA-52-years old woman diagnosed right pulmonary squamous cell carcinoma was carried out right pneumonectomy, the pulmonary artery and right superior pulmonary vein were dissected and ligated intrapericardial. The patient developed tachycardia arrhythmias, hypotension, followed by loss of consciousness at about 18 h after operation. After resuscitation, the patient was conscious but developed cyanosis of the superior vena cava drainage area, uropenia, and hypotension (80/30 mmHg). Bedside-echocardiography showed that the SVC was obstructed due to thrombus formation. Chest radiography a shift of the heart into right hemithorax. Rethoracotomy was performed and the herniated heart was replaced into the pericardium, and the pericardium was repaired with Gore Tex patch. The patient recovered smoothly after the second surgery.ConclusionCardiac herniation is a rare and fatally complication after thoracic surgery, and the prompt recognition with timely intervention is life-saving. Cardiac herniation is a rare but fatal complication of pneumonectomy. The increasing frequency of surgical resection for locally advanced thoracic carcinoma has led to a renewed emphasis regarding early diagnosis and treatment for cardiac herniation. Here we discuss a case of cardiac herniation presented with acute superior vena cava obstruction syndrome and hemodynamic instability after intrapericradial right pneumonectomy.

아두이노를 활용한 방향지시 라이딩웨어 개발에 관한 연구

This research to provide comfortable apparel for bike riding that incorporates safety. Specifically, the information and communications technology (ICT) device, arduino, is applied to the clothing design process. Riders’ moving direction is considered to maximize their visibility and thus their safety. With this focus, a proper jumper and vest are developed. As the first part of our research method, a demand survey was performed. Based on its result, the actual clothes were made. The concept of this kind of clothing is basically urban sports wear. Clothes are designed for bike riding women in their 20s; and they will also work as designs for their daily lives during the spring and fall seasons. Three-layered Gore Tex was selected as the main fabric. Colors such as pistachio green, reflex blue, deept mahogany, and crimson were chosen. For the direction indicating device, an arduino device was adopted. LED lighting indicators were applied to both the jumper and the vest at key areas, including the front, right side, and left side, as well between the lower part of scapula and the waist line.

Triple histology of an extracted polytef (gore-tex) implant

Triple histology of an extracted polytef (gore-tex) implant

Congenital abdominal aortic aneurysm in a term neonate: a case report

Background: Congenital abdominal aortic aneurysm (AAA) is a rare condition in neonates. To our knowledge, the natural course of the disease in a Thai neonate has not yet been reported. Objectives: To report the characteristics and clinical course of congenital AAA in a Thai neonate. Methods: A female Thai infant was born spontaneously at term (3,990 g) having a large, pulsatile, abdominal mass. Computed tomographic angiography (CTA) of the abdominal aorta showed a large infrarenal AAA, and a fusiform aneurysm at the left common iliac artery. Two small right renal arterial aneurysms were also noted. The large aneurysm was partially resected and a Gore-Tex vascular graft was placed at 15 days old. Histopathology of the aneurysmal wall revealed no specific etiology. Ultrasonography revealed thrombosis of the graft on the 13th day after surgery. Results: Repeated CTA of the abdominal aorta at age 13 mo showed complete thrombosis of the graft with reconstitution of collateral circulation. The infrarenal AAA and left common iliac aneurysm and 2 small right renal artery aneurysms were completely thrombosed. The patient grew and developed normally to the most recent follow up at age 36 mo. Conclusions: Congenital AAA with failure of graft replacement may regress spontaneously. Keywords: Abdominal aortic aneurysm, neonate, aortic aneurysm, idiopathic abdominal aortic aneurysm, neonatal abdominal aortic aneurysm, pulsatile abdominal mass

Effect of 3% 4-hexylresorcinol silk vascular patch on healing of injured carotid artery in a rat model

Event Abstract Back to Event Effect of 3% 4-hexylresorcinol silk vascular patch on healing of injured carotid artery in a rat model Min Keun Kim1, Chang Hwan Kim1, Young Wook Park1, Hae-Yong Kweun2 and Seong Gon Kim1 1 College of dentistry, Gangneung Wonju National University, Department of oral and maxillofacial surgery, Korea 2 National Academy of Agricultural Science, Sericultural & Apicultural Materials Division, Korea Aims and Objectives: The aim of this study is to determine the effect of 3% 4-hexylresorcinol(4HR) silk vascular patch as a vascular repairing material on the injured carotid artery of the rat. The other objective is to analysis of the functional results of the healed carotid arteries between direct closure group and vascular patch groups. Materials and Methods: We used the 21 Sprague-Dawley rats with 8 weeks old and body weights of 250~300 g. The right caoritd artery of every rats were excised with sharp scissor, the defect size was 1 x 0.5 mm. And then we applicate 4-hr silk membrane(Group A) and GORE® ACUSEAL Cardiovascular Patch(Group B), and direct closrue(Group C). We use ultrasonic device for compare the peak systolic velosity, (PSV), end diastolic velosity(EDV) and rdsistivity index(RI) of all groups. And we use the angiography of carotid artery to confirm the patency of the injured carotid artery. After the carotid angiography, we get the tissue sample and histologic analysis was done. Results: The 4-HR silk membrane show good success rate of re-anastomosis than direct closure and gore-tex vascualr patch group. At the histologic analysis, 4-HR group show better result than gore tex group with minimal foreign body reactions. In gore tex group, there was 2 foreign body granulomas. At the ultrasonographic analysis, direct closure group show higher velosities than vascular patch groups. Discussion and Conclusion: In this experiment, the potential of 4-hr silk membrane as a possible candidate for vascular patches to accelerate vascular wall regeneration was discovered. The silk membrane can help regeneration of injured carotid artery and show good result compared with gore-tex vascular parch. Key words: Rat, carotid artery, microsurgery, vascular patch, gore-tex, 4-HR silk membrane, direct closure. Acknowledgements: This work was supported by a grant from the Next-Generation BioGreen 21 Program (No. PJ011214042016) of the Rural Development Administration, Republic of Korea. This work was supported by a grant from the Next-Generation BioGreen 21 Program (No. PJ011214042016) of the Rural Development Administration, Republic of Korea.

AB023. Penile augmentation surgery: characteristics of artificial graft material and preoperative preparation

Penile augmentation surgical procedure includes diverse graft materials such as artificial collagen material as well as dermo-fat graft. Important factors of postoperative satisfaction are natural appearance of genitalia at the flaccid state and minimal resorption of graft volume. Artificial collagen materials and acellular dermal matrix are available for surgical procedure with variable size. History of penile augmentation surgery: Pediatric penile surgical procedure for lengthening and reconstructive surgery was developed as penile plastic surgical procedure combined with dermo-fat graft. In 1971, Kelly, Eraklis et al. reported preservation of dorsal neurovascular bundle and division of corporal crus from ischiopubic ramus for penile lengthening procedure. In 1974, Johnson reported the surgical cases in epispadias patient as division of crus from ischiopubic ramus and penile skin graft. The procedures include division of suspensory ligament and blunt dissection of fundiform ligament. In 1970’s Horton reported suprapubic fat resection and Z-plasty with anchoring on Scarpa’s fascia for lengthening procedure. In 1980’s several fat injection procedures in Darto’s fascia have been reported for girth enhancement but they were lack of reproducibility. (1year Resorption 50%) Later reports the result of cystic nodule, lump formation and fat migration. In 1990’s V-Y plasty for lengthening was reported. Historically illegal liquid injection materials with non-medical hands were reported as correction or reconstructive procedures for removal and treatment of deformed genitalia. In 1992 Horton reported flank abdominal free dermo-fat graft to Darto’s fascia. This procedure showed fair graft survival rate and developed to buttock skin crease dermo-fat graft. Medical grade silicone; long-term implantable; Gortex plate, polytetrafluoroethylene (PTFE); Acelluar dermal graft/(Alloderm, Surederm); Acellular xenogeniccollagen structure/(Lyoplant, Terudermis); Autologous tissue culture procedure with PLGA scaffold; Complex synthetic collagen with elastin (Matriderm); SIS (small intestine submucosa, porcine SIS). 48-72 h; Tissue fluid diffusion, 4 days; circulation and beginning of collagen accumulation. Initial graft survival depends on tissue condition and vascular supply of recipient bed. For stable vascular permeability graft should be anchored to recipient bed tissue. The prerequisites for wound healing; no infection, no hematoma, no seroma. Skin suture with no tension. Dermo-fat thickness less than 1 cm. Minimal incision on Darto’s fascia (external pudendal system). Graft anchoring between internal pudendal system and Buck’s fascia. Successful penile augmentation procedure means not only excellent surgical procedure and good wound healing process, but also patient subjective satisfaction. Preoperative interview with the patient is important for understanding the anatomy, procedure and goal of augmentation surgery. Also the proper selection of graft material is also important factor of successful girth enhancement with graft survival.

A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach

A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.

Vaginal Insertion of Kidney and Robotic Assisted Laparoscopic Kidney Transplantation: The First World Experience.

Introduction: Following laparoscopic or robotic assisted living donor nephrectomy kidney retrieval through vagina are reported. Here we present our initial experience of insertion of kidney through vagina and robotic assisted laparoscopic kidney transplantation (RKT). Material and methods: Permission of IRB was obtained. Major inclusion criteria were at least one normal vaginal delivery and good capacity of vagina on examination. Exclusion criteria were active vaginal infection or atrophic vagina. Antibiotic prophylaxis was used. Total 3 transplants carried out. Recipient surgery: In 30 degree Trendelenberg and Lithotomy position six ports were placed; one camera port, three robotic ports, one assistant port and one port for suction and irrigation. External iliac vessels were dissected. Robot was undocked. Gynecologist placed an incision in posterior fornix of vagina and kidney was inserted into abdomen. Wound of posterior fornix was closed and vagina packed. Robot was re-docked and kidney brought close to previously dissected external iliac vessels. Vascular anastomosis was carried out by Gore Tex CV6 suture. Ureteric reimplantation was performed using 4/0 vicryl without stent. Results: There was no injury to kidney parenchyma, no delayed graft function and no infection. Mean anastomosis time, rewarming time and blood loss were 51 min., 72 min., 67.5 ml respectively. Six months graft and patient survival is 100%. Conclusion: Vaginal insertion of kidney and RKT is feasible and safe. Larger studies are required for confirmation of these findings.

Guided bone regeneration with Pericardium membranes

There a plethora of evidence suggesting the role of barrier membranes in bone augmentation at sites of inadequate bone volume and height. Amongst the resorbable membranes, native collagen membranes are the standard treatment for guided regeneration procedures. However, native collagen resorbs rapidly whereas cross linking delays it. Pericardium membranes are multilayered, resulting in prolonged barrier function with the properties of native collagen intact. These membranes have proved their utility in the field of vascular, cardiac, thoracic surgery because of their mechanical and clinical handling properties. However, there very little evidence of bone augmentation with pericardium membranes in the field of dentistry, particularly Implantology. The purpose of this review to discuss the potential applications of these membranes in guided bone regeneration. I. INTRODUCTION Periodontal therapy has almost always focused on the arrest of the disease progress and maintenance of the remaining periodontal support. Treatment to restore periodontal health and achieve restitution of attachment apparatus has varied based on the etiology and encompasses procedures such as root planing, soft tissue curettage and various types of flap procedures, often in combination with the placement of bone grafts or bone substitutes into the defects. Most procedures have merely brought about tissue repair, which signifies replacement of the lost apparatus with scar tissue which does not completely restore the architecture or function of the part replaced. Regenerative procedures currently in use in periodontal therapy have not been able to achieve regeneration in the true sense. There have been reports of gaining new attachment by the formation of new cementum.(1) However; bone formation largely insubstantial or delayed. Melchers hypothesis of selective cell repopulation contributed to the understanding of the mechanics of wound healing. This concept was used further by series of experiments and formed the basis of the biologic principle of Guided tissue regeneration. Guided tissue regeneration (GTR) is used to define procedures wherein regeneration of lost periodontal structures (cementum, periodontal ligament, and alveolar bone) sought via selective cell and tissue repopulation of the periodontal wound. Periodontal literature replete with the research work related to tissue and bone regeneration achieved with GTR. This concept further evolved to a more evolved compartmentalized principle of guided bone regeneration (GBR). The biological basis for guided bone regeneration involves fulfillment of bone growth requirement: establishing stable immobile base, allow for release of growth factors, and finally, preserving the blood supply to the area of defects. The guided bone regeneration promotes bone formation by protection against invasion of competing, non osteogenic tissues with the use of barrier membranes. There are three generation of membranes which includes resorbable membranes like collagen and polylactide-co- glycolide, non resorbable membranes like ePTFE and Gore tex and few other membranes under investigation which includes membranes like alloderm, gelfoam, cargile and pericardium membranes. The purpose of this review to throw light on the potential application of pericardium membranes in GBR. The pericardium a fibroserous sac surrounding the mammalian heart. It has long been used in cardiac repair for reconstruction, valve repair and pericardial closure.(2, 3) Pericardial tissue has exceptional handling characteristics and uniform suture retention. In addition, it nonthrombogenic and naturally resists infection. Xenogenic pericardium commonly derived from bovine, porcine and, less frequently, equine sources. Tissues from these sources are available in large patches, allowing custom configuration to a variety of cardiovascular applications. It largely comprised of collagen fibers and has elastic properties allowing conformity to complex anatomy. (4) Bovine pericardium found its application initially as patches for arterial closure during vascular and cardiac surgery. The native structure of bovine pericardium has three layers: 1) the serosa, the inner thin layer consisting of mesothelial cells; 2) the fibrosa, the thicker layer formed by diversely oriented, wavy bundles of collagen and elastin; and 3) the epipericardial connective tissue layer, the outer layer that partly continuous with the pericardiosternal ligaments.(5) BP widely used in cardiac and thoracic surgery, as bioprosthetic valve leaflets, for repair of intracardiac defects, for repair of diaphragmatic defects, vascular surgery, including general surgery, urologic surgery and ophthalmology. The various beneficial properties promoting the use of

Early and midterm outcomes of artificial chordae transplant in mitral valve repair

To summarize the early and midterm outcomes of artificial chordae transplant in mitral valve repair. A total of 50 patients underwent mitral valve repair with artificial chordae transplant from January 2009 to January 2010 in General Hospital of Shenyang Military Command. Follow-up was conducted on 48 cases (96%) for 3-4 years. No early postoperative mortality occurred. All cases had cardiac function New York Heart Association (NYHA) grade I/II at discharge. Among 48 cases, one died of cerebral infarction after 13 months and the reminder survived and no one underwent reoperation. Among survivors, 45 cases were in cardiac function NYHA grade I and another 2 in grade II. Echocardiography showed that postoperative 3 years left atrial diameter, left ventricular end-diastolic dimension, left ventricular end-systolic dimension and the ratio of regurgitation beam area and left atrial area were significantly smaller than those preoperative ones (39.5% ± 9.7% vs 5.6% ± 0.1%, P < 0.01) and left ventricular ejection fraction increased markedly (0.55 ± 0.06 vs 0.67 ± 0.07, P < 0.01). There was no instance of artificial chordae rupture. Gore-Tex artificial chordae transplant is a safe and effective technique in mitral valve repair with excellent early and midterm operative outcomes.

Gore tex medialization thyroplasty- A case series

Unilateral vocal fold paralysis classically presents with voice change, aspiration of ingested materials and cough. Medialization thyroplasty has become treatment of choice for un recovering vocal fold palsy. Still the ideal implant has not been defined in the surgical medialization of vocal folds. We present our experience of gore tex as the implant material.

Heat loss and moisture retention variations of boot membranes and sock fabrics: A foot manikin study

Heat loss and moisture retention properties of footwear were characterized using a walking thermal manikin foot. The same type of military boot was equipped with different membranes: (i) GORE TEX with IQ TEX, (ii) halve OUTDRY, (iii) full OUTDRY, and (iv) OUTDRY with IQ TEX. In a separate experiment a single boot type was used to evaluate four different sock fabrics: (i) wool/polypropylene, (ii) polypropylene, (iii) polypropylene/polyamide, and (iv) wool/polyamide. Both boot membranes and sock fabrics were assessed under three conditions: (i) standstill no sweating, (ii) walking no sweating, and (iii) walking and sweating. The walking rate was set at 15 step min−1 and the sweat rates were 9 g h−1 and 12 g h−1, for boot membrane and sock fabric measurements, respectively. Moisture retention was assessed by weighing the footwear components before and after each measurement. GORE TEX with IQ TEX resulted in a higher heat loss during walking without sweating compared to the other membranes (p = 0.017). GORE TEX with IQ TEX retained more moisture in the sock compared to the other membranes (p < 0.001) but also retained more moisture in the inlay sole compared to halve OUTDRY (p = 0.015). No differences in heat loss were found among sock fabrics, while wool/polyamide retained more moisture compared to polypropylene/polyamide (p = 0.036). Furthermore, a moisture vapour transmission rate of 61.2 ± 6.6 g m−2 h−1 was calculated for all sweating conditions. Finally, the measurements suggest that no pumping effect takes place in the measured footwear under the present conditions.Relevance to industry: Understanding heat loss and moisture retention of footwear is necessary for optimization of footwear for blister incidence and (thermal) comfort.

4-6 taper型Gore Tex血管の透析用A-V fistulaに対する有用性

4-6 taper型Gore Tex血管の透析用A-V fistulaに対する有用性

Response to Letter to Editor

We would like to thank Dr Chaudhuri for his in-depth response on our recent publication “Dacron or ePTFE for femoro-popliteal above-knee bypass grafting: short and long-term results of a multicentre randomised trial.” Eur J Vasc Endovasc Surg 2009; 37: 457–463. Indeed it was mentioned that the patency rates with large-caliber prosthetic grafts in the fem-distal position (8 mm instead of 6 mm) were maybe better.1Abbott W.M. Green R.M. Matsumoto T. Wheeler J.R. Miller N. Veith F.J. et al.Prosthetic above-knee femoropopliteal bypass grafting: results of a multicenter randomized prospective trial. Above-Knee Femoropopliteal Study Group.J Vasc Surg. 1997 Jan; 25: 19-28Google Scholar, 2Green R.M. Abbott W.M. Matsumoto T. Wheeler J.R. Miller N. Veith F.J. et al.Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial.J Vasc Surg. 2000 Mar; 31: 417-425Google Scholar Unfortunately all these studies were flawed by nonrandomised design and potential selection bias. There is no level 1 evidence which clearly showed the better results of 8 mm prostheses in the femoro-distal position. We agree that new graft technologies might give better results compared to both, the standard Dacron and ePTFE, we used in our study. The older vascular surgeons remembered the “strong expert opinion” that patency rates with PTFE femoro-popliteal bypass above and below the knee were equal to or better than those with the same operation performed with saphenous vein.3Veith F.J. Moss C.M. Fell S.C. Rhodes B.A. Somberg E. Weiss P. et al.Expanded polytetrafluorethylene grafts in reconstructive arterial surgery. Preliminary report of the first 110 consecutive cases for limb salvage.JAMA. 1978 Oct 20; 240: 1867-1869Google Scholar This “evidence” was the background of our prospective RCT which clearly showed the opposite of the opinion of the experts in the 80th. Our group was also involved in the prospective non-consecutive cohort study of the Gore–Tex Propaten Vascular Graft in the femoro-distal position. The design of this study lodged all the potential risks of bias.4Gurusamy K.S. Gluud C. Nikolova D. Davidson B.R. Assessment of risk of bias in randomised clinical trials in surgery.Br J Surg. 2009; 96: 342-349Google Scholar The primary patency result of 91% of the Gore Propaten resembles our 1-year patency result of Dacron.5Walluscheck K.P. Bierkandt S. Brandt M. Cremer J. Infrainguinal ePTFE vascular graft with bioactive surface heparin bonding. First clinical results.J Cardiovasc Surg (Torino). 2005; 46: 425-430Google Scholar The two-year primary patency was also comparable with our Dacron result.6Peeters P. Verbist J. Deloose K. Bosiers M. Results with heparin bonded polytetrafluoroethylene grafts for femorodistal bypasses.J Cardiovasc Surg (Torino). 2006 Aug; 47: 407-413Google Scholar We agree with Dr Chaudhuri that we should not ignore possible renewals of allograft materials but he should also agree with us that we should learn from the past. Only proper designed RCTs without a mix of above-knee and below-knee bypass grafts could prove that heparin bounding ePTFE grafts should become the first choice allograft material in the femoro-distal position. Lacking this evidence so far we still conclude that Dacron is the preferential graft material in the above-knee fem-pop position if a suitable saphenous vein is absent. Re: Dacron or ePTFE for Femoro-popliteal Above-Knee Bypass Grafting: Short- and Long-term Results of a Multicentre Randomised Trial, van Det et al. in Eur J Vasc Endovasc Surg (2009) 37, 457–463European Journal of Vascular and Endovascular SurgeryVol. 38Issue 2PreviewI read with interest the paper by the above authors that challenges the more conventional use of ePTFE for prosthetic above-knee femoropopliteal bypasses. A few issues arise: firstly, the use of grafts of 6 mm diameter when an 8 mm graft is an option, which is not an unconventional one. The authors have also ignored the issue of heparin-bonded ePTFE grafts such as the Gore Propaten vascular graft in the discussion, which has demonstrated 84% and 91% 1-year primary patency rates,1,2 which is also supported on a haematological basis. Full-Text PDF Open Archive

Technical Notes and Tips: Avoiding the Unsanitary Hip Spica

Treatment of infants with hip dysplasia commonly involves application of a hip spica for several months. During this period, the spica invariably becomes heavily soiled around the perineal opening. Gore-tex® (WL Gore and Associates, Inc., Flagstaff, AZ, USA) cast liners have previously been shown to avoid skin excoriation from soiled casts.1 These cast liners are, however, expensive. We describe a simple, cheap, and replaceable alternative. Disposable adhesive sanitary towels are folded over the cast edges, with absorbent surfaces facing the perineum (Fig. 1). Towels can be changed by the infant's parents once soiled. We recommend a wingless ultra-thin towel for ease of application. Figure 1 Hip spica (A) before and (B) after application of sanitary towels.

Influence of the suture in the propagation of tears in calf pericardium employed in the construction of cardiac bioprostheses.

The tearing of the fibers of biomaterials employed in implants or bioprostheses leads to early the failure of these devices. The purpose of this study was to determine the force necessary to propagate a tear in a biological tissue, calf pericardium, when sutured. We analyzed the outcome of 230 trials. There was a loss of resistance to tearing in samples sutured edge-to-edge as compared to unsutured control samples. This loss was not observed when the suture was preceded by an intact or protective zone. The values corresponding to the tearing force for an overlapping suture, especially when sewn with Gore-Tex(R), were higher than those obtained in controls. This study confirms the deleterious effect of the edge-to-edge suture, which can be minimized by protecting the suture, and the excellent behavior of the overlapping suture.

Survival of Full-Thickness Skin Graft on the Prelaminated Expanded Polytetrafluoroethylene in Spraque-Dawley Rats

The purpose of this study is to evaluate and compare the survival and deformity of a full-thickness skin graft over the flap prelaminated by Gore-tex (ePTFE, expanded polytetrafluoroethylene, Gore-tex Soft Tissue Patch, Gore & Assoc Inc, Flagstaff, AZ, USA) in Spraque-Dawley (S-D) rats. The materials were implanted subcutaneously for prelamination of a 2-, 4-, and 6- week period. A pedicle flap enveloping the implant was then elevated. After applying Biobrane under the composite flap, the harvested full-thickness skin was grafted onto the composite flap. The survival of the FTSG and deformity of synthetic materials were evaluated at the time of one week after skin graft surgery. In this study, the survival of skin graft in the Gore-tex group was about 32%. Microscopically, the Gore-tex scaffold was integrated by fibroneovascular tissue. Based on the survival rate of the skin graft, this study demonstrates that prelamination with Gore-tex can produce a relatively lower survival rate of in-situ skin graft on composite tissue flap, and less implant expulsion was observed. The Gore-tex scaffold allowed growth of fibroneovascular tissue but showed visible deformity. The secondary deformity of the Gore-tex scaffold and lower survival of skin graft neglected the clinical usage of this synthetic flap.

Repair of aortic leaflet prolapse: a ten-year experience☆

Leaflet plication (PL), triangular resection (TR), resuspension with running suture of Gore-Tex (GTx) and extension with autologous pericardial patch (PP) are different techniques to repair aortic leaflet prolapse (LP) for aortic insufficiency (AI). In this study, we report and compare the early and mid-term results of these techniques for aortic valve repair. From 1996 to 2006, 298 patients underwent elective aortic valve (AV) repair. In 146 of them, prolapse of one (n=72) or more than one leaflet (n=74) was found. LP was defined either as a longer or lower leaflet free margin compared to the other leaflet(s) or a relatively low coaptation level of all leaflets. When leaflet tissues were of good quality (thin and pliable), prolapse was treated by GTx (n=39), PL (n=25) or GTx+PL (n=23). When leaflet tissues were of poor quality (thickened, calcified), prolapse was treated by TR or PP (n=13) or TR or PP+GTx (n=47). There was no hospital mortality. During the initial hospitalization two patients required reoperation for recurrent AI and one for aorto-right ventricular fistula; of them, two were re-repaired. Median follow-up was 35 months (range 9-136). Three patients needed late reoperation for recurrent AI. At 4 years, overall survival was 99+/-1% and freedom from reoperation and from recurrent AI (grade >2) was 94+/-5% and 91+/-7% respectively. Freedom from recurrent AI was similar in patients having one versus more than one LP repair (88+/-11% vs 92+/-8%, p=0.2) and among the different techniques used to repair leaflet of good quality (PL: 95+/-8% vs GTx: 83+/-18% vs PL+GTx: 100%; p=0.37). When leaflet resection was needed, the addition of GTx significantly reduced the recurrence of AI (TR or PP: 82+/-18% vs TR or PP+GTx: 97+/-4%; p=0.026). Leaflet plication and Gore-Tex resuspension are both effective and durable techniques for aortic leaflet prolapse repair. The addition of Gore-Tex to triangular resection and pericardial patch repair techniques is efficient to reinforce the suture line and to improve the outcome of the repair. Multiple leaflet prolapse is not a prohibitive factor for successful repair even in the absence of a clear reference level such as a normal leaflet, as long as normal anatomical coaptation is achieved.

Successful vascular decompression in an 11-year-old patient with trigeminal neuralgia

We present the case of an 11-year-old boy who was suffering distinct trigeminal neuralgia. At the age of 3 years, the patient had contracted a severe Epstein-Barr virus infection and developed mild meningoencephalitis. Magnetic resonance imaging scans showed a slight enhancement in the pontomesencephalic cistern as well as a neurovascular conflict at the right trigeminal nerve. Intraoperatively, thickened fibrous tissue was found that was attached to both the trigeminal nerve and the superior cerebellar artery. Microvascular decompression using Gore Tex as tissue implant brought immediate relief. Trigeminal neuralgia in pediatric patients is very rare. We present a case of typical trigeminal neuralgia in a child, demonstrating the pathogenesis of the neurovascular conflict due to subarachnoidal adhesions after meningoencephalitis.