Mesh Wrap Research Articles

ENABLING SCAN-TO-BIM WORKFLOW FOR HERITAGE CONSERVATION AND MANAGEMENT PROCESS

Abstract. The paper stresses the potential of digital technology in the field of Cultural Heritage (CH), focusing on Architectural Heritage (AH) conservation and management process. It presents a workflow based on non-parametric automatic 3D modeling and Industry Foundation Classes (IFC) authoring to combine geometry and semantic information. The goal of such a methodology is to overcome time-consuming manual tasks that still limit the Historical Building Information Modelling (HBIM), which nevertheless proves to be one of the most effective digital tools for the conservation and management of AH in the medium to long term. The proposed workflow consists of five steps: the 3D survey campaign and raw data processing, the semantic annotation of images according to different information layers, the annotation transfer from images to the point cloud representing the studied architecture, the obtained Point Cloud Information Model (PCIM) automatic segmentation and 3D mesh wrapping, and finally the IFC generation for the HBIM representation. This unconventional digital chain was tested to support the knowledge representation of Villa Leonardi, an historical house in the Marche Region (Italy). The final output is a 3D model of the building, automatically processed from digital survey data, and semantically enriched thanks to the material consistency and decay analysis carried out and annotated on spherical panoramas. The effectiveness of this approach was proven in the conservation project for the façades of the house: enriched data on materials and decay supported an action plan of restoration works, which was then recorded in the HBIM model, thus permitting time and cost control.

Captive-reared Delta Smelt (Hypomesus transpacificus) exhibit high survival in natural conditions using in situ enclosures.

Conservation of endangered fishes commonly includes captive breeding, applied research, and management. Since 1996, a captive breeding program has existed for the federally threatened and California endangered Delta Smelt Hypomesus transpacificus, an osmerid fish endemic to the upper San Francisco Estuary. Although this program serves as a captive refuge population, with experimental releases being initiated to supplement the wild population, it was uncertain how individuals would survive, feed, and maintain condition outside hatchery conditions. We evaluated this and the effects of three enclosure designs (41% open, 63% open, and 63% open with partial outer mesh wrap) on growth, survival, and feeding efficacy of cultured Delta Smelt at two locations (Sacramento River near Rio Vista, CA and in Sacramento River Deepwater Ship Channel) in the wild. Enclosures exposed fish to semi-natural conditions (ambient environmental fluctuations and wild food resources) but prevented escape and predation. After four weeks, survival was high for all enclosure types (94-100%) at both locations. The change in condition and weight was variable between sites, increasing at the first location but decreasing at the second location. Gut content analysis showed that fish consumed wild zooplankton that came into the enclosures. Cumulatively, results show that captive-reared Delta Smelt can survive and forage successfully when housed in enclosures under semi-natural conditions in the wild. When comparing enclosure types, we observed no significant difference in fish weight changes (p = 0.58-0.81 across sites). The success of housing captive-reared Delta Smelt in enclosures in the wild provides preliminary evidence that these fish may be suitable to supplement the wild population in the San Francisco Estuary. Furthermore, these enclosures are a new tool to test the efficacy of habitat management actions or to acclimate fish to wild conditions as a soft release strategy for recently initiated supplementation efforts.

Personalized statistical modeling of soft tissue structures in the knee.

Background and Objective: As in vivo measurements of knee joint contact forces remain challenging, computational musculoskeletal modeling has been popularized as an encouraging solution for non-invasive estimation of joint mechanical loading. Computational musculoskeletal modeling typically relies on laborious manual segmentation as it requires reliable osseous and soft tissue geometry. To improve on feasibility and accuracy of patient-specific geometry predictions, a generic computational approach that can easily be scaled, morphed and fitted to patient-specific knee joint anatomy is presented. Methods: A personalized prediction algorithm was established to derive soft tissue geometry of the knee, originating solely from skeletal anatomy. Based on a MRI dataset (n = 53), manual identification of soft-tissue anatomy and landmarks served as input for our model by use of geometric morphometrics. Topographic distance maps were generated for cartilage thickness predictions. Meniscal modeling relied on wrapping a triangular geometry with varying height and width from the anterior to the posterior root. Elastic mesh wrapping was applied for ligamentous and patellar tendon path modeling. Leave-one-out validation experiments were conducted for accuracy assessment. Results: The Root Mean Square Error (RMSE) for the cartilage layers of the medial tibial plateau, the lateral tibial plateau, the femur and the patella equaled respectively 0.32mm (range 0.14-0.48), 0.35mm (range 0.16-0.53), 0.39mm (range 0.15-0.80) and 0.75mm (range 0.16-1.11). Similarly, the RMSE equaled respectively 1.16mm (range 0.99-1.59), 0.91mm (0.75-1.33), 2.93mm (range 1.85-4.66) and 2.04mm (1.88-3.29), calculated over the course of the anterior cruciate ligament, posterior cruciate ligament, the medial and the lateral meniscus. Conclusion: A methodological workflow is presented for patient-specific, morphological knee joint modeling that avoids laborious segmentation. By allowing to accurately predict personalized geometry this method has the potential for generating large (virtual) sample sizes applicable for biomechanical research and improving personalized, computer-assisted medicine.

Jacketing of RCC columns with varying stiffness

The attempt in this article was made in a reinforced concrete frame with doors and windows left in owing to architectural requirements. Due to lateral loading, columns of varied stiffness have been badly damaged in the past, and this type of structure is prone to serious failure during earthquakes. The behaviour of such columns was not perfectly known. The behaviour of columns with varying stiffness under later pressure after jacketing with a carbon fibre mesh is investigated systematically in this project. The analytical study's parameters also include the infill wall aspect ratio (Lw/Hw, where Lw = infill length and Hw = infill height), column displacement and failure with varying stiffness, and carbon mesh wrapping. The load vs displacement curve and stiffness of the three models with variable stiffness columns and carbon fibre mesh wrapping were investigated. The lateral strength and rigidity of the columns increased when the stiffness of the column was strengthened with carbon mesh wrapping, while the displacement and ductility of the column reduced. Furthermore, the bare frame shows the largest displacement and failures at the beam-column joints and supports, causing the structure to become severely unstable and finally breaks. When a partial infill is applied to the frame of a column of different stiffness, failures are noted at the beam-column and infill junction, but supports show higher stability, and when jacketing is applied to the columns of varying stiffness, it exhibits the most stability and shows the least failure.

Effect of Dual Mesh Wrap on The Stability of Colonic Anastomosis

Effect of Dual Mesh Wrap on The Stability of Colonic Anastomosis

Design tailoring of curvilinearly grid-stiffened variable-stiffness composite cylindrically curved panels for maximum buckling capacity

In this paper, the buckling performance of curvilinearly grid-stiffened variable-stiffness composite cylindrically curved panels subjected to in-plane compressive loads under different boundary conditions is addressed. A Python-Abaqus script is developed to perform the buckling analysis of the panels. A novel planar mesh wrapping based approach is proposed to ease modelling of such curved panels with complex geometry. This approach offers numerous advantages including but not limited to separately modelling the skin and stiffeners using conventional shell elements as well as studying the mesh convergence of each component independently leading to more efficient and robust finite element models appropriate for optimization implementation. Using the proposed approach various parametric studies are conducted to investigate the influence of the panel curvature and the stiffness variation created by the fibers and stiffeners on the buckling response. Subsequently, an optimization routine is implemented to simultaneously determine the optimal fiber and stiffener paths for maximum buckling capacity. It is shown that by replacing the straight stiffeners by curvilinear ones the buckling resistance of the grid-stiffened quasi-isotropic skins can be enhanced. It is also shown that the panel curvature has a significant effect on the optimal layout of the grid-stiffeners. Optimization results demonstrate that for shallow curved panels up to 100% improvement in the buckling performance can be achieved by concurrently optimizing the curvilinear fiber trajectories of both the skin and stiffeners compared to their straight fiber and stiffener design counterparts.

\u201cSandwich\u201d mesh reconstruction of female giant urethral diverticulum: a case report

BackgroundThere is no consensus between urologists on the diagnosis and treatment of female urethral diverticula. Once the diagnosis has been established, the most common treatment approach is surgical excision and reconstruction. Whether a staged procedure or simultaneous management is more appropriate for treating concomitant urethral diverticula and stress urinary incontinence remains controversial.Case presentationA 63-year-old woman was hospitalized for repeated frequent urination, urgent urination, odynuria, and dysuria accompanied by intermittent overflow urinary incontinence for over 10 years. She had a 5 year history of urinary stress incontinence prior to onset of these symptoms and had had four urethral caruncles resected on four separate occasions. There was visible leakage of urine when abdominal pressure was increased during physical examination and urodynamic studies. Additionally, turbid urine was discharged when the anterior vaginal wall was squeezed. Cystourethrography showed circumferential filling with contrast and multiple bladder diverticulae in the mid plane of the pubic symphysis. Urethrocystoscopy showed an orifice to a diverticulum at 7 o’clock in the proximal urethra, into which an F19.8 urethroscope could be inserted, enabling examination of most of the diverticulae. The urethral diverticulae were resected, followed by mesh reconstruction of the urethra. During a 20-month follow-up, the treatment outcomes were satisfactory.ConclusionWe here report a case of a giant circumferential urethral diverticulum combined with stress urinary incontinence that was successfully managed by an uncommon surgical reconstructive technique: a minimally invasive “Sandwich” mesh repair procedure utilizing synthetic mesh wrap in the midurethral region.

Muscle-Sparing ADM-Assisted Breast Reconstruction Technique Using Complete Breast Implant Coverage: A Dual-Institute UK-Based Experience

Background: We report our early experience of a novel muscle-sparing breast (prepectoral) reconstruction technique using a pre-shaped Braxon® mesh (acellular dermal matrix) which completely wraps around the breast implant. Methods: All patients who underwent prepectoral implant-based breast reconstruction between April 2014 and September 2015 were included in the analysis. The dermal matrix Braxon® used is a pre-shaped matrix which forms a complete implant mesh wrap. The new breast created is placed over the chest wall without disturbing the pectoralis musculature. Results: A total of 51 (42 unilateral and 9 bilateral) muscle-sparing breast reconstructions were carried out. Complications included implant loss (n = 1; 1.7%) secondary to wound infection, seroma (n = 4; 6.7%), and superficial wound dehiscence (n = 1; 1.7%) which was re-sutured without further complication. The median follow-up period was 16.4 (range 8-25) months. Conclusion: The early experience appears highly satisfactory with good clinical outcome. The novel prepectoral implant-based breast reconstruction using the mesh wrap provides an effective alternative to the more traditional submuscular implant-based technique.

Mesh wrapping for severe hepatic injury: a beneficial option in the trauma surgeon's armamentarium

BackgroundThe purpose of this study was to assess the efficacy of absorbable mesh wrapping (MW) versus perihepatic packing (HP) for severe hepatic injury. MethodsFrom January 2001 to December 2012, data were collected for MW patients with hepatic injury. Patients who underwent HP were matched with MW patients by injury mechanism, liver injury grade, Injury Severity Score, and age. ResultsTwenty-six MW and twenty-six HP patients were matched. Eighteen blunt and 8 penetrating injuries were present in each group. There were 9 (35%) mortalities in the MW group and 16 (62%) in the HP groups (P = .03). Average transfusions were 12.0 and 24.5 (P = .03) packed red blood cells in the MW and HP groups, respectively. Average laparotomies per survivors were 1.3 for the MW and 3.1 for the HP groups (P = .01). Average length of stay for survivors was 19 and 47 (P = .04) days in the MW and HP groups, respectively. ConclusionMW for hepatic injuries can significantly decrease mortality, transfusions, laparotomies, and length of stay.

Optimized ventricular restraint therapy: Adjustable restraint is superior to standard restraint in an ovine model of ischemic cardiomyopathy

The effects of ventricular restraint level on left ventricular reverse remodeling are not known. We hypothesized that restraint level affects the degree of reverse remodeling and that restraint applied in an adjustable manner is superior to standard, nonadjustable restraint. This study was performed in 2 parts using a model of chronic heart failure in the sheep. In part I, restraint was applied at control (0 mm Hg, n = 3), low (1.5 mm Hg, n = 3), and high (3.0 mm Hg, n = 3) levels with an adjustable and measurable ventricular restraint (AMVR) device. Restraint level was not altered throughout the 2-month treatment period. Serial restraint level measurements and transthoracic echocardiography were performed. In part II, restraint was applied with the AMVR device set at 3.0 mm Hg (n = 6) and adjusted periodically to maintain that level. This was compared with restraint applied in a standard, nonadjustable manner using a mesh wrap (n = 6). All subjects were followed up for 2 months with serial magnetic resonance imaging. In part I, there was greater and earlier reverse remodeling in the high restraint group. In both groups, the rate of reverse remodeling peaked and then declined as the measured restraint level decreased with progression of reverse remodeling. In part II, adjustable restraint resulted in greater reverse remodeling than standard restraint. Left ventricular end diastolic volume decreased by 12.7% (P = .005) with adjustable restraint and by 5.7% (P = .032) with standard restraint. Left ventricular ejection fraction increased by 18.9% (P = .014) and 14.4% (P < .001) with adjustable and standard restraint, respectively. Restraint level affects the rate and degree of reverse remodeling and is an important determinant of therapy efficacy. Adjustable restraint is more effective than nonadjustable restraint in promoting reverse remodeling.

Surgical experiences with inflammatory arterial aneurysms due to Takayasu's arteritis

This report shows clinical manifestations and provides aspects of surgical strategy for inflammatory aneurysms due to Takayasu's arteritis. Fourteen cases of inflammatory aneurysms among 81 patients with Takayasu's arteritis who underwent surgery in our institute were reviewed. The patient group consisted of six males and eight females, ages from 20 to 61 (mean 39.6±3.5) years. Aneurysmal lesions were located in the ascending aorta or aortic arch (type I) in six (42.9%) patients and the thoracic and/or abdominal aorta (type II) in six patients (42.9%). Type III distribution was determined for two patients (14.3%). Operative procedures for aneurysms included aortic replacement using prosthetic graft (n=6), aneurysmorraphy (n=1), patch angioplasty (n=1), Hardy operation (n=1), aortic valve replacement (AVR) (n=2), and AVR associated with mesh wrapping or aneurysmorraphy (n=3). Operative mortality was 21.4% (three cases) at initial operation and late deaths were found in five cases. Causes of late deaths included rupture of suture aneurysms, rupture of the aortic aneurysm at other aortic lesions, and sudden death due to acute perivalvular leakage. Aggressive surgical approach prior to rupture is required for cases with progressive aortic dilatation even if inflammation signs appear to be controlled. Careful long-term follow-up using periodical angiogram or computed tomography are essential to the best prognosis in pre- and postoperative periods.

Iatrogenic liver trauma managed with mesh-wrapping and ligation of portal vein branch: A case report

IntroductionLiver trauma is a critical condition that requires swift multidisciplinary approach. In complex hepatic injuries perihepatic packing is an established life-saving procedure. The aim of this study is to evaluate and highlight the value of absorbable mesh wrapping of the injured liver, combined with ipsilateral ligation of portal vein branch. Case presentationAn 82-year-old patient underwent an open cholocystectomy, for gallbladder empyema. The second postoperative day he was re-operated on due to active hemorrhage. The bleeding was controlled by suturing the bed of the gallbladder fossa. During this maneuver a portal vein branch was torn resulting in a rapidly expanding subcapsular liver hematoma which led to the formation of two deep lacerations on the liver parenchyma. This life-threatening condition was treated by wrapping an absorbable mesh around the right liver lobe and subsequently ligating the right portal vein branch extrahepaticaly. ConclusionMesh wrapping of the fragmented liver with absorbable mesh constitutes a safe and effective method, in treating grade IV and V liver injuries, especially when combined with ipsilateral ligation of the bleeding vessel.

Polypropylene mesh wrap around reinforced pancreatojejunostomy for soft pancreas

To evaluate the preventive effect of a new anastomotic technique upon pancreatic leakage-polypropylene mesh wrap around reinforced pancreatojejunostomy on soft pancreas. From August 2005 to August 2008, polypropylene mesh wrap around reinforced pancreatojejunostomy was performed on 24 cases of pancreatodudeonectomy with soft pancreas. The operating duration was 5 to 7.5 hours. The mean duration of performing pancreatojejunostomy was 25 min. Blood loss was 200 to 1, 500 ml. All patients recovered without pancreatic leakage. The polypropylene-mesh wrap around reinforced pancreatojejunostomy is a feasible and reliable procedure to prevent pancreatic leakage of soft pancreas.

Low Morbidity Profile of Spleen Mesh Wrapping in Children

Spleen mesh wrapping is a valuable and efficacious technique for treating severely traumatized spleens. We report the morbidity of the procedure and describe its management in children. A retrospective survey of children admitted to the Hillel Yaffe Medical Center with a traumatized spleen was carried out. Between 1985 and 2000, we treated 168 children for blunt spleen trauma. The spleen was the only intra-abdominal organ injured in 102 of them. Absorbable mesh wrapping was chosen for 20 children (age range 1 - 15 years), with grade III/IV lesions that would otherwise probably have required splenectomy. Hemostasis was achieved in all 20 children. All children survived with intact spleens as suggested by the absence of long-term infectious complications and by normal hematological, US and scintigraphy studies. Anti-pneumococcal vaccination was not required. Complications were diagnosed in 12 cases, the most common being prolonged fever. Perisplenic fluid, oozing, and left pleural effusion were also present. Only one intrasplenic pseudoaneurysm occurred and this resolved spontaneously. There was one splenic abscess which was successfully treated by transmesh transcutaneous computerized tomography-guided drainage. No complications were detected at the 1 year follow-up. Absorbable mesh wrapping is safe and effective for treating grade III/IV spleen ruptures in children. Complications are mostly minor, and resolve spontaneously. Major complications are rare and can usually be managed nonsurgically.

Long-Term Experience of Girdling the Ascending Aorta With Dacron Mesh as Definitive Treatment for Aneurysmal Dilation

The management of the mildly to moderately dilated ascending aorta (3.5 to 4.9 cm) in cardiac surgery remains controversial. Therapeutic options have included radical aortic resection with synthetic graft substitution, external aortic reinforcement or wrap, with or without partial aortic wall excision, and a watch-and-wait approach. We reviewed our institutional experience with Dacron (DuPont, Wilmington, DE) mesh wrap support of dilated ascending aortas. During the last 20 years, 102 patients with aneurysmal dilatation of the ascending aorta underwent wrapping of the ascending aorta with a fine Dacron mesh from the ventricular-aortic junction to the origin of the innominate artery. For the last 10 years, the wrap was anchored to the aortic annulus with pledgeted sutures. Aortic diameters up to 6 cm, without focal areas of thinning, were wrapped. Aortic diameters exceeding 6 cm, or with focal thinning, underwent tailored aortic wall resection and wrapping. Primary end points of the study included mortality, aortic diameter growth, dissection or rupture, or both. The mean age of the group was 54.7 +/- 19 years (range, 12 to 90 years). A single patient underwent aortic wrapping without cardiopulmonary bypass. Sixty-six patients (65%) required additional aortic valve surgery. Five patients (5%) had reinforcement of dilated sinuses with glutaraldehyde-treated pericardial patches combined with wrapping. Twenty-seven patients (26%) had combined coronary and valve surgery, and 2 patients had coronary revascularization alone. There was neither early nor hospital mortality. Among the 81 patients (79%) we were able to contact, 7 (7%) late deaths had occurred at 0.5, 1, 3, and 9 years after operation that were unrelated to aortic pathology. Various levels of follow-up were obtained in the 88 patients (86.2%). In 78 patients, echocardiograms, computed tomography angiograms, or magnetic resonance angiograms were obtained. In 2 of these patients, aneurysmal dilatation of the sinuses developed below the wrap and reoperation was required. No patient in whom the mesh wrap was anchored to the aortic annulus required reoperation. All 81 patients that were contacted by us and monitored by referring physicians were asymptomatic and free of problems related to the aorta. The mean (+/- SD) preoperative diameter of the ascending aorta was 49.2 +/- 7.8 mm (range, 35 to 87 mm), the postwrap intraoperative diameter was 32.9 +/- 3.4 mm (range, 20 to 40 mm), and the follow-up postoperative aortic diameter was 35.6 +/- 12.7 mm (range, 27 to 52 mm). The mean average change in the aortic diameter during the follow-up period was 2.6 +/- 14.8 mm (range, -7 to 22 mm), a mean of 8%. The mean follow-up period was 5.7 years (median, 4.77 years; range, 9 days to 21 years). There were no infections or other early complications related to the wrap. Dacron mesh support of the moderately dilated aneurysmal ascending aorta, alone or in conjunction with coronary revascularization, aortic root surgery, or valvular operations, or both, is safe and durable. Dacron mesh is transparent and stretchable, permitting tight girdling of the aorta. These properties prevent hematoma formation, facilitate proximal vein graft anastomoses, and provide visualization and access to aortic suture lines. Finally, this technique retards further aortic dilation, altering the natural history of aortic aneurysms.

Splenic salvage using an absorbable mesh: feasibility, reliability and safety.

Forty-nine adults underwent surgery for splenic injury: 17 (group 1) had salvage with a splenic mesh, seven (group 2) underwent other preservation techniques, and 25 (group 3) underwent splenectomy. There were six, zero and 11 hilar lesions in groups 1, 2 and 3, respectively. Seven of 15 associated lesions involved the digestive tract. There was no significant difference in transfusion requirements, length of operation or postoperative complications. One patient died in each of groups 1 and 2, and eight in group 3. Secondary splenectomy was performed once in groups 1 and 2. The duration of hospital stay was shorter in the preservation groups (1 and 2) than in group 3. Splenic preservation was feasible in 24 of 49 adults with splenic injury requiring surgery. The splenic mesh wrap is safe and reliable, and allows splenic salvage even with hilar injury.

Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease

The purpose of this study is to evaluate the efficacy of aortic valve-sparing repair with glutaraldehyde-treated autologous pericardium in congenital valvular pathology. Sixty-two patients underwent reparative aortic valve surgery from January 1997 through December 2003. The mean age was 25 +/- 20 years (+/- standard deviation) (range, 10 days to 81 years). Fifty percent (31 of 62) were less than 19 years old at operation. The diagnoses included bicuspid aortic valve (39 patients), ventricular septal defect (14 patients), severe aortic stenosis (6 patients), subaortic stenosis (7 patients), bacterial endocarditis (7 patients), neonatal truncus arteriosus (2 patients), Shone's complex (2 patients), transposition complex (1 patient), double-chambered right ventricle (1 patient), and Marfan's syndrome (1 patient). Twelve patients (19 %) had prior sternotomy and cardiac operations. Valve-sparing techniques included pericardial leaflet extensions in 62 patients, creation of one or more pericardial neoaortic sinuses in 8, subcommissuroplasty in 8, pericardial patch of perforated leaflets in 9, Dacron mesh wrap (Boston Scientific, Wayne, NJ) of dilated ascending aorta in 12, and concomitant tricuspid and mitral valve repairs in 3 and 4 patients, respectively. There was one early death (1.6%). There were no late deaths at a mean follow-up of 25 +/- 16 (range, 0.1 to 72.5 months). Six patients required reoperation and prosthetic or homograft replacement for aortic valve incompetence. One out of 6 reoperations required re-repair. The remaining patients are well with a mean aortic regurgitation grade by echocardiography of 1.3 +/- 0.9 (scale, 0 to 4). Aortic valve repair with pericardial leaflet extension is a promising technique for the growing child.

Small Bowel Obstruction After Absorbable Mesh Wrap Splenorraphy

Absorbable polyglactic (Vicryl) or polyglycolic acid (Dexon) mesh wrap splenorraphy has added to the ease and safety of splenic salvage. We present a case of small bowel obstruction resulting from polyglactic (Vicryl) mesh placed during a prior wrap splenorraphy. The literature regarding complications of mesh wrap splenorraphy is reviewed. Of 116 reported cases of absorbable mesh wrap splenorraphy, a total of 39 complications were reported, giving a complication rate of 33.6%. The majority of complications were pulmonary (64%), followed by peri-splenic fluid collections (21%), abscess (5%), re-bleeding (5%), incisional hernia (2.5%) and small bowel obstruction (2.5%). Absorbable mesh may promote inflammation significant enough to produce dense adhesions. Bowel obstruction should be considered in the differential diagnosis of a patient with nausea and vomiting up to three months following absorbable mesh placement.

Mesh wrap in severe pediatric liver trauma

Purpose This study reviews the authors’ experience in treating severe pediatric liver injuries with absorbable mesh wrapping. The authors found this relatively new therapeutic method very useful in selected cases, although its use is not very common in children. The authors analyze the indication describe some technical aspects, and discuss the advantages and the pitfalls of the method. Methods In a 10-year period between 1990 and 2000, 181 children were admitted to Hillel-Yaffe Medical Center with blunt hepatic trauma. A total of 132 children were treated conservatively, and 49 (27%) were operated on. The operated group included 35 cases of isolated liver injuries and 14 cases of additional intraabdominal injuries. Thirty-four children were operated on between 1990 and 1995 (36% of 96 children), whereas between 1995 and 2000, 15 children were operated on (17% of 85 children), including 4 children aged 18 months to 15 years with massive liver bleeding who were treated with mesh wrap technique. The retrospective analysis of these 4 cases indicates a progressive policy in the recognition of cases suitable for mesh wrapping and gallbladder conservation. Results The perihepatic mesh wrap technique controlled the bleeding in all children. In 3 of them the right lobe was wrapped, and, in 1 case, total liver wrapping was performed. Hepatic enzymes and bilirubin levels were elevated in the first 3 to 7 days and declined gradually to normal levels. The perihepatic mesh was not an obstacle to a transcutaneous drainage of an intrahepatic biloma. All 4 children returned to normal physical activities. Conclusions Liver mesh wrap is a simple, effective, and rapid way to obtain hemostasis and to conserve parenchyma in severe traumatized liver. The decision to wrap the liver should be done early to prevent acidosis and hypothermia. Cholecystectomy is not an integral part of the procedure in children. The morbidity is low, and most of the complications can be treated nonsurgically.

Is there a Place for External Mesh Wrapping of Abdominal Aortic Aneurysms in the Modern Endovascular Era?

Introduction due to unacceptably high operative risk. Comorbidities and factors that influenced our decision to consider External mesh wrapping is an old idea practised long mesh-wrapping are shown in Table 1. All operations were performed by a single surgeon using a transverse before the first successful abdominal aortic aneurysm (AAA) repair. In recent years, with the advent of abdominal incision. The aorta was exposed proximally, distally, and on both sides, but no attempt was made endovascular surgery, this technique is mainly of historical interest. However, not all aneurysms are suitto mobilise the posterior aspect of the aneurysm from its attachment to the anterior longitudinal ligament of able for endovascular repair. Occasionally, vascular surgeons are faced with the dilemma of a patient the spine. The lumbar and inferior mesenteric arteries were left undisturbed. A sheath of Marlex mesh was deemed unfit for open repair and an aneurysm unsuitable for endovascular repair. The option they have used to wrap the anterior and lateral aspects of the aneurysm and stitched down on the sides of the anthen is to opt for no operation at all, or consider less invasive alternatives. In this report we present a single terior longitudinal ligament with interrupted sutures. The peritoneum was then closed over the top of the surgeon’s experience with external mesh wrapping of AAAs. mesh. Postoperatively, patients were followed up in the outpatients department.