Omental Pedicle Research Articles

ASO Author Reflections: Significance of Predicting Omental Insufficiency in Breast Cancer Patients Receiving Immediate Breast Reconstruction with Pedicled Omental Flap After Mastectomy.

ASO Author Reflections: Significance of Predicting Omental Insufficiency in Breast Cancer Patients Receiving Immediate Breast Reconstruction with Pedicled Omental Flap After Mastectomy.

The Predictive Factors of Combined Implant Application for Breast Cancer Patients Receiving Immediate Breast Reconstruction with a Pedicled Omental Flap.

Whether a laparoscopically harvested omental flap is adequate for total breast reconstruction could not be determined preoperativaly due to lack of reliable assessment methods. This study aimed to establish a statistical model to predict the probability of omental flap insufficiency. In this study, 200 female patients with breast cancer receiving immediate breast reconstruction with pure pedicled omental flaps or pedicled omental flaps combined with implants after nipple-areolar complex-sparing mastectomy were divided into two groups depending on whether implants were needed or not. The clinical characteristics of these two groups were compared. Correlation of body mass index (BMI) and omental volume was analyzed. Binary logistic regression was performed to predict the probability of implant requirement based on clinical parameters, showing significant differences between the two groups. The patients who needed implants in adjunct treatment were younger. In addition, they had larger breast specimens and smaller omental volumes than the others whose omental flaps were sufficient for total breast reconstruction. Body mass index and omental volume showed a moderately positive correlation. Age, specimen volume, and BMI all were entered into the logistic regression equation. For the patients with a BMI lower than 24.0kg/m2, the probability of requiring implants was 5.467 times that of comparable patients with a BMI of 24.0kg/m2 or higher. At the cutoff of 0.61, the regression equation yielded a sensitivity of 84.2% and a specificity of 72.1% in recognizing subjects with the necessity of implant application. The combination of BMI, age, and volume of breast specimen could predict with high accuracy whether implants are required for breast cancer patients receiving pedicled omental flap-based breast reconstruction.

The effect of omental pedicle flap with platelets-rich fibrin on reconstruction of induced-urinary bladder defect in dogs

The effect of omental pedicle flap with platelets-rich fibrin on reconstruction of induced-urinary bladder defect in dogs

Augmented anastomotic ureteral reconstruction using buccal mucosal graft, initial experience.

To assess the augmented anastomotic ureteral reconstruction using buccal mucosal graft based on omental flap for managing ureteral stricture. This prospective cohort study was conducted on 13 patients with ureteric strictures of different lengths secondary to Bilhalziasis, iatrogenic (post endoscopy) and post inflammatory etiology in upper and mid ureteral segments were treated with buccal mucosal patch grafts and The graft is fixed to the undersurface or the posterior surface of the omentum before doing graft anastomosis to the ureteral walls as to ensure the process of graft take sticky to the principles of tissue transfer. All patients were subjected to full history taking, clinical examination for assessment of pain, lower or upper urinary track symptoms and laboratory investigation (complete blood count, CRP, liver function test and kidney function test (serum urea and creatinine). The mean operative time was 148.85 min and mean hospital stay was 3 days. Mean blood loss was ranged from 20 to 210 ml and Stent was removed after 8-12 weeks. The mean follow up was 13 months, all patients had a non-obstructive RI value <0.7 with a non-obstructed drainage pattern on the diuretic renogram except one patient who had severe postoperative UTI necessitating nephrostomy tube insertion his drainage curve was plateau. BMG ureteroplasty is a valuable option for a carefully selected patient. The fixation of the graft on the back surface of the omentum allows for better anatomical reconstruction without any twisting to the omental pedicle.

Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study.

Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.

Robotically-harvested, thoracoscopically-tunneled transdiaphragmatic omental pedicle flap for obliteration of radiated empyema cavity

Intra-thoracic defects continue to pose a challenge for the reconstructive surgeon. Stable soft tissue coverage and obliteration of dead space can be particularly challenging when complicated by infection or previous radiation. These cases may require a less conventional method of reconstruction. We describe a case in which vacuum-assisted closure followed by pedicled omental flap transposition was successfully used to reconstruct a complicated intra-thoracic wound following pneumonectomy, radiation therapy, and recurrent wound dehiscences secondary to chronic infection.

A case of retroperitoneal abscess secondary to duodenal perforation

Abstract The development of a retroperitoneal abscess in the setting of duodenal perforation is a rare occurrence. There are various causes of duodenal perforation such as trauma, iatrogenic injury and, most commonly, peptic ulcer disease [1]. Urgent surgical intervention is required when a patient presents with a perforated duodenal ulcer and signs of peritonitis. Generally, closure is performed with an omental pedicle or Graham patch [2]. In cases of large perforations, surgical resection, gastric partition with diverting gastrojejunostomy or T-drain placement may be required [2]. In this case, we present a patient with duodenal ulcer perforation complicated by retroperitoneal abscess formation. Treatment involved interventional radiological (IR) drainage of the abscess, followed by laparotomy for persistence of fluid. The surgery comprised of a right-side hemicolectomy, Braun jejunojejunostomy, pyloric exclusion, intraoperative retroperitoneal abscess drainage and Graham patch repair of retroperitoneal duodenal perforation.

Deep Infiltrating Endometriosis Affecting Ileoanal Anastomosis (J-Pouch): Surgical Approach

<h3>Study Objective</h3> To review a patient case of deep infiltrating endometriosis of an ileoanal anastomosis. <h3>Design</h3> Case report. <h3>Setting</h3> Academic institution, Minimally Invasive Gynecologic Surgery and Colorectal combined procedure. <h3>Patients or Participants</h3> 38-year-old with history of ulcerative colitis status post ileoanal anastomosis (J-pouch) with deep infiltrating endometriosis. <h3>Interventions</h3> Robotic-assisted total laparoscopic hysterectomy with bilateral salpingectomy, left oophorectomy, excision of deep infiltrating endometriosis of J-pouch, ureteral ICG injection, and pouchoscopy. <h3>Measurements and Main Results</h3> Patients with endometriosis are at increased risk of co-morbid inflammatory bowel disease. Ileoanal anastomosis is indicated in patients with disease affecting the entire colon and rectum such as ulcerative colitis. The J-pouch is created with an anastomosis of folded terminal ileum following total resection of the colon and rectum. An enterotomy of the pouch and anal anastomosis are then completed, forgoing the need for ileostomy. The primary vascular supply consists of terminal branches of the superior mesenteric artery and is therefore limited. The patient presented with pain and on MRI was found to have deep infiltrating endometriosis of the ileoanal anastomosis approximating 3.2 by 1.0 cm, as well as a left endometrioma. Intra-operatively, the deep infiltrating lesion was identified on the efferent limb on the antimesenteric border of the J-pouch ileum and removed using a shave technique. Care is taken to avoid the vascular supply to the J-pouch on the mesenteric aspect, as no collateral supply is available. An omental pedicle flap was created and secured overlying the pouch to reduce the risk of fistula formation. The patient underwent the procedure without complications. <h3>Conclusion</h3> Patients with endometriosis are at increased risk of comorbid inflammatory bowel disease. Knowledge of J-pouch anatomy is crucial to dissection in cases of endometriosis involvement, including delicate blood supply. The use of an omental flap can be helpful to prevent formation of future adhesions. A multidisciplinary approach is key to patient care.

Surgical strategy for treating mycotic aneurysms of thoracic and abdominal aorta and iliac artery: Analysis of long-term follow-up data.

Mycotic aneurysms of the aorta and iliac arteries are rare, but life-threatening conditions. We reviewed our experience to determine the best surgical strategy. Between 2007 and 2015, we operated 14 patients with mycotic aneurysms of the aortic arch (n = 6), descending aorta (n = 1), thoracoabdominal aorta (n = 2), abdominal aorta (n = 4), and iliac artery (n = 1). The mean age was 70.4 ± 8.8 years, and 10 males were included. Blood culture, tissue culture, or both were positive in 11 patients. Four of five patients with mycotic aneurysms of the abdominal aorta and iliac artery underwent extra-anatomical bypass. Ten underwent in-situ graft replacement for managing mycotic aneurysms of the thoracic aorta. One patient with a mycotic thoracoabdominal aortic aneurysm underwent visceral bypass of the descending aorta and extra-anatomical bypass. Omental pedicle grafting was performed in 10 patients. The mean follow-up period was 8.6 ± 3.1 years. Three patients (21.4%) died. Recurrent infection was observed in one patient with a mycotic aneurysm of iliac artery three months after the initial surgery. The patient underwent extra-anatomical bypass with omental pedicle grafting as a redo. Nine patients were discharged, and no recurrence of infection was observed. Two patients died of cancer and heart failure. The five- and seven-year survival rates were 100% ± 0.0% and 85.7% ± 13.2%, respectively. A combination of radical debridement of the infectious source and omental pedicle grafting with either in-situ graft replacement or extra-anatomical bypass is an effective strategy.

Early and late outcomes of surgical repair of mycotic aortic aneurysms: A 30-year experience

ObjectiveMycotic aortic aneurysm and its associated complications are often catastrophic. In this study, we examined the early and late outcomes of surgical repair of mycotic aortic aneurysm at our center over the last 3 decades. MethodsWe retrospectively reviewed our prospectively maintained aortic surgery database with supplemental adjudication of medical records. Aortic infection was confirmed through clinical, radiological, intraoperative, pathological, and treatment evidence. ResultsSeventy-five patients (median age, 68 years; interquartile range, 62-74) who underwent surgical repair of a mycotic aortic aneurysm between 1992 and 2021 were included. Almost all patients (n = 72; 96%) presented with symptoms, including 26 patients (35%) with rupture, and many underwent urgent or emergency repair (n = 64; 85%). Sixty-one patients underwent open repair, and 14 patients underwent hybrid or endovascular repair. Infection-specific adjunct techniques included rifampin-soaked grafts (n = 16), omental pedicle flaps (n = 21), and antibiotic irrigation catheters (n = 8). There were 15 early deaths (20%), including 10 of the 26 patients (38%) who presented with rupture; however, persistent stroke, paraplegia or paraparesis, and renal failure necessitating dialysis were uncommon (each <5%). Almost all early survivors (52/60; 87%) were discharged with long-term antibiotic therapy. Estimated survival at 2, 6, and 10 years was 55.7% ± 5.8%, 39.0% ± 5.7%, and 26.9% ± 5.5%, respectively. ConclusionsA substantial proportion of patients with mycotic aortic aneurysm present with rupture and generally require urgent or emergency repair. Operative mortality and complications are common, especially for patients who present with rupture, and late survival is poor.

A study on the clinical application of greater omental pedicle flap transplantation to correct anterior resection syndrome in patients with low rectal cancer.

IntroductionLow anterior resection syndrome (LARS) is the most common complication after total mesorectal excision (TME) in patients with low rectal cancer and has been a challenge in colorectal surgery that severely impacts the quality of life of patients. This study aimed to introduce a revised surgical procedure which could effectively maintain rectal compliance and significantly improve LARS after the operation.MethodsWe performed mesorectal reconstruction after routine Dixon TME using greater omental pedicle flap transplantation in 11 patients with low rectal cancer (5 cases of preoperative neoadjuvant chemoradiotherapy, 5 cases of preoperative neoadjuvant chemotherapy, and 1 case of postoperative adjuvant chemotherapy), thereby simulating the initial anatomical structure of the mesorectum and significantly reducing the postoperative anterior resection syndrome. The lars precision syndrome assessment scale (LARSS) was used to access the LARS.ResultsAt 12 weeks after the 11 patients recovered from the anal defecation function, the average score on the LARS questionnaire was 25.5 ± 1.5 (minor). The average time at which anal function began to recover was 6.2 ± 2.6 weeks after surgery. The recovery was rapid, as the rectal and anal function of all patients generally returned to normal levels within 12 weeks, and the quality of life was close to that before surgery.ConclusionGreater omental flap transplantation can significantly improve LARS after Dixon TME in patients with low rectal cancer.

Laparoscopic and hand-assisted cystorrhaphy strengthened with omental pedicle in dogs: Radiographic and ultrasonographic study

This study was designed to evaluate the using of two laparoscopic techniques for repairing an experimental cystotomy of urinary bladder reinforced with omental pedicle in dogs. Eighteen local breed male dogs were randomly allocated into two equal groups: first group an experimental cystotomy (about 2 cm) was induced laparoscopically at the ventral surface of the urinary bladder, repaired with titanium clips and reinforced with the omental pedicle. In the second group: similar technique was followed; however, the induced was repaired with hand-assisted extracorporeal laparoscopic method. In both groups, several diagnostic parameters were followed including clinical / laparoscopic exploration, radiology, and ultrasonography. Results obtained in the first group shown the titanium clips 4-6 clips freely applicated and whole time consuming for performing operation was 45±2.1 minutes. Clinically, the experimental animals didn't show any abnormal changes in their behavioral activities. Radiographic examination revealed distention of the urinary bladder accompanied by the presence of distances between the titanium clips; however, ultrasonography didn't show any leakage or thickness at the site of operation. Laparoscopic examination demonstrated mild adhesion between urinary bladder and adjacent organ. In the second group, the operation required 36±1.1 minutes to be completed. Postoperatively, no signs of pain were observed, however, animals demonstrated post-operative transient hematuria, lasts for 24 hours, accompanied with severe adhesion between the bladder and abdominal wall. Radiographically, regular distention of the bladder was revealed, while ultrasonographic examination showed hyperechoic dots and thickening of the bladder wall. We concluded that the hand-assisted laparoscopic cystorrhaphy strengthened by omentum is a practical, time saving and mini-invasive surgical technique.

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula.

Patients undergoing resectional surgery for enterovesical fistulas generally have an indwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the role of a cystogram as part of the postoperative follow-up of such surgery, when it should be performed and for how long the bladder should be drained after surgery. A retrospective single-centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary end-point of recurrent urinary fistula. Between 1994 and 2015, 46 patients (23 male; mean age 55.4±18.3years) underwent surgery [23 (50%) for diverticular disease, 16 (34.8%) for Crohn's disease, five (10.9%) for malignancy and two (4.3%) for previous radiotherapy]. Closure of the bladder fistula was by simple suture in 21 (46%) patients and with an omental pedicle in 16 (36%). Overall median duration of urinary drainage was 10.5 [interquartile range (IQR): 7.3-14.0] days. A postoperative cystogram was performed in 26 (57%) patients after a median of 10.0 (IQR: 8.0-13.0) days. This demonstrated persistent leakage in three patients, of whom two had undergone surgical closure of the bladder. This group required prolonged drainage (7, 19 and 40days). One patient who had undergone surgery following radiotherapy for urothelial cancer developed a recurrent malignant fistula at 9months, even though the postoperative cystogram had been negative. This study suggests that a routine postoperative cystogram after surgery for enterovesical fistula may not be necessary for all patients if the bladder is drained for 1-2weeks after bowel resection.

Recommendations for management of infected aortic pathology based on current evidence

The management of infection involving the abdominal aorta requires clinical decisions based on patient factors and the nature of the infectious process. Any infection occurring after endovascular aortic aneurysm repair or open aortic replacement grafting should be treated promptly with appropriate systemic antibiotic therapy. Once a vascular prosthesis becomes infected, surgical treatment is necessary. There should be a low threshold for graft excision and extra-anatomic bypass in the presence of fistula or abscess cavity, when feasible entire graft should be excised. In selected patients, graft excision with in situ aorta reconstruction is an appropriate option using an autogenous femoral vein, cryopreserved allograft, or a prosthetic graft impregnated with antibiotic. The replaced in situ aortic graft should be covered with an omental pedicle. For primary aortic graft infections, endovascular treatment may act as a bridge to more definitive treatment; or, in the absence of gross retroperitoneal infections, endovascular grafting alone with prolonged systemic antibiotic therapy is a viable option, particularly in patients not fit for open surgical procedures.

A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft

A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft

Abstract: Comparison of Tumor Recurrence in Oncoplastic Pelvic Reconstruction with Vertical Rectus Abdominis Musculocutaneous (VRAM) versus Omental Flaps: Outcomes Following Ablative Abdominoperineal Resection (APR) and Pelvic Exenteration

BACKGROUND: Little is known about the impact of the type of soft-tissue reconstruction on local tumor recurrence in patients with pelvic malignancy undergoing abdominoperineal resection. Therefore, the purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. STUDY DESIGN/METHODS: All patients who underwent oncoplastic reconstruction following APR with either VRAM or omental flaps at the Mayo Clinic in Rochester, Minnesota from January 1992 – January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities (i.e. hypertension, diabetes mellitus, smoking status) were collected for all patients. Additionally, chemotherapy and radiation therapy (neoadjuvant, intra-operative, or adjuvant) data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach, including use of skin paddle and rationale for using one approach over the other (i.e. previous omentectomy or diverting colostomy). Oncologic data collected includes cancer type, stage at time of APR, tumor recurrence within the flap and stage of tumor at time of recurrence. Statistical analysis was performed with SPSS Version 11.0 statistic software package (SPSS, Chicago, IL). Comparisons between groups were performed with analysis of non-parametric test. A value of P < 0.05 was considered statistically significant. Univariate and multivariate analyses were performed. RESULTS: A total of 585 patients were identified who underwent pelvic soft-tissue reconstruction with either VRAM or omental pedicle flaps. Of these, 297 (50.8%) underwent VRAM reconstruction (270, 90.90% with skin paddle) and 288 (49.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Specific complications and their respective rates of occurrence in each reconstructive approach included bowel obstruction [VRAM=0; Omentum=17(5.9%)], wound dehiscence [VRAM=31(10.4%); Omentum=26(9.0%)], and tumor recurrence within pedicle flap [VRAM=14(4.7%); Omentum=40(13.9%)]. Of the 31 cases (10.4%) of wound dehiscence in VRAM patients, 6 occurred in the abdomen and 25 occurred in the perineum at the skin paddle. Chi-squared test comparing tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared to VRAM flaps (p= 0.000127). CONCLUSIONS: The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared to patients reconstructed with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in oncoplastic pelvic reconstruction.

VS02.02: LAPAROSCOPIC TRANS-HIATAL REPAIR FOR BOERHAAVE’S SYNDROME: A CASE REPORT

Abstract Description Introduction Spontaneous esophageal rupture, also known as Boerhaave's syndrome, is an uncommon and potentially life-threatening condition that requires urgent surgical management. We report a case of spontaneous esophageal rupture that was successfully treated by primary closure and drainage laparoscopically. Case report The patient was a 49 year-old man with a history of liver cirrhosis. He experienced sudden-onset epigastric pain triggered by vomiting after drinking alcohol, and transported to our hospital. On admission, a thoracic CT scanning revealed mediastinal emphysema without pleural effusion. We diagnosed BS and performed an emergency operation. We chose laparoscopic trans-hiatal approach as it was thought to be minimally invasive compared with open thoracic surgery. Five trocars were placed in a similar way of gastric cancer surgery. We identified laceration on the left wall of the lower esophagus under assistance of intra-operative upper endoscopy, and conducted drainage and repair by primary closure with continuous barbed suture. Finally, an omental pedicle flap was applied for over sutured site. The operation time was 214 minutes and the amount of blood loss was 50 cc. In the post-operative course, intra-mediastinal abscess was observed and he required antibiotic therapy. However, the patient was discharged on the 16th post-operative day without a serious complication such as anastomotic leakage. Discussion Primary esophageal repair is the gold standard in Boerhaave's syndrome and the approach is usually left thoracotomy. However, if there is no perforation into the thoracic cavity as in our case, less invasive approach should be considered such as laparoscopic trans-hiatal approach. We could observe the lower esophagus completely under a good field of view in this approach. There are several treatments, and it should always be tailored to the patient's condition. Laparoscopic trans-hiatal approach is considered to be useful for the treatment of lower esophageal wall rupture. It is difficult to conduct a comparative study of the various methods that can be used to treat spontaneous esophageal rupture in cases that require emergent surgery, as the number of cases is limited. Therefore, the further accumulation of cases is necessary. Disclosure All authors have declared no conflicts of interest.

Pedicled gastric seromuscular patch for one-stage closure of a bronchopleural fistula: a case report

BackgroundOne-stage closure and fenestration are the available surgical options for bronchopleural fistula (BPF). One-stage closure may be applicable in cases with favorable infection control. Closing the bronchopleural stump is difficult due to thick adhesion caused by inflammation and a high risk of pulmonary artery injury. We report the successful closure of a BPF using a gastric seromuscular patch with an omental pedicle flap.Case presentationA 73-year-old man underwent right lower lobectomy with ND2a-2 lymph node dissection for lung adenocarcinoma. He was admitted to a local hospital for pneumonia. Three days after admission, his thoracic cavity was drained and a BPF was suspected. During the primary operation, the latissimus dorsi muscle and anterior serratus muscle were dissected via posterolateral incision, and we decided to close the fistula using the gastric seromuscular layer and omental pedicle flap. The patient was discharged 20 days after surgery. After 2 years, he has not had cancer recurrence and currently leads an active life.ConclusionsThis method provided immediate airtight closure and luminal opening of the middle bronchus in our patient with a large BPF and appeared superior to using the omentum alone. This procedure is useful for one-stage closure and does not require fenestration in cases with favorable infection control.

Successful Management of Refractory Prosthetic Vessel Infection, Prosthetic Valve Endocarditis and Mediastinitis: Report of a Case-Late Timing Caused Repeated Surgery

The patient was diagnosed with anuloaortic ectasia with localized dissection in the right Valsalva sinus. He underwent aortic root replacement with mechanical valve. But, he was re-admitted for mediastinitis. Although his serum (CRP) level was normalized for one month, his body temperature suddenly rose to 40°C. An emergency operation was performed including re-sternotomy, drainage, and irrigation. However, a proximal anastomotic site ruptured and he went into shock. Following cardiopulmonary bypass, we performed a second aortic root replacement. Therefore, the patient was operated for sternum debridement and to wrap the prosthetic vessel into an omental pedicle. Nine days after the last intervention, bleeding from the chest wound suddenly appeared and he went into shock. He was transported to the operating room to initiate cardiopulmonary bypass. During circulatory arrest, laceration was detected at the same annular position. Deep into the left ventricle, we made interrupted sutures in the left cardiac muscle. Next, we implanted a Freestyle aortic root bioprosthesis using the full root technique. After removing all former implants, another prosthetic vessel was anastomosed between the Freestyle conduit and the distal aorta, and wrapped with omental pedicle. After three weeks, his serum CRP level was normal. He remained free of infection for at least three years.

Development of tracheal reconstruction methods from scaffold engineering to injectable matrix

Backgrand: For patients with long segment of tracheal stenosis, resection and replacement is necessary. Tracheal reconstruction associated with complications such as stenosis, insufficiency of blood supply and surgical complication. Methods: In this study, we prepared collagen-chitosan scaffold and sheep's decellularized trachea plus culture medium with nanocup contain growth factors for chondrocyte and fibroblast-epithelial cell culture in rotary bioreactor. After attachment of cells, engineered trachea put into the omentum. Peritoneal stem cell interact with the epithelial and chondrocytes with attendance of growth factors released from nanocup. The bioengineered trachea with omental pedicle transposed from behind the sternum and transplanted in the position of resected trachea. In third experiment, we introduce the in situ tracheal repair technique with injectable matrix for reconstruction of long-segmental stenosis of trachea in a 29-year-old woman. Results: Severe tortuosity in the first experiment and mild stenosis was seen in the second experiment. In third experiment, normal shape in tracheal diameter was seen at injection sites. The interior portion of the trachea at virtual computed tomography (CT) scan and bronchoscopy were similarity to normal after four month fallowing up of injection. Conclusions: Severe tortuosity, mild stenosis in whole length of trachea in this study and disadvantage of trachea transplantation include open surgery, fatal consequences of anastomosis leakage, and rupture besides large mediastinal vessels; hence, we decided to introduce the novel in situ tracheal repair technique. Injectable bioresorbable scaffolds may be used as a temporary scaffolding for transplanted cells and thereby allow the cells to secrete extracellular matrix of their own to enable, in the long term, a complete and natural tissue replacement.