Patch Infection Research Articles

Brown patch on tall fescue as influenced by nitrogen and fungicide applications

AbstractTall fescue (Festuca arundinacea Schreb.) is a cool‐season turfgrass species commonly used in the transition zone. Brown patch (Rhizoctonia solani Kuhn) can have a significant impact on quality of tall fescue between late spring and late summer and is impacted by management strategies including fertilization and fungicide use. The objective of this study was to evaluate the influence of four nitrogen (N) sources and two application rates (0, 74 kg ha−1 [low], or 220 kg ha−1 [high] annually) along with fungicide application (azoxystrobin applied or not applied) on tall fescue brown patch infection. Highest quality occurred when tall fescue received the highest level of N and fungicide treatment. If high levels of N were applied and no fungicide was used, quality was reduced significantly when brown patch was observed in tall fescue. For example, on July 21, 2023, when most intense brown patch occurred, tall fescue had variable brown patch levels: low N levels 2%–23% and high N levels 48%–66%. Across three rating dates in summer 2023, tall fescue receiving the low N level exhibited statistically similar brown patch among all N sources. Conversely, brown patch treated with high levels of N had lower brown patch in urea compared to humic‐coated urea and slow‐release N on at least one of the three dates. Applying N at a level of 220 kg ha−1 annually or higher can result in significant brown patch in some summers; lower N levels will reduce brown patch. Desiring high tall fescue quality requires the high N level and inclusion of preventive fungicide applications.

Patch Infection Following Carotid Endarterectomy: A Single-Center Audit and Literature Review.

Carotid endarterectomy (CEA) is a surgical procedure that carries a rare but serious risk of patch infection. This study examines the management and outcomes of patch infections in CEA patients treated in our department over 23 years. A literature review of studies on prosthetic patch infection following CEA published from January 1992 up to December 31, 2022 was also carried out. We conducted a retrospective audit of patients who underwent CEA in a hospital in Athens, Greece, between January 1, 1999, and December 31, 2022. Between January 1999 and December 2022, we treated seven patients with carotid patch infections who had their original CEA at our department. Staphylococcus epidermidis and Staphylococcus aureus were the most common infecting organisms. One patient (14%) died from hemorrhagic shock before surgery, while the remaining six (86%) underwent debridement, patch excision, and great saphenous vein patching. No peri-operative deaths or strokes occurred, and there were no re-infections during a median follow-up of 159 months. Excision of infected material followed by revascularization using a vein graft remains the prevailing treatment.

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection

Synthetic patch infection after congenital diaphragmatic hernia repair: A case series

Synthetic patch infection after congenital diaphragmatic hernia repair: A case series

Carotid EndoVAC: a novel hybrid technique for carotid Dacron patch infection

This paper reports the use of the EndoVAC technique in a case of left carotid artery Dacron patch infection. The EndoVAC technique involves a sequence of endovascular relining with a stent graft, surgical debridement with explantation of infected graft material and secondary intention wound healing with a vacuum-assisted closure (VAC) device and long-term antibiotic treatment. Our patient was considered a high-risk surgical candidate due to previous cranial nerve injury, high carotid stent graft positioned in zone 3 of the neck, and high stroke risk due to aberrant cerebrovascular anatomy. The carotid EndoVAC technique was performed without complication and a successful outcome was observed at 1-year follow-up. Although currently not recommended as first-line management in treating vascular graft and endograft infections of the carotid vessels, the EndoVAC approach should be considered in a select cohort of patients when neither traditional radical surgery nor conservative simple VAC therapy are considered feasible or safe.

Patch angioplasty during carotid endarterectomy using different materials has similar clinical outcomes

ObjectivePatch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. However, the choice of which patch to use remains a matter of debate. Autologous venous material has disadvantages such as wound-related problems at the harvest site and a prolonged intervention time. These limitations can be bypassed when synthetic or biological patches are used. Both materials have been associated with divergent advantages and disadvantages. Therefore, the aim of our study was to compare the long-term follow-up outcomes in patients who underwent CEA and closure with either a bovine pericardial patch (BPP) or polyester patch. MethodsA retrospective cohort study was conducted including all patients who underwent primary CEA and closure with a BPP or a polyester patch between January 2010 and December 2020 at our tertiary referral center. In 2015, the BPP was introduced as an alternative for polyester. The primary outcome was the occurrence of transient ischemic attack (TIA) or cerebrovascular accident (CVA) during follow-up and secondary outcomes included restenosis, reintervention, all-cause mortality, and patch infection. Cox proportional hazard models were used and hazard ratios with 95% confidence intervals were used to predict these outcomes. ResultsWe included 417 CEA patients; 254 patients (61%) received a BPP and 163 received (39%) a polyester patch. The mean age was 70.2 ± 8.7 years and 67% were male. The median follow-up time was 15 months (range, 12-27 months) for BPP and 42 months (range, 16-60 months) for polyester (P < .001). Postoperative hematoma (≤30 days) was significantly lower in the BPP cohort (2% BPP vs 6% polyester; P = .047). No other significant differences on short-term outcomes were found. Univariable Cox regression analyses showed no significant differences between the effect estimates of polyester and BPP on TIA or CVA (P = .106), restenosis (P = .211), reintervention (P = .549), or all-cause mortality (P = .158). No significant differences were found after adjusting for confounders in the multivariable analyses: TIA or CVA (P = .939), restenosis (P = .057), reintervention (P = .193) and all-cause mortality (P = .742). Three patients with a polyester patch had patch infection compared with none of the patients in the group who received a BPP. ConclusionsThis large retrospective study showed comparable safety and durability of both BPP and polyester suggesting that both patch types can be safely applied for CEA with patch angioplasty. Patch infection was rare and was absent in the BPP group.

Outcomes of Upper Extremity Access with Surgical Exposure of the Axillary Artery in Fenestrated and Branched Endovascular Aneurysm Repair

This study aims to assess the safety of upper extremity access with surgical exposure of the axillary artery in fenestrated and branched endovascular aneurysm repair (F/B-EVAR), evaluating neurological and local complications as well as re-interventions associated with the technique. All patients undergoing an F/B-EVAR procedure with surgical exposure of the axillary artery between January 2010 and March 2020 were included in this retrospective single centre study. Endpoints were neurological and access related complications and re-interventions related to the upper extremity access. Complications related to the technique included stroke/transient ischaemic attack, wound infection, peripheral nerve injury, and arterial complications. 264 patients (192 male, mean age 70 ± 7 years) were included. Upper extremity access was performed over the left axillary artery in 257 (97%) of the cases, and over the right axillary artery in the remaining seven cases. Six (2.2%) patients had early complications related to the arterial access: four with post-operative bleeding and two with acute arm ischaemia. Two patients with post-operative bleeding and both patients with ischaemic complications required re-intervention. One of these patients with arm ischaemia died five weeks after the re-intervention due to sepsis complications related to patch infection. Sixteen (6%) patients presented with transient arm paraesthesia or sensory neurological deficit post-operatively. The symptoms completely recovered in all cases with no residual deficits. Peri-operative ischaemic stroke occurred in three (1%) patients (two minor, one major). No other access related complications were recorded during follow up in any of the patients with no cases of late stenosis/occlusion. Upper extremity access with surgical exposure of the axillary artery is a safe method for antegrade catheterisation of fenestrations and branches in complex endovascular aneurysm repair.

Clinical Analysis of 5 Cases of Delayed Patch Infection with Sinus Formation after Tension-free Inguinal Hernia Repair

Clinical Analysis of 5 Cases of Delayed Patch Infection with Sinus Formation after Tension-free Inguinal Hernia Repair

Hybrid Repair of Infected Carotid Patch

A 76 year old male underwent a Dacron patched left carotid endarterectomy in 2014. In 2019 a left sided neck mass was removed by surgical oncologists, with further excision three months later. In 2021, he presented with 48 hours of neck pain and swelling. (A) Computed tomography angiography revealed carotid irregularity with haematoma (arrow). A patch infection with pseudoaneurysm was treated by Viabahn stent graft insertion (WL Gore, Flagstaff, AZ, USA), external carotid artery coiling (B, arrow), and carotid patch excision, leaving the exposed Viabahn stent graft in the wound. Microbiology was negative. Intravenous antibiotics were administered for six weeks. Secondary wound closure was achieved after three weeks of Vacuum Assisted Closure therapy.Image 1

Methods of carotid endarterectomy

This literature review is devoted to various carotid endarterectomy (CE) methods that exist today in Russia. The pros and cons of conventional and eversion technique of the operation are given. It is indicated that the former is associated with higher long-term rate of restenosis, aneurysm and patch infection. The second is associated with higher prevalence of intraoperative internal carotid artery (ICA) thrombosis due to intimal detachment distal to endarterectomy area. The following CE methods for patients with prolonged ICA involvement are described: neo bifurcation formation, autoarterial reconstruction, ICA autotransplantation, plastic using an occipital artery flap. The methods of CE with carotid body saving have been demonstrated: 1. Swallow tail type patch repair proposed by R.I. Izhbuldin; 2. S-shaped arteriotomy proposed by K. A. Antsupov; 3. Two types of operations proposed by R. А. Vinogradov; 4. Сutting off the ICA with sections of common and external carotid artery proposed by A. N. Kazantsev; 5. Glomus-saving ICA autotransplantation in patients with prolonged atherosclerotic involvement. The role of ICA transposition over the hypoglossal nerve in eversion CE is presented. The glomus-saving CE with ICA transposition, called Chik-Chirik CE, is described. Conclusions are drawn on the need to demonstrate all CE types in the novel Russian guidelines for the management of patients with of head and neck arterial diseases.

Treatment of patch infection after carotid endarterectomy: a systematic review.

Carotid endarterectomy (CEA) with patch angioplasty is a widely used method for treating carotid artery stenosis. Patch infections are extremely rare, but the consequences may be serious. The current gold standard for treatment is patch excision and reconstruction with autologous material. However, no consensus has been reached and other options may be valuable as well in certain cases. The objective of this study was to evaluate the various treatment options for carotid patch infection after CEA with patch angioplasty on the basis of their outcomes (reinfection, ischemic stroke, and infection-related mortality). This systematic review was conducted in accordance with the PRISMA statement. The electronic bibliographic databases PubMed, Cochrane, and EMBASE were searched. Case series and case reports were included. Studies in languages other than English were excluded. Patients who developed a post-operative patch infection of CEA with patch angioplasty were included. Angioplasty could be performed with any type of patch. Patch infection needed to be confirmed by clinical presentation in combination with imaging, culture, or during the operation. The primary outcome measures were reinfection, ischemic stroke, and infection-related mortality. Eleven retrospective case series, two prospective case series, and seventeen case reports were included. The study size was 165 patients (mean age 69.7 years, M/F ratio 1.75:1). One hundred and seventy-one patches developed a patch infection after CEA with patch angioplasty and needed treatment. Treatment strategies included conservative treatment (14.0%), endovascular treatment (4.7%), and open surgery (81.4%). Mean follow-up was 34.8 months and extended up to 180 months. Reinfection rate was 4.7%, ischemic stroke rate 5.8%, and infection-related mortality rate 2.3%. No statistical comparison between treatment options could be performed, because of the heterogeneity of the included studies. Autologous material should be the primary choice of treatment if patch infection is diagnosed after CEA with patch angioplasty. In emergency situations, endovascular treatment, carotid ligation, or abscess drainage could be considered. Endovascular treatment and abscess drainage are temporary solutions. After the patient has recovered sufficiently, a more durable treatment i.e., open surgery is advised. Endo vacuum assisted closure (EndoVAC) seems to be promising. Further research is needed to determine the applicability of each treatment option.

The Effect of Foliar Application of an Amino Acid-Based Biostimulant on Lawn Functional Value

The purpose of this research was to assess the functional value of the “Super Trawnik” lawn mixture. The studies were carried out between 2017 and 2019 at the Experimental Station of the University of Agriculture in Krakow (50°07′ N, 20°05′ E), and the experimental factor was the AGRO-SORB® Folium, a biostimulant containing amino acids and applied at three doses: 1, 2, and 3 L·ha−1. Lawn visual quality was assessed on a 9-point scale, with 10–11 mowings at 4 cm during the growing period. An increase in the concentration of the stimulant applied as a spray resulted in a significant increase in its effectiveness; plants in plots with the highest dose of amino acid solution (Variant III) had the highest aesthetic and functional values. The AGRO-SORB® Folium reduced the occurrence of fungal diseases; compared to control plants, there was a 16% reduction of Fusarium patch (Microdochium nivale) infection and a 20% reduction of Dreschlera leaf spot (Drechslera siccans). Satisfactory effects were also recorded on plots where the product was applied at a dose of 2 L·ha−1 (Variant II). Those plots had more favourably rated turf, with higher resistance of plants to Fusarium patch by 12% and to Dreschlera leaf spot by 20% compared to control.

Use of an expanded polytetrafluoroethylene valved patch with a sinus in right ventricular outflow tract reconstruction†.

The objective of this study was to evaluate our late outcomes using expanded polytetrafluoroethylene (ePTFE) valved patches with bulging sinuses and a fan-shaped valve for right ventricular outflow tract (RVOT) reconstruction. Six hundred and ninety patients underwent RVOT reconstruction using fan-shaped ePTFE valves and ePTFE valved patches with a bulging sinus. The patients' median age and weight were 1.3 years [range 4 days-64.2 years, interquartile range (IQR) 0.9-2.3 years] and 8.7 (range 2.8-83.1, IQR 7.4-10.5) kg, respectively. The patches were monocuspid in 634 patients, bicuspid in 49 patients and tricuspid in 7 patients. Preoperative and postoperative data were collected retrospectively from the patients' medical records. The longest follow-up period was 17.5 (7.6 ± 3.9) years. There were no deaths related to the ePTFE patch. Pulmonary insufficiency was less than mild in 77.3%, and the peak RVOT gradient was <36 mmHg in 92.3% at the latest follow-up. Redo of RVOT reconstruction was performed in 40 patients, in no cases because of patch infection. Overall freedom from reoperation at 5, 10 and 15 years was 96.5%, 93.1% and 87.9%, respectively; by patient age, the rates at 5, 10 and 15 years for those younger than 1 year were 93.2%, 91.0% and 88.9%, respectively, while for those 1 year or older, they were 97.9%, 94.0% and 88.3%, respectively. Satisfactory long-term outcomes were achieved with ePTFE patches with a bulging sinus and a fan-shaped valve. This ePTFE valved patch could be the optimal choice for RVOT reconstruction.

Management of patch infections after carotid endarterectomy and utility of femoral vein interposition bypass graft

ObjectivePatch infection after carotid endarterectomy (CEA) is a rare but devastating complication. A variety of different treatment options are reported; however, there is currently no consensus on how to manage this highly morbid problem. The purpose of this study was to review our experience with management of infectious patch complications after CEA and to highlight utility of femoral vein interposition bypass grafting. MethodsAll CEA patch infection operations at the University of Florida from 2002 to 2017 were reviewed retrospectively. Preoperative history, intraoperative details, and postoperative complications were recorded. Bypass patency was verified with duplex ultrasound imaging (1 month, 6 months, annually). The primary end point was 30-day stroke or death; secondary end points included cranial nerve injury, reintervention, reinfection, and survival. Life tables were used to estimate end points. ResultsTwenty-nine patients (mean age, 70 ± 9 years; male, 76%) were identified. The index CEA occurred at a median of 15 months (interquartile range, 1-55 months) preoperatively (39% <2 months after the index procedure). A variety of patch materials were implicated (Dacron, n = 9; unknown/undocumented, n = 8; bovine pericardium, n = 5; expanded polytetrafluoroethylene, n = 3; unidentified nonbiologic prosthetic, n = 3; saphenous vein, n = 1). Carotid reintervention antecedent to the infected patch presentation occurred in 41% (incision and drainage, n = 10; carotid stent, n = 2; vein patch, n = 1). The most common infecting organisms were Staphylococcus and Streptococcus species (52%; n = 15). The most frequent presentation (46%; n = 13) was pericarotid abscess or phlegmon (pulsatile neck mass or pseudoaneurysm, 28% [n = 8]; carotid-cutaneous fistula, 28% [n = 8]). Reconstruction strategy included femoral vein interposition bypass in 24 patients (83%; nonreversed configuration, 16/24 [67%]), saphenous vein patch in 4 patients (14%), and femoral vein patch in 1 patient (3%). Median postoperative length of stay was 5 days (interquartile range, 4-8 days). Twelve patients (41%) experienced a complication, and the 30-day stroke/death rate was 7% (death, n = 1; stroke, n = 1). The single postoperative death occurred in a patient with history of congestive heart failure who developed a pulseless electrical activity arrest on postoperative day 11 that resulted in multiorgan system failure. Cranial nerve injury occurred in 28% (n = 8; cranial nerves X [3], VII [2], XII [2], and IX [1]), all of which resolved by last follow-up. In follow-up (mean clinical follow-up, 17 ± 14 months; mean survival time, 108 months [95% confidence interval, 81-135 months]), two (7%) complained of limb edema with femoral cutaneous nerve palsy that resolved by 3 months. One interposition bypass occluded at 3 months (asymptomatic); the remaining grafts remained patent with no restenosis, reinfection, or reintervention events. The 1- and 5-year survival was 87% ± 6% and 82% ± 8%, respectively. ConclusionsCEA patch infection can be successfully managed with femoral vein interposition bypass with acceptable postoperative outcomes. Excellent patency can be anticipated with good long-term survival. This strategy can be considered especially in cases with carotid size mismatch or if there is limited availability of alternative biologic conduits.

Prevention of patch infection after abdominal external hernia repair

Abstract External abdominal hernia is a common clinical disease. The application of hernia patch is a breakthrough in the treatment of external abdominal hernia. However, complications such as patch infection need to be solved urgently. Patch infection markedly prolongs the hospitalization time and increases the medical expenses of patients. At present, a standard method for the diagnosis, treatment, and prevention of patch infection remains to be developed. This paper summarizes the literature in recent years to explore the research progress in the prevention and treatment of patch infection.

A long term evaluation of differential potassium fertilization of a creeping bentgrass putting green

The objective of this research was to evaluate bentgrass quality, growth, and disease incidence over a range of soil and tissue potassium levels. ‘Penn A4’ creeping bentgrass (Agrostis stolonifera L.) on a sand root zone was maintained as a putting green. The treatments included four levels of liquid potassium sulfate, ranging from 0 to 249 kg ha−1 yr.−1 K and one level of granular gypsum at a rate of 100 kg ha−1 yr.−1 Ca. No differences in vegetative or quality parameters were observed over the 6 year study period. Tissue K, Mehlich-3 extractable K, and Microdochium patch infection were all affected by treatment, with high-K treatments being greater than control and Ca treatments in all three instances. Near-daily turfgrass harvest resulted in much greater K removal than was estimated to be available from the pools extracted by Mehlich-3 and 1 M HNO3, suggesting that K became plant-available from more recalcitrant pool. Traditional soil testing methods may be inadequate for determining plant-available K in sand root zones. Total soil K analysis of the 0-K treatment indicated an increase in K during the study period, likely as a result of regular additions of sand via topdressing. Weathering of mineral K likely provided sufficient K to compensate for the lack of fertilizer.

Management challenges of late presentation Dacron patch infection after carotid endarterectomy

An 83-year-old man presented 4 years after right carotid endarterectomy (CEA) with an infection of his prosthetic Dacron patch. Initial scans (CT angiogram and whole body labelled white cell scan)...

PC160 Common Femoral Artery Endarterectomy: Contemporary Results Using Eversion Endarterectomy vs Standard Endarterectomy With Patch

For over 50 years, standard endarterectomy with patch (SEP) of the common femoral artery (CFA) has been well described with durable results. Eversion endarterectomy (EE) uses a complete CFA transection above its bifurcation and subsequent end-to-end anastomosis. EE is potentially advantageous over SEP by avoiding prosthetic patch infection and easing future transfemoral access. With subjectively more focal femoral artery lesions encountered during the endovascular era, we reviewed our SEP and EE outcomes to see whether there were any differences between the two methods. We retrospectively identified all patients undergoing CFA endarterectomy by a single surgeon who adopted preferential EE at a single institution between 2007 and 2015. Patient demographics and surgical details were captured from the electronic medical record, including endarterectomy type and the performance of concurrent endovascular and/or bypass surgery. Complications and adverse events were recorded. Statistical comparison of means was performed using the t-test, and categoric variables were evaluated using the Fisher exact test. Eighty-nine sequentially encountered patients underwent 97 endarterectomies of the CFA (68 SEP and 29 EE). More SEP than EE cases were performed concomitant with either bypass or stenting (62% vs 34%). Most patients were smokers (80% of SEP vs 93% of EE). Patients undergoing EE were older (67 vs 62 years; P = .01), with less hypertension (59% vs 79%; P = .04), and less chronic kidney disease (4% vs 27%; P = .01). The observed frequencies of diabetes, dyslipidemia, coronary artery disease, stroke, coagulopathy, and cancer were not significantly different among EE and SEP patients. The average follow-up duration was 28 months, longer among SEPs patients than EE patients (32 vs 20 months; P = .02). We observed favorable primary patency with EE (Table). There were no statistically significant differences observed among adverse events associated with SEP and EE patients (Fig): CFA restenoses (10% vs 3.4%), CFA thromboses (12% vs 0%), and wound infections (10% vs 7%). EE and SEP both offer reasonably durable outcomes for the treatment of focal femoral arterial occlusive disease. EE may offer an attractive alternative to SEP, potentially decreasing the risk of significant wound complications associated with prosthetic patch infections.TablePrimary patencyProcedureNo.Duration in months6% (n/N)12% (n/N)18% (n/N)24% (n/N)30% (n/N)36% (n/N)42% (n/N)EE All29100 (17/17)100 (16/16)100 (15/15)100 (12/12)100 (9/9)100 (7/7)100 (5/5) Alone19100 (10/10)100 (9/9)100 (8/8)100 (6/6)100 (4/4)100 (4/4)100 (1/1)SEP All6886 (49/57)77.6 (38/49)76 (34/45)74 (32/43)67.6 (23/34)60.7 (17/28)52 (12/23) Alone2685.7 (18/21)81 (12/16)78.6 (11/14)78.6 (11/14)70 (7/10)57 (4/7)57 (4/7)All, All cases; Alone, cases without concurrent operations; EE, eversion endarterectomy; SEP, standard endarterectomy with patch. Open table in a new tab

Performance of Three Warm Season Turfgrasses under Linear Gradient Irrigation

The appropriate level of irrigation for turfgrasses is vital to the performance of the turfgrass as well as conservation of water. Linear gradient irrigation system (LGIS) facilitates long-term study of turf performance under continuous irrigation gradients at extreme ends of the irrigation scale. The objectives of this study were to: a) determine the minimum irrigation requirements and relative drought resistance in three warm season turfgrasses; and b) evaluate the medium to long-term effects of irrigation levels on turf persistence, weed invasion, and susceptibility to diseases. Results suggest that grasses differed in drought resistance and persistence under variable irrigation regimes. Irrigation (Ep) required for consistent acceptable turf quality for respective grasses was Cynodon dactylon x C. transvaalensis (61%), Zoysia matrella L. Merr (73%), and Stenotaphrum secundatum 'Palmetto' (86%). Brown patch infection was most prevalent in Stenotaphrum secundatum 'Palmetto' at 12 and 125% Ep irrigation. Cynodon dactylon x C. transvaalensis and Zoysia matrella L. Merr were better able to adapt to the various irrigation regimes, and this ability allowed these species to resist drought, and maintain turf coverage which in turn, kept weeds and the occurrence of diseases at bay. Ranking these grasses for their drought tolerance abilities showed that Cynodon dactylon x C. transvaalensis had the most outstanding resistance against drought, followed by Zoysia matrella L. Merr, and lastly, Stenotaphrum secundatum 'Palmetto'. Despite having the highest irrigation requirement, Stenotaphrum secundatum 'Palmetto' was still not able to maintain persistence at high irrigation regimes. Likewise, this grass also lost turf coverage at low irrigation levels.