Patch Repair Research Articles

Graham’s patch omentopexy versus modified Graham’s patch omentopexy in duodenal perforation – A comparative study

Background: Peptic ulcer perforation is a serious complication which affects 2–10% of peptic ulcer patients. Peptic ulcer perforation presents with an overall mortality of 10% although various authors had reported incidence between 1.3% and 20%. Being a life-threatening complication of peptic ulcer disease, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be contained. Aims and Objectives: The aim of the study was to the comparative study of Graham’s omentopexy versus modified Graham’s omentopexy in duodenal perforation. Materials and Methods: This prospective and single-center study was done in Birsa Munda, GMC Shahdol Madhya Pradesh from 2021 to 2023 for 2 years of periods. A total of 160 patients divided into two groups-Graham’s omentopexy 80 cases group “A” and modified Graham’s omentopexy 80 cases group “B.” Results: One hundred and forty-six (91%) were male and 14 (9%) were female with M:F Ratio 10:1. Most of the patients were 20–78 years of age in both groups. Post-operative leakage was 7.5% and 1.25%, respectively. Mortality rate in Group A (3.75%) and in Group B (1.25%). The overall mortality rate was 7.14%. In this study, average hospital stay was 12.4 days in Group A and 9.0 days in Group B. Conclusion: This study showed that modified Graham’s patch repair is as effective as Graham’s patch repair in terms of the mean operative time period, the timing of oral feed allow, and mean hospital stay timing.

Application of Patch Repair and Zinc Anode on RC Structures Damaged by Chloride Contamination – 3 Year Evaluation

Application of Patch Repair and Zinc Anode on RC Structures Damaged by Chloride Contamination – 3 Year Evaluation

Simple Aortopulmonary window: Outcomes of surgical repair at Vietnam National Children’s Hospital

Purpose: Evaluate the midterm outcomes of surgical repair for patients diagnosed with simple aortopulmonary window at Vietnam National Children’s Hospital. Methods: We retrospective review data of patients who underwent surgical repair for simple aortopulmonary window from May 2014 to December 2023 at Vietnam National Children’s Hospital. Patients who had ventricular septal defect, interrupted aortic arch, aortic arch hypoplasia, double outlet of the right ventricle, or Berry syndrome were excluded from this study. Results: There were 37 patients who underwent surgical repair in this study. The mean age at the time of surgery was 259.37 ± 702.59 days, and the mean weight was 5.04 ± 3.7 kg. According to the Society of Thoracic Surgeons Congenital Heart Database Committee classification, sixteen patients were type1, twelve were type2, and nine were type3. Two patients underwent ligated window, 3 had window division and sutures without bypass, and 32 had patch repair. There were 4 in-hospital deaths (10.8%), no late deaths, and no patients required cardiac reoperation during a mean follow-up of 62.09 ± 31.07 months. Conclusions: Midterm survival beyond discharge of simple aortopulmonary window is excellent.

Flexible Sono-Piezo Patch for Functional Sweat Gland Repair through Endogenous Microenvironmental Remodeling.

Remodeling the endogenous regenerative microenvironment in wounds is crucial for achieving scarless, functional tissue regeneration, especially the functional recovery of skin appendages such as sweat glands in burn patients. However, current approaches mostly rely on the use of exogenous materials or chemicals to stimulate cell proliferation and migration, while the remodeling of a pro-regenerative microenvironment remains challenging. Herein, we developed a flexible sono-piezo patch (fSPP) that aims to create an endogenous regenerative microenvironment to promote the repair of sweat glands in burn wounds. This patch, composed of multifunctional fibers with embedded piezoelectric nanoparticles, utilized low-intensity pulsed ultrasound (LIPUS) to activate electrical stimulation of the target tissue, resulting in enhanced pro-regenerative behaviors of niche tissues and cells, including peripheral nerves, fibroblasts, and vasculatures. We further demonstrated the effective wound healing and regeneration of functional sweat glands in burn injuries solely through such physical stimulation. This noninvasive and drug-free therapeutic approach holds significant potential for the clinical treatment of burn injuries.

Preparation and Performance of a Novel Polyurethane Microporous Film on Polypropylene Medical Mesh Surface

This study aims to develop a medical patch surface material featuring a microporous polyurethane (PU) membrane and to assess the material's properties and biological performance. The goal is to enhance the clinical applicability of pelvic floor repair patch materials. PU films with a microporous surface were prepared using PU prepolymer foaming technology. The films were produced by optimizing the PU prepolymer isocyanate index (R value) and the relative humidity (RH) of the foaming environment. The surface morphology of the PU microporous films was observed by scanning electron microscopy, and the chemical properties of the PU microporous films, including hydrophilicity, were analyzed using infrared spectroscopy, Raman spectroscopy, and water contact angle measurements. In vitro evaluations included testing the effects of PU microporous film extracts on the proliferation of L929 mouse fibroblasts and observing the adhesion and morphology of these fibroblasts. Additionally, the effect of the PU microporous films on RAW264.7 mouse macrophages was studied. Immune response and tissue regeneration were assessed in vivo using Sprague Dawley (SD) rats. The PU films exhibited a well-defined and uniform microporous structure when the R value of PU prepolymer=1.5 and the foaming environment RH=70%. The chemical structure of the PU microporous films was not significantly altered compared to the PU films, with a significantly lower water contact angle ([55.7±1.5]° ) compared to PU films ([69.5±1.7]° ) and polypropylene (PP) ([ 104.3±2.5]°), indicating superior hydrophilicity. The extracts from PU microporous films demonstrated good in vitro biocompatibility, promoting the proliferation of L929 mouse fibroblasts. The surface morphology of the PU microporous films facilitated fibroblast adhesion and spreading. The films also inhibited the secretion of tumor necrosis factor-α (TNF-α) and interleukin (IL)-1β by RAW264.7 macrophages while enhancing IL-10 and IL-4 secretion. Compared to 24 hours, after 72 hours of culture, the expression levels of TNF-α and IL-1β were reduced in both the PU film and PU microporous film groups and were significantly lower than those in the PP film group (P<0.05), with the most notable decreases observed in the PU microporous film group. IL-10 and IL-4 levels increased significantly in the PU microporous film group, surpassing those in the PP film group (P<0.01), with the most pronounced increase in IL-4. The PU microporous film induced mild inflammation with no significant fibrous capsule formation in vivo. After 60 days of implantation, the film partially degraded, showing extensive collagen fiber growth and muscle formation in its central region. The PU microporous film exhibits good hydrophilicity and biocompatibility. Its surface morphology enhances cell adhesion, regulates the function of RAW264.7 macrophages, and promotes tissue repair, offering new insights for the design of pelvic floor repair and reconstruction patch materials.

Influence of Adhesive Curing Temperature and Geometrical Parameters on Composite Patch Repair of Cracked Structures

Influence of Adhesive Curing Temperature and Geometrical Parameters on Composite Patch Repair of Cracked Structures

Cyclic inelastic behaviour of a bonded patch repair system used for pipes with through-wall corrosion damage

Repairs of through-wall corrosion damage in pipes conveying liquids using bonded metallic patches are becoming common in the oil and gas industry. Usually, this kind of patch is used in association with a composite sleeve, and it is essential to assure that the repair wońt leak. The use of bonded metallic patches associated with the composite sleeve is not forbidden in the standards for the design of composite repair systems (such as ASME PCC-2 and ISO 24817). However, they do not address this very frequent practice adopted in industry. Since the patch is responsible for sustaining most of the pressure of the repair, it becomes necessary to further understand its behaviour. This paper investigates the cyclic inelastic behaviour of a metal patch/adhesive system and its effect on the failure pressure. Hydrostatic tests were performed regarding how pressure variations can generate cyclic inelastic strains in the adhesive layer that bonds the metal patch to the pipe, and how this cyclic loading–unloading process ultimately affects the failure pressure. The failure pressure in monotonic burst tests can be reasonably modelled using basic concepts of linear elastic fracture mechanics. Although the assumption of a brittle-elastic behaviour of the repair system seems adequate in the case of monotonic loading, it is not in the case of cyclic tests with high pressure amplitudes. Repairs in steel pipes under pressure with a 25 mm diameter hole failed after a very small number of cycles with pressure amplitude of 80% of the average failure pressure obtained in monotonic burst tests. To help understanding the behaviour of the system, single lap joints were studied. The patch and pipe are not subjected to significant permanent deformations, while the adhesive layer has an inelastic behaviour. Results show that the lap joints present a rate-dependent behaviour in tensile tests and may present highly different cyclic responses which are quite sensitive to very small perturbations in the manufacturing process.

Multi objective optimization of composite laminate repaired by patches in considering static strength and fatigue life

The patch repair is a widely used method for repairing the damaged composite structure, optimizing the repair structure in considering static strength and fatigue life can greatly improve the reliability and safety. However, only static strength and fatigue life are considered during the design or optimization. In this article, the multi-objective optimization of composite laminate repaired by patches in considering static strength and fatigue life was carried out. The models used for predicating static strength and fatigue life were established through finite element method (FEM). Then, the established models were adopted to investigate the effect of repair parameters on static strength and fatigue life, results show that patch radius has the strongest impact on static strength and fatigue life, while the repair thickness and stacking sequence of patch show a greater impact on fatigue life. Based on the above conclusions, Non-dominated Sorting Genetic Algorithm (NSGA-II) was employed to optimize the repair structure. The optimization results show that strength and fatigue life was greatly improved, the repair thickness, and patch volume was greatly reduced, patches that radius is larger than 14 mm can ensure that the repair structure has both higher strength and better fatigue resistance. The proposed optimization method has a good optimization effect for composite laminate repaired by patches.

The use of minimally invasive surgical techniques ın pediatric patients with partial anomalous pulmonary venous return

Aim The use of minimally invasive procedures in low-risk congenital heart surgeries has been increasing recently. Compared to traditional median sternotomy, minimally invasive techniques offer better cosmetic results and provide more satisfaction to both the patient and their parents. Partial anomalous pulmonary venous return (PAPVR) can be safely repaired using these techniques. Material and Metods The perioperative data of right- sided PAPVR patients who were operated on using minimally invasive approaches in our clinic between March 2019 and January 2023 were reviewed retrospectively. The perioperative data of the patients' including , type of surgery , cardiopulmonary bypass time, cross-clamp time, postoperative cardiac rhythm, total operation time, total drainage, total intensive care unit time, and total hospital stay time were obtained. The results were compared with the data in the current literature. Results During the study period, 14 patients underwent surgical repair. Five (36%) of them were female and nine (64%) were male. Patients undergoing right infraaxillary vertical thoracotomy (RIAVT) and right anterolateral thoracotomy (RALT) had mean ages of 48±26.6 and 42±18.2 month, respectively. High venosum type atrial septal defect (ASD) was detected in 12 (85.7%) of the patients. The most frequently used surgical treatment was the double patch technique which was used in 12 patients (85.7%). This was followed by single patch repair with one patient (7.1 %). The Warden procedure was used in one patient (7.1%) who was operated on with the RIAVT technique. Patients’ cross-clamp, cardiopulmonary bypass (CPB), and total operation times were comparable to those reported in the medical literature. Conclusion RIAVT and RALT are two of the oftenly used minimally invasive surgical techniques in congenital heart surgery. After gaining sufficient experience, both of these methods can be safely applied to PAPVR repair.

Date estimation of fabrication and repair of Color garments encouragement banner

The Color Garments Encouragement Banner was designated a Korean Heritage in 2014 to recognize it as the most significant object of the color garments encouragement campaign. However, despite its significance, nothing is known about its manufacture. Therefore, this study attempted to analyze the materials of the banners to estimate when they were manufactured and repaired. The investigation of materials on the banner involved visual examination, literature review, microscopy, SEM–EDS, FT-IR, Py-GC–MS, ICP-MS, and LC–MS. The fabric, patch, and threads comprising the artifact were identified as cotton. FT-IR and Py-GC–MS confirmed that the repair patch was a woven blend of polyester and cotton yarns. EDS analysis indicated that the polyester was treated with titanium delustering. ICP-MS detected high concentrations of chromium that were not used in traditional dyeing techniques. The azo and sulfur compounds were identified by LC–MS analysis. The material layered on the grommet patch was thought to be a mixture of Pb, Ti with CaCO3 and BaSO4. Based on the overall results, the production date of the banner was narrowed down to the late 1920s, and the repair date to the mid-1950s. Although the materials used could not be identified owing to the limitations of the applicable analysis. Nonetheless, it is hoped that the analyses conducted in this study can serve as a scientific foundation for dating modern cultural heritage objects with limited handed-down record and historical documentation.

A Design Optimization Study of Step/Scarf Composite Panel Repairs, Targeting the Maximum Strength and the Minimization of Material Removal

This study aimed to optimize the geometry of composite stepped repair patches, using a parametric algorithm to automate the process due to the complexity of the optimization problem and various factors affecting efficiency. More specifically, the algorithm initially calculates the equivalent strengths of the repaired laminate plate according to a max stress criterion, then calculates the dimensions of several elliptical repair patches, taking into account several design methods extracted from the literature. Next, it creates their finite element models and finally, the code conducts an assessment of the examined patch geometries, given specific user-defined criteria. In the end, the algorithm reaches a conclusion about the optimum patch among the designed ones. The algorithm has the potential to run for many different patch geometries. In the current research, five patch geometries were designed and modeled under uniaxial compressive loading at 0°, 45° and 90°. Overall, the code greatly facilitated the design and optimization process and constitutes a useful tool for future research. The results revealed that elliptical stepped patches can offer a near-optimum solution much more efficient than that of the conservative option of the circular patch, in terms of both strength and volume of healthy removed material.

Comparing clinical and echocardiographic outcomes following valve-sparing versus transannular patch repair of tetralogy of Fallot: a systematic review and meta-analysis.

Transannular patch (TAP) repair of tetralogy of Fallot (ToF)relieves right ventricular tract obstruction but may lead to pulmonary regurgitation. Valve-sparing (VS) procedures can avoid this situation, but there is a potential for residual pulmonary stenosis. Our goal was to evaluate clinical and echocardiographic outcomes of TAP and VS repair for ToF. A systematic search of the PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials and Web of Science databases was carried out to identify articles comparing conventional TAP repair and VS repair for ToF. Random-effects models were used to perform meta-analyses of the clinical and echocardiographic outcomes. Forty studies were included in this meta-analysis with data on 11723 participants (TAP: 6171; VS: 5045). Participants who underwent a VS procedure experienced a significantly lower cardiopulmonary bypass time [mean difference (MD): -14.97; 95% confidence interval (CI): -22.54, -7.41], shorter ventilation duration (MD: -15.33; 95% CI: -30.20, -0.46) and shorter lengths of both intensive care unit (ICU) (MD: -0.67; 95% CI: -1.29, -0.06) and hospital stays (MD: -2.30; 95% CI: [-4.08, -0.52). There was also a lower risk of mortality [risk ratio: 0.40; 95% CI: (0.27, 0.60) and pulmonary regurgitation [risk ratio: 0.35; 95% CI: (0.26, 0.46)] associated with the VS group. Most other clinical and echocardiographic outcomes were comparable in the 2 groups. This meta-analysis confirms the well-established increased risk of pulmonary insufficiency following TAP repair while also demonstrating that VS repairs are associated with several improved clinical outcomes. Continued research can identify the criteria for adopting a VS approach as opposed to a traditional TAP repair.

Innovative hydrogel-patch combination for large annulus fibrosus defects: a prospective approach to address herniation recurrence

BACKGROUND CONTEXTLarge annulus fibrosus (AF) defects often lead to a high rate of reherniation, particularly in the medial AF region, which has limited self-healing capabilities. The increasing prevalence of herniated discs underscores the need for effective repair strategies. PURPOSEThe objectives of this study were to design an AF repair technique to reduce solve the current problems of insufficient mechanical properties and poor sealing capacity. STUDY DESIGNIn vitro biomechanical experiments and finite element analysis. METHODSThe materials used in this study were patches and hydrogels with good biocompatibility and sufficient mechanical properties to withstand loading in the lumbar spine. Five repair techniques were assessed in this study: hydrogel filler (HF), AF patch medial barrier (MB), AF patch medial barrier and hydrogel filler (MB&HF), AF patch medial-lateral barrier (MLB), and AF patch medial-lateral barrier and hydrogel filler (MLB&HF). The repair techniques were subjected to in vitro testing (400 N axial compression and 0–500 N fatigue loading at 5Hz) and finite element analysis (400 N axial compression) to evaluate the effectiveness at repairing large AF defects. The evaluation included repair tightness, spinal stability, and fatigue resistance. RESULTSFrom the in vitro testing, the failure load of the repair techniques was in the following order HF <MB <MB&HF <MLB <MLB&HF. Both HF and MB groups failed to effectively increase intervertebral disc (IVD) stiffness, resulting in a reduction in spatial stability. The MLB, MB&HF, and MLB&HF groups partially restored IVD stiffness, with MLB&HF showing the most effective recovery (−24.13% ± 3.59%). From the finite element models, incorporating a hydrogel filler was best able to maintain the IVD height. Patch repair alone could not adequately reduce the high AF stress due to AF injury, but with hydrogel support, stress was substantially low and more uniformly distributed. All repair techniques demonstrated reduced stress around the damaged area on the AF, in comparison to the unrepaired model. The NP pressure in the HF group was closest to the intact group, and the patch repair reduced the NP pressure. The maximum patch deformation and suture stress were ranked as MB >MLB >MB&HF >MLB&HF. CONCLUSIONSThe combined use of patches and hydrogels exhibited promising mechanical properties postdiscectomy, providing a promising solution for addressing large AF defects and improving disc stability. CLINICAL SIGNIFICANCEThis study introduces a promising method for repairing large annular fissure (AF) defects after disc herniation, combining patch repair with a hydrogel filler. These techniques hold potential for developing clinical AF repair products to address this challenging issue.

Prevalence and early surgical outcome of congenital diaphragmatic hernia in the Netherlands: a population-based cohort study from the European Pediatric Surgical Audit

BackgroundCongenital diaphragmatic hernia (CDH) is a rare birth defect with substantial mortality. This study aims to generate a population-based overview of CDH care and outcomes in the Netherlands. Moreover, it...

Hybrid alkali-activated fly ash-Portland cement binders with modified polymer as patch repair

The alternative patch repair derived from hybrid alkali-activated binders (HAAB) were investigated in this paper. The HAAB mortar was produced with fly ash (FA), Portland cement (PC), and polymer-modified material (PMM). The additives (PC and PMMs) were used to replace FA at the dosage of 30 % by weight of binder. The proportions of PC-to-PMM at 30:0, 20:10, 10:20, and 0:30 were investigated. Sodium silicate (NS) and sodium hydroxide (NH) solutions were used as the alkaline activators. Constant NS-to-NH ratio of 2.0 and liquid/solid binder ratio of 0.60 were used for all mixtures. Experimental results showed that the setting time, compressive and shear bond strengths of the HAAB mortars met the requirement for repair material as specified by ASTM standard. The 7-day bond strength increased with increasing PMM replacement up to an optimum level; thereafter, it started to decline. A combination of PC and PMM in FA-based HAAB enhanced the adhesion at contact zone. Moreover, the HAAB mortars showed greater durability compared to conventional PMMs after immersion in sulfate and acid solutions, as evidenced by its relatively low strength loss. The increased formation of ettringite might be the main factor for the substantial reduction in the strength of PMM mixes. Therefore, the HAAB mortar is an attractive choice for patch repair material in terms of excellent durability, high bond strength, cost-effectiveness, and low carbon footprint compared to conventional PMM.

Cohesive failure analysis of carbon-fiber composite patch repair in perforated steel tubular elements

The use of composite materials to repair corroded steel structural components has expanded in the offshore oil and gas sector. The effective use of composites requires a meticulous process for choosing appropriate constituent elements. In this regard, numerical modeling is an efficient tool to better understand the impact of associated variables and enables the identification of failure causes and simulation of failure propagation. This study aims to assess the mechanical behavior of the adhesive layer at the steel - composite material interface in the repair of perforated tubular structures under bending, compression, and bending-compression. A numerical model is developed simplifying the examination and characterization of the cohesive failure mechanisms and modes occurring between the laminate patch repair and the perforated steel tubular element. The stress distribution and cohesive failure at the interface are then thoroughly investigated. The impacts of the inclusion of fillets at the patch repair ends to smoothen the transition between the composite material and the tube and the repair length are also evaluated. A Python subroutine is developed to identify the failure mode mechanisms to characterize the adhesive areas subjected to peel, shear, or mixed modes. Results suggest that pure shear mode is predominant in most of the repair locations across the three types of loading. For bending loads, the cohesive failure close to the cutout shows prominent shear mode. In the other loading conditions, the adhesive nearly fails in the vicinity of the cutouts (i.e., damage values are close to 1) in a predominant near pure shear failure mechanism. The use of fillets displaces the failure location for bending load, hence increasing the failure load level. Repairs were more extensive under Bending Moment load conditions compared to other load types. The mode ratio analysis and methodology presented in this work offer valuable tools for understanding the causes of failure modes.

Instantly adhesive and ultra-elastic patches for dynamic organ and wound repair

Bioadhesive materials and patches are promising alternatives to surgical sutures and staples. However, many existing bioadhesives do not meet the functional requirements of current surgical procedures and interventions. Here, we present a translational patch material that exhibits instant adhesion to tissues (2.5-fold stronger than Tisseel, an FDA-approved fibrin glue), ultra-stretchability (stretching to >300% its original length without losing elasticity), compatibility with rapid photo-projection (<2 min fabrication time/patch), and ability to deliver therapeutics. Using our established procedures for the in silico design and optimization of anisotropic-auxetic patches, we created next-generation patches for instant attachment to tissues while conforming to a broad range of organ mechanics ex vivo and in vivo. Patches coated with extracellular vesicles derived from mesenchymal stem cells demonstrate robust wound healing capability in vivo without inducing a foreign body response and without the need for patch removal that can cause pain and bleeding. We further demonstrate a single material-based, void-filling auxetic patch designed for the treatment of lung puncture wounds.

The Use of the CardioCel 3D 60° Patch for Aortic Arch Reconstruction in Infancy—A Word of Caution

BackgroundThere are limited data on outcomes after implantation of the CardioCel 3D 60° patch in great vessel repair. After anecdotally witnessing an increase in negative outcomes, we reviewed our experience using this patch in our neonate and infant patients undergoing aortic arch repair. MethodsAortic arch repair with implantation of the CardioCel 3D 60° patch was performed in 24 patients between July 2018 and July 2021. Dominant cardiac morphologies were hypoplastic left heart syndrome (66%), atrioventricular canal defects (13%), and other (21%). Median age at implantation was 44 days (interquartile range [IQR], 6-112 days). Recurrent obstruction was defined as the need for reoperation or catheter intervention or recurrent peak pressure gradient of descending aorta ≥25 mm Hg on echocardiography. ResultsFive deaths occurred after a median of 217 days (IQR, 69-239 days). Twelve patients (50%) had recurrent obstruction. Three patients (13%) required redo aortic arch operation after a median of 148 days (IQR, 128-193 day), with extensive fibrous coating of the patch interior causing obstruction. Eleven patients (46%) required at least 1 balloon angioplasty on their aorta after a median of 102 days (IQR, 83-130 days) after repair, and 3 needed >1 catheter intervention. The estimated probability of having recurrent obstruction was 85% at 6 months and 71% at the 1-year follow (P = .06). ConclusionsRecurrent aortic obstruction occurred in half of our patients shortly after repair. The use of the CardioCel 3D 60° patch for aortic arch reconstruction in neonates and infants should be reevaluated.

Tetralogy of Fallot transannular patch repair with or without monocusp valve reconstruction

Tetralogy of Fallot transannular patch repair with or without monocusp valve reconstruction

Spall Repair Patch Health Monitoring System Using BIM and IoT

Spall Repair Patch Health Monitoring System Using BIM and IoT