Reconstructive Procedures Research Articles

Breast cancer statistics for Japan in 2022: annual report of the national clinical database-breast cancer registry-clinical implications including chemosensitivity of breast cancer with low estrogen receptor expression.

This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62years (interquartile range, 50-73years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype.

Robot-Based Procedure for 3D Reconstruction of Abdominal Organs Using the Iterative Closest Point and Pose Graph Algorithms

Image-based 3D reconstruction enables robot-assisted interventions and image-guided navigation, which are emerging technologies in laparoscopy. When a robotic arm guides a laparoscope for image acquisition, hand–eye calibration is required to know the transformation between the camera and the robot flange. The calibration procedure is complex and must be conducted after each intervention (when the laparoscope is dismounted for cleaning). In the field, the surgeons and their assistants cannot be expected to do so. Thus, our approach is a procedure for a robot-based multi-view 3D reconstruction without hand–eye calibration, but with pose optimization algorithms instead. In this work, a robotic arm and a stereo laparoscope build the experimental setup. The procedure includes the stereo matching algorithm Semi Global Matching from OpenCV for depth measurement and the multiscale color iterative closest point algorithm from Open3D (v0.19), along with the multiway registration algorithm using a pose graph from Open3D (v0.19) for pose optimization. The procedure is evaluated quantitatively and qualitatively on ex vivo organs. The results are a low root mean squared error (1.1–3.37 mm) and dense point clouds. The proposed procedure leads to a plausible 3D model, and there is no need for complex hand–eye calibration, as this step can be compensated for by pose optimization algorithms.

Anterior Cruciate Ligament Reconstruction: Common Intraoperative Mistakes and Techniques for Error Recovery.

Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure among general orthopedists, and is a logged procedure required for graduation from accredited orthopaedic residency programs. ACL reconstruction surgery has a number of critical steps, and intraoperative errors can significantly impact the success rate and morbidity of this operation. Technical errors are frequently cited as some of the most common reasons for ACL reconstruction failure. This narrative review provides low-volume surgeons and trainees with an overview of the common errors that can be made during the critical steps of an ACL reconstruction procedure. We suggest technical points for avoiding commonly-encountered errors and provide a description of evidence-supported error recovery techniques to address these errors if they occur intraoperatively. These key steps include femoral tunnel creation, tibial tunnel creation, graft harvest and preparation, and graft fixation within the tunnels. We discuss a number of primary and backup fixation strategies as well as all commonly used autografts (bone-patellar tendon-bone, hamstring, and quadriceps tendon). Additionally, we provide a brief overview on address intra-operative graft contamination citing currently available evidence.

Ureteroureterostomy for the Management of Non-Neoplastic Distal Ureteral Lesions: A New Challenger of Care in the Era of Robotic Surgery?

Background: Iatrogenic lesions of the distal ureter represent a frequent and feared complication of abdominal surgery that is traditionally managed by ureteral reimplantation. The aim of this systematic review (SR) is to summarize the published literature on the role of minimally invasive ureteroureterostomy (UU) in the surgical treatment of non-neoplastic distal ureteral lesions. Methods: We performed a comprehensive literature search on PubMed, Embase, and Cochrane CENTRAL including published peer-reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The intra-, peri-, and postoperative outcomes as well as the safety profile and the success rates of minimally invasive UU are presented. Results: Seven retrospective studies with 116 patients were included in this SR. If the basic principles of the ureteral reconstructive procedure are followed, both laparoscopic and robotic UU are feasible, safe, and with a success rate ranging between 81.8% and 100%, depending on the definition of success. A single comparative study documented a significant difference in operative time and length of hospitalization in favor of robotic UU. The success of both laparoscopic and robotic UU has been mainly evaluated in the short and intermediate follow-up. Conclusion: Minimally invasive UU may represent a viable treatment option for the treatment of non-neoplastic distal ureter pathology such as iatrogenic injuries or radiotherapy-induced stenosis. Larger, prospective studies adopting a standard definition of the postoperative success are required to affirm UU as a first-line option in the management of benign distal ureteral lesions.

Discovery of the Ligament of Modiolus: Anatomical Insights and Clinical Relevance.

The modiolus is a critical anatomical structure in facial expressions and oral competence, serving as a hub where multiple muscles converge. Our recent cadaveric study has identified a previously unreported structure, the ligament of modiolus, aligning with the line of ligament between the modiolus and its adjacent muscular and fascial attachments. This novel finding offers new perspectives on the anatomical organisation of the perioral region and its functional significance. Importantly, it has been identified as a false ligament rather than a true ligament, originating from the modiolus and extending to the dermal layer. The discovery has potential implications for aesthetic and reconstructive procedures involving the midface and oral commissures. Here, we present our findings and discuss their relevance to facial anatomy, surgical approaches, and clinical outcomes.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessing Predictors and Outcomes of Secondary Debulking Procedures in Lower Limb Trauma Reconstruction: A Retrospective Cohort Study

Assessing Predictors and Outcomes of Secondary Debulking Procedures in Lower Limb Trauma Reconstruction: A Retrospective Cohort Study

Patient Outcomes After Penile Prosthesis Placement with Concomitant Non-Reconstructive Urologic Procedures.

There is substantial literature demonstrating minimal to no increased risk of three-piece penile prosthesis (PP) complications for patients undergoing placement with concomitant reconstructive urologic procedures. However, there is a paucity of research investigating outcomes for patients suffering from erectile dysfunction (ED) who undergo concomitant non-reconstructive urologic procedures at the time of PP placement. We performed a retrospective review of patients undergoing PP placement and a second non-reconstructive urologic procedure performed concomitantly at our institution between January 2007 and July 2021. This was compared to a control cohort of 127 patients who underwent PP placement only. Outcomes of interest were complications and device infections. Comparative statistics were used to compare the two groups, and the Kaplan-Meier method was used to estimate the rate of complications and infections over time. We identified 44 patients who underwent concomitant surgery and 127 patients who underwent single surgery only. The types of concomitant surgeries were as follows: 23 endoscopic (52.3%), 9 penile (20.5%), 10 scrotal (22.7%), 1 hardware placement (2.3%), and 1 oncologic (2.3%). Hypertension was the only comorbidity that was more prevalent in the concomitant group (65.9% vs. 43.8%, P < 0.01). Patients undergoing concomitant surgery had similar complication (4.6% vs. 3.6%, P=0.79) and device infection (2.3% vs. 0.7%, P=0.43) rates as the single surgery group. In the largest study of its kind, we observed that patients undergoing concomitant non-reconstructive urologic procedures at the time of PP placement are not at an increased risk of adverse events.

Urogenital Tuberculosis: A Narrative Review and recommendations for diagnosis and treatment.

to review the more relevant aspects of urogenital tuberculosis (UGT) and make recommendations about the diagnosis and treatment. a literature review was conducted in the Pubmed, Embase and Scielo databases in search of studies on UGT in the past 60 years. A narrative review was performed concerning six topics of UGT diagnosis and treatment. Recommendations were made supported on degrees of evidence according to the modified GRADE system. UGT suspicion occurs in persistent hematuria or pollakiuria with sterile pyuria; stenosis and/or thickening of the urinary tract; or chronic prostatitis or epididymitis. Urinary bacteriological tests have low sensitivity, and a negative test does not rule out UGT diagnosis. In ureteral stenosis, a double-J catheter or nephrostomy should be used early (up to 1 month) during pharmacological treatment and in single less than 2 cm stenosis endoscopic treatment may be attempted. Bladder augmentation with ileum, sigmoid or ileocecal segments should be performed when the contracted bladder capacity is less than 100 mL. Spontaneous voiding occurs in most patients after bladder augmentation. The diagnosis of UGT depends on a high degree of suspicion based on non-specific symptoms and radiological findings. Urinary bacteriological tests have low sensitivity, but even in the absence of diagnostic confirmation, treatment can be carried out through a combination of drugs for a period of six months. In the presence of ureteral stenosis or contracted bladder, complex but well stablished reconstruction procedures are necessary.

Contralateral Autologous Augmentation in DIEP Flap Reconstruction: Employing Computed Tomography Angiography and Volumetric Analysis for Preoperative Planning.

Autologous reconstruction accounts for approximately 20% of all breast reconstruction procedures. In cases of unilateral reconstruction, contralateral breast augmentation using autologous tissue can be performed to improve symmetry, and it is a viable option for patients interested in having more volume relative to their current size without the use of implants. Computed tomography scans have been used for preoperative planning in autologous reconstruction to evaluate available perforators. In this article, the authors report their experience using computed tomography angiography for preoperative volumetric assessment for autologous contralateral breast augmentation in the setting of unilateral autologous breast reconstruction. Twelve patients underwent autologous augmentation during the study period. The average reconstruction flap weight was 561.2 ± 253.6 g, and the average augmentation flap weight was 218.0 ± 133.7 g. No patients experienced flap loss. The authors demonstrate that the predicted volumes for the augmented and reconstructed breasts were comparable to the actual respective flap volumes. In addition, postoperative patient-reported outcome measures demonstrated high levels of satisfaction across multiple BREAST-Q subscales. This study demonstrates the utility of using computed tomography angiography to estimate reconstructive volumes to help preoperative planning and achieve predictable postoperative breast volumes. It also supports that contralateral autologous augmentation is a good option for patients who would like to avoid implants and are interested in a small to moderate increase in size. Therapeutic, IV.

Plastic Surgery Awareness and Perceptions among Healthcare Professionals: A Single Centre Study at Liaquat University Hospital

Plastic surgery encompasses both reconstructive and aesthetic procedures, addressing functional and cosmetic needs. Misconceptions about its scope are common, even among healthcare professionals, underscoring the need to evaluate their awareness and perceptions. Objectives: To assess the level of awareness and perceptions of plastic surgery as a speciality among healthcare professionals at Liaquat University Hospital, Hyderabad and Jamshoro. Methods: A cross-sectional questionnaire-based study was carried out at Liaquat University Hospital, Hyderabad, and Jamshoro. Participants included 108 house officers and postgraduate residents working in nonsurgical specialities. The study excluded doctors from other specialities related to surgery and dermatology due to overlaps in the scope of practice with plastic surgery. Results: A majority of participants (79.6%) recognized that cosmetic surgery was a component of plastic surgery, while 12% considered them to be the same, and 3.7% disagreed. In terms of the origin of the term "plastic surgery," 82.4% of participants did not know the reason behind the term. Regarding the aesthetic procedures, participants reported rhinoplasty as done by plastic surgeons (61.1%), with 37% favouring ENT surgeons. Non-surgical procedures such as Botox were mostly attributed to dermatologists (51.9%), with 40.7% selecting plastic surgeons. Conclusions: It was concluded that the study revealed significant gaps in both awareness and perceptions regarding plastic surgery among healthcare professionals. There was a noticeable misunderstanding regarding the appropriate speciality for aesthetic procedures, such as liposuction and breast reduction, where other surgeons were preferred over plastic surgeons, indicating a need for improved education and awareness in the medical community.

Robotic surgery for paediatric neurogenic lower urinary tract dysfunction: a systematic review.

To evaluate in a systematic review the outcomes, benefits, and limitations of robot-assisted surgeries for paediatric neurogenic lower urinary tract dysfunction (LUTD), as robot-assisted techniques have emerged as a potential alternative, offering enhanced precision, dexterity, and visualisation. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier CRD42023464849) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies of paediatric patients (aged <18 years) with neurogenic LUTD undergoing robot-assisted continence surgery, assessing safety and efficacy. Literature searches in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Scopus were conducted until 12 July 2024. Data extraction included surgical procedures, complications, operative times, lengths of stay, and bladder function outcomes. A total of 42 studies (20 case reports, 10 case series, six cohort studies, six comparative cohort studies) were included. Robotic procedures for continent catherisable channel construction, augmentation cystoplasty, and bladder neck reconstruction showed comparable peri- and postoperative outcomes. Meta-analysis of five studies comparing robotic vs open appendicovesicostomy indicated a significant reduction in length of stay for robotic groups, while operative time, complications, and re-intervention rates were not significantly different. Conversions to open surgery were rare, indicated by adhesions or small appendices during channel constructions. Robot-assisted surgeries for paediatric neurogenic LUTD demonstrate potential benefits, including reduced hospital stays and comparable complication rates to open surgery in certain contexts. However, the available evidence is limited by heterogeneity in study designs, small sample sizes, and single-centre experiences, which constrain generalisability. Standardised reporting of complications and outcomes, alongside multicentre studies, is essential to clarify the long-term efficacy and broader applicability of these techniques.

Reconstruction full-thickness defect of calcaneus post trauma using sural fascio-cutaneous flap: a case report

Traffic accidents often cause degloving injuries to the extremities that can cause an avulsion of the skin. Injuries of the feet and lower legs require special management, specifically the calcaneus region, which is an anatomical challenge for reconstructive surgery. The sural flap is often used for calcaneus defect reconstruction. This method provides more volume compared to skin graft methods. We report the case of a 33-year-old woman who was injured in a motorcycle accident. The patient had a wound on the calcaneus about 8 cm×3 cm long, just below the medial malleolus. The wound is circular, leaving intact tissue as a pedicle with a plantar pedis measuring 3 cm×2×cm×1 cm. The patient underwent debridement with a sural flap. Follow-up post-surgery, the flap was viable, but other procedures (casting, in setting flap, and refinement flap) are still needed to achieve better outcomes and physiotherapy to restore function. Degloving injuries generally cause devascularization. In cases like this, debridement is used as the initial therapy to preserve the surrounding soft tissue and skin. The second treatment is to prevent contractures. Most surgeons recommend a skin graft in the first stage. We performed a flap that has a rapid reconstruction process and can prevent the risk of skin necrosis as a weight-bearing area. Due to the existence of a long, retractable vascular pedicle, the sural flap is a helpful treatment in the reconstruction of skin defects in the distal area of the lower extremity. Reconstruction using fasciocutaneous flap procedure, for the patient's lower extremity defect (calcaneal defect) was successful. In trauma cases that cause damage full full-thickness skin and soft tissue, it is advisable to perform a flap as one of the reconstructive surgery procedures to restore the best function and shape of the involved lower extremity.

Applying the Modified Five-Item Frailty Index to Predict Complications following Lower Extremity Free Flap Reconstruction in Trauma Patients.

Free flap reconstruction in the setting of lower extremity trauma continues to be a challenging clinical problem fraught with a high risk of complications including flap compromise. Although studies have described certain risk factors that predispose these patients to poor outcomes, there remains a paucity of literature detailing frailty as a risk factor. As such, the aim of our study was to examine the application of the 5-item modified frailty index (mFI-5) in trauma patients undergoing lower extremity free flap reconstruction. The 2012 to 2020 American College of Surgeons-National Surgical Quality Improvement Program database was queried for lower extremity free flap reconstructive procedures. After excluding nontrauma etiologies, patients were stratified into three cohorts by their respective mFI-5 score (0, 1, and ≥2). Univariate and multivariate logistic regressions were performed to assess the effect of mFI-5 scores on postoperative complications. A total of 219 patients were included (64.8% male) with an average age of 47.6 ± 16 years. A total of 22.4% (n = 49) of patients had at least one complication. An increased mFI-5 score was associated with an increase in any complication (p < 0.001), hematological complication (p = 0.023), and reoperation (p = 0.004) rates. A high mFI-5 score was found to be an isolated risk factor for having at least one complication (mFI-5 ≥ 2: odds ratio [OR]: 3.829; p < 0.007; 95% confidence interval [CI]: 1.445-10.145) and reoperation (mFI-5 ≥ 2: OR: 5.385; p < 0.002; 95% CI: 1.826-15.877). Our results indicate that the mFI-5 can be a helpful assessment tool for lower extremity trauma patients undergoing free flap reconstruction to predict the risk of surgical complications and reoperation rates. Patients with an mFI-5 score > 2 should be counseled preoperatively of their increased risk of complications.

Plastic surgical treatment of neurofibromatosis type 1

Neurofibromatosis type1 (NF1, formerly Recklinghausen's disease) is a genetic tumor predisposition syndrome in which the mutation of atumor suppressor gene (neurofibromin) leads to the development of mostly benign neurofibromas of the skin and the central and peripheral nervous systems and malformations or tumors of other organ systems. Patients with NF1 should receive lifelong interdisciplinary care in specialized centers and important treatment decisions should be made by a regularly meeting interdisciplinary panel of experts. Plastic surgery plays an important role in the multidisciplinary management of all clinical forms of NF1-associated peripheral nerve sheath tumors, from cutaneous and subcutaneous to deep nodular and diffuse plexiform neurofibromas. Each patient requires individualized surgical planning, whereby the timing and extent of surgery are determined by the accompanying symptoms, functional and esthetic limitations, disease progression and potential malignant transformation. As any region of the body can be affected, the esthetic and reconstructive procedures required include awide range of interventions, such as eyelid surgery and facial restoration to breast shaping and nerve reconstruction or motor replacement surgery. A timely surgical intervention can have aprofoundly positive effect on the course of the disease and the quality of life of those affected and, in the case of transformation into amalignant peripheral nerve sheath tumor (MPNST), can even be lifesaving.

The Pierre Auger Observatory open data

The Pierre Auger Collaboration has embraced the concept of open access to their research data since its foundation, with the aim of giving access to the widest possible community. A gradual process of release began as early as 2007 when 1% of the cosmic-ray data was made public, along with 100% of the space-weather information. In February 2021, a portal was released containing 10% of cosmic-ray data collected by the Pierre Auger Observatory from 2004 to 2018, during the first phase of operation of the Observatory. The Open Data Portal includes detailed documentation about the detection and reconstruction procedures, analysis codes that can be easily used and modified and, additionally, visualization tools. Since then, the Portal has been updated and extended. In 2023, a catalog of the highest-energy cosmic-ray events examined in depth has been included. A specific section dedicated to educational use has been developed with the expectation that these data will be explored by a wide and diverse community, including professional and citizen scientists, and used for educational and outreach initiatives. This paper describes the context, the spirit, and the technical implementation of the release of data by the largest cosmic-ray detector ever built and anticipates its future developments.

Ulnoradial - metacarpal reconstruction for emergency one-stage procedure in complicated wrist amputation.

Complicated wrist amputation caused by severe trauma poses a real challenge for orthopedic and hand surgeons. This study aimed to evaluate a procedure of ulnoradial-metacarpal reconstruction as a rescue option in this challenging situation. In total, 12 patients with complicated wrist amputation induced by serious injury were selected from 2015 to 2020 and followed up for 1∼6 years at a level 1 trauma center. All patients underwent initial treatment in the Emergency Department followed by transfer to the main operating theater for emergency ulnoradial-metacarpal reconstruction. Patient demographics, surgical techniques, clinical outcomes, and complications were also retrieved from medical records. Functional outcomes were assessed with Disabilities of Arm, Shoulder and Hand score (DASH) and Mayo Wrist Score (MWS). Descriptive statistics were used to calculate, including frequencies for categorial variables and mean values and ranges for continuous variables. The mean age of patients was 49.3 years (ranging from 41 to 61 years), with ten males and two females. The mean time to union was 4.8 months; 11 patients had a complete union. There was one case of nonunion due to bone resorption resulting from inadequate blood supply and smoking. Compared with the contralateral limb, the total active motion of the hand was 25% (ranging from 17 to 38%), and grip strength was 7% (ranging from 0 to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6mm (ranging from 8 to 12mm). All mean outcome scores indicated moderate disability, including disabilities of Arm, Shoulder, and Hand (12; ranging from 4 to 27). Based on Mayo Wrist Score, all patients were loss of wrist function forever. The majority of patients were satisfied with the hand function after recovery. Despite all patients experiencing significant impairments in their overall hand function, ulnoradial-metacarpal fusion presents a viable option for hand replantation in instances where the carpus has been irreparably damaged. Therapeutic IV.

Robot-Assisted Versus Conventional Harvesting of DIEP and Latissimus Dorsi Flaps for Breast Reconstruction in Post-Mastectomy Women: A Systematic Review and Meta-Analysis

Background/Objectives: Robotic breast reconstruction is an innovative surgical technique that integrates robotic technology into breast reconstruction procedures, offering several advantages over conventional approaches. These benefits include enhanced visualization, increased surgical dexterity, and superior cosmetic outcomes. This study aims to comprehensively compare robotic-assisted and conventional breast reconstruction approaches in terms of complication profiles and operation-related measurements. Methods: A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, CENTRAL, and VHL from inception to October 2024 to identify relevant studies. Risk ratios for the following complications were calculated between the groups: donor site seroma, hematoma, infection, and unplanned reoperation. Mean differences were also calculated for the duration of surgery, length of postoperative hospital stays, and opioid use. Results: A meta-analysis was performed on 9 studies including a total of 1094 patients. No significant differences were found between the groups in the risk ratios for reoperation, seroma formation, delayed healing, infections, and hematomas. Similarly, there were no significant differences in postoperative opioid use. The duration of surgery was longer in the robot-assisted reconstruction group, whereas the duration of hospital stay was shorter compared to the conventional group. Meta-regression analysis for the duration of surgery model showed that none of the moderators had a statistically significant effect on this outcome. ROBINS-I assessment indicated that all the included studies had a serious risk of bias. Conclusions: Our results suggest that using a robot-assisted approach is associated with a shorter duration of hospital stay and a longer duration of surgery.

BHSeP41 The use of Phasix™ bioresorbable mesh with posterior component separation for complex abdominal wall reconstruction: 3 year series

Abstract Phasix™ biosynthetic mesh, manufactured from a biologically-derived absorbable polymer Poly-4-hydroxybutyrate (P4HB), comprises a monofilament scaffold that allows tissue ingrowth and is fully resorbed by hydrolysis in 12–18 months. Advantages include maintaining the tensile strength of a synthetic mesh whilst addressing the favourable properties of remodelling of a biological mesh. We report our 3 year follow-up outcome data for this mesh in Abdominal Wall Reconstruction (AWR) at the largest UK AWR centre. Method 5 year retrospective analysis (2016–2021) of consecutive AWR procedures performed using Phasix™ mesh, with minimum 3-year follow up period. Patients identified from electronic records. Standardised procedure involved radical skin excision, extraperitoneal posterior component separation (Rives-Stoppa [RS] or transversus abdominis release [TAR]) and sublay mesh placement. All patients operated jointly by a single plastic and general surgery consultant pair. Results 206 reconstructive procedures performed using Phasix TM mesh in patients with a male:female ratio of 1.6:1, mean age 53 (range 27–86) and mean BMI 30.9 (16.9–55.4). RS technique used in 81% with 19% requiring TAR. Mean LOS was 4.75 days (SD 3.6). Wound complications reported in 12.6% (n = 26) and seroma rate 6.8% (n = 14), both significantly associated with obesity (OR 6.6, P &amp;lt; 0.09 and OR 6.3, P &amp;lt; 0.02 respectively). Venous thromboembolism reported in 2% (n = 4), respiratory complications in 9% (n = 19) and ileus in 1.9% (n = 4). Hernia recurrence 1.9% (n = 4). Mortality in 1 patient (BMI 44, ASA 3). Conclusion Our data supports the safe use of biosynthetic mesh in AWR with a low recurrence rate and acceptable complication rate.

Modelling diffusive phase transformations in multiphase systems using the Voronoi implicit interface method

Abstract This paper presents a general level set framework for modelling diffusive solid-state phase transformation processes in binary systems comprising several grains and phases. Notably, it is demonstrated how the Voronoi implicit interface method (VIIM) can be used to simulate microstructure evolution in polycrystals driven by diffusion. The key advantage of VIIM is that a single level set function can be utilized to describe the evolution of the microstructure. Thus, the computational cost is significantly reduced compared to more traditional approaches, in which each grain in the microstructure is assigned a separate level set function. Moreover, VIIM facilitates the reconstruction of a fully compatible grain boundary network without the presence of any void regions or grain overlaps. The reconstruction procedure does not require any special handling of junctions and can be easily extended to higher dimensions. Moreover, the reconstruction step enables an adaptive remeshing technique to be employed such that the mesh nodes conform with the location of the grain boundaries. Hence, the diffusion problem can be solved in distinct phase domains, demarcated by sharp interfaces. The kinetics of the phase interfaces are described by the amount of flux towards the interface in accordance with the theory of diffusion-controlled phase transformations. To examine the capabilities of the proposed model, both single-phase and multiphase problems are examined. For the single-phase problem, it is shown that the model behaves in accordance with analytical solutions and maintains mass conservation. For the multiphase problems, two model cases of polycrystals that share the same initial geometry but exhibit different phase distributions are investigated, as well as a representative microstructure example. The evolution of the microstructures towards an equilibrium state is in agreement with the expected phase fractions and demonstrates that the model produces reliable results. The error in mass conservation of the considered multiphase examples is within a margin of ±5%.

Modified superior capsule reconstruction using the peroneus longus for irreparable massive rotator-cuff tears: A cadaveric study

Background: Irreparable massive rotator cuff tears (IMRCTs) present substantial treatment challenges, highlighting the necessity of making effective treatments available. Objective: To evaluate the biomechanical characteristics of a modified procedure of superior capsule reconstruction (mSCR) employing the autologous peroneus longus tendon for the treatment of irreparable massive rotator-cuff tears (IMRCTs), encompassing the entire supraspinatus tendon and 50% of the infraspinatus tendon. Methods: Seven cadaveric specimens were tested at 0°, 30°, and 60° glenohumeral abduction under the following three conditions: (1) intact, (2) IMRCT, and (3) mSCR using the autologous peroneus longus tendon. Humeral rotational range of motion (ROM), superior translation of the humeral head, and subacromial contact pressure were measured. Repeated-measures ANOVA was followed by Tukey's post hoc test to perform statistical analyses. Results: At all the abduction angles, superior translation of the humeral head and subacromial contact pressure were higher in the IMRCT group than in the intact group but were significantly lower in the mSCR group than in the IMRCT group. All these differences were statistically significant ( P &lt; 0.05). Conclusion: The mSCR procedure can reduce the superior translation of the humeral head and subacromial contact pressure without limiting humeral ROM in IMRCTs. Utilizing mSCR with the peroneus longus tendon may serve as a therapeutic approach for IMRCTs.