Prosthetic Infection Research Articles

Validez clínica de la histología intraoperatoria en el diagnóstico de la infección protésica

Background and aimDifferent authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyze the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement. Material and methodsWe present a retrospective study including 133 hip and knee prosthetic replacements performed in our center between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined. OutcomesThe clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%. ConclusionsThe determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.

Comparison of dynamic and static spacers for the treatment of infections following total knee replacement: a systematic review and meta-analysis

BackgroundRevision surgery is the most common treatment for patients who develop infection after total knee arthroplasty (TKA). Two types of spacers are often used in revision surgery: dynamic spacers and static spacers. The comparative efficacy of these two types of spacers on knee prosthesis infections is not well established. Therefore, we carried out a systematic evaluation and meta-analysis with the aim of comparing the difference in efficacy between dynamic and static spacers.MethodsWe conducted the literature search in PubMed, Web of Science, Cochrane Library, and Embase databases. The articles searched were clinical study comparing the difference in efficacy between dynamic spacers and static spacers for the treatment of prosthetic infections occurring after total knee arthroplasty.ResultsWe conducted a literature search and screening based on the principles of PICOS. Ultimately, 14 relevant clinical studies were included in our current study. We use infection control rate as the primary evaluation indicator. The KSS knee scores (KSSs), KSS functional scores, bone loss and range of motion (ROM) are secondary indicators of evaluation. Thirteen of these included studies reported the infection control rates, with no significant difference between dynamic and static shims (RR: 1.03; 95% Cl 0.98, 1.09; P = 0.179 > 0.05). The KSSs were reported in 10 articles (RR: 5.98; 95% CI 0.52, 11.43; P = 0.032 < 0.05). Six articles reported the KSS functional scores (RR: 13.90; 95% CI 4.95, 22.85; P = 0.02 < 0.05). Twelve articles reported the ROM (RR: 17.23. 95% CI 10.18, 24.27; P < 0.0001). Six articles reported the bone loss (RR: 2.04; 95% CI 1.11, 3.77; P = 0.022 < 0.05).ConclusionCurrent evidence demonstrates that dynamic spacers are comparable to static spacers in controlling prosthetic joint infection. In terms of improving the functional prognosis of the knee joint, dynamic spacers are more effective than static spacers.

One Third of Patients before Endoprosthesis Implantation Show an Oral Focus as Potential Source of Infectious Complication-The Value of Pre-Operative Dental Risk Stratification in a German Cohort.

Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.

A combination of hydrodebridement with pulsed lavage and negative pressure wound therapies may enhance outcomes.

Deep sternal wound infection (DSWI) with prosthetic graft infection is a rare, though lethal, complication after cardiovascular surgery via median sternotomy. This commentary is a review of a report by Takagi et al. published in the Journal of Cardiac Surgery that reported favorable outcomes in patients with DWSI with prosthetic graft infection treated with an enhanced strategy consisting of hydrodebridement with pulsed lavage and negative pressure wound therapies.

Numerical Analysis of the Crack Growth Path in the Cement of Hip Spacers

The use of temporary hip prosthesis made of orthopedic cement (spacer) in conjunction with antibiotics became a prevalent method used for prosthetic infections remedy; consequently, this method makes bone cement (PMMA) more fragile. Hence, the necessity of reinforcement incorporation is crucial to strengthen the bone cement. In this study, the finite element (FE) method was used to analyze the spacers behavior. FE model using an implicit integration method was used to simulate the mechanical behavior of the spacer under static loading. In addition, the extended finite element method (XFEM) was also used to investigate the fracture behavior of the non-reinforced and reinforced spacers. The results of this numerical analysis showed that the simulated crack initiation and propagation were in a good accordance with in vivo radiography and in vitro experimental observations. The full-stem reinforcement of 8 mm using reduce significantly the stress intensity factor and, consequently prevent the spacer fracture effectively. The FE models developed in this study contribute to help mechanical designers and engineers for prostheses’ quality and durability improvement. Abstract must be 200 words maximum, without figures or refs.

Effect of Optiglaze Coating on the Staphylococcus aurous and Porosity of Heat Cured Acrylic Material

Background: Polishing technique for acrylic resin material have great effect on properties of acrylic material and bacterial colonization such as staphylococcus aurous, which are responsible for many acrylic prosthetic infections such as the commonly ocular infections. Ineffective polishing technique could affect roughness and subsequently porosity of acrylic materials.So, a new effective method for polishing acrylic was used depending on the use of optiglaze coating material. So, this study aimed to evaluate the effect of optiglaze polishing on porosity of acrylic resin material and staphylococcus aurous activity in comparison to conventional polishing technique. &#x0D; Materials and methods: Specimen(n=120) were prepared :20 specimens constructed as circle shaped diameter 30mm with 1 mm thickness for porosity test (10 control polishing by conventional technique and 10 polishing by optiglaze technique). Other 82 specimens were prepared as circle specimen (6mm diameter and 1mm thickness) for sensitivity and adherences test ( each test have 20 specimens10 control and 10 optiglaze) and 42 specimens for viability test for three dilution,21 specimens for control and 21 for optiglaze (7 specimens for each dilution). Porosity were tested by light microscopic while agar well technique, adherence test and viability count test were tested for antibacterial activity of optiglaze against staphylococcus aurous.&#x0D; Result: The high mean value for porosity test was recorded by control while low mean value was recorded by optiglaze group with significant differences between them. Sensitivity and adherence test high mean value recorded by optiglaze with highly significant differences in comparison to control. Viability count test all dilution 10-7 ,10-6, 10-5 showed highly significant reduction in viability count of staphylococcus aurous by optiglaze group in comparison to control. Conclusion Polishing technique by Optiglaze significantly decrease porosity of acrylic resin and this method inhibited growth of staphylococcus aurous, and decrease its viable count (have antibacterial effect) but had less effect in adherence of this bacterial in comparison to control.

Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study.

Posterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam. A retrospective study of PKIs using PS spacers with or without a Kirschner wire-reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed. The cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P= .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P= .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m2, femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year. This preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.

Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study.

PurposeThis study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups.MethodsA total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50–65 y, and > 65 y.ResultsThe mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). Streptococcus was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection.ConclusionCHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. Streptococcus is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection showed poorer in-hospital outcomes.

Analysis of Mechanical Prostheses Excised from the Aortic Valve Position

Described herein are certain clinical and morphologic findings in 33 patients who had their dysfunctioning native aortic valves replaced with a mechanical prosthesis and 4 to 302 months (mean 127) later had the mechanical prosthesis explanted because of developing prosthetic stenosis or regurgitation because of thrombus forming on a metallic disc, pannus on the cloth ring with overhanging the prosthetic orifice, or because of parabasilar regurgitation. Of the 33 patients, 25 were not infected and 8 were infected. At follow-up at least 23 of the 25 patients without infection and 7 of the 8 patients with prosthetic infection survived >1 year after the prosthetic valve explantation.

A Retrospective Review of Relative Value Units in Revision Total Knee Arthroplasty: A Dichotomy Between Surgical Complexity and Reimbursement.

Revision total knee arthroplasties (TKA) are costly, time-intensive, and technically demanding procedures. There are concerns regarding the valuation of Current Procedural Terminology (CPT) codes and the assigned relative value units (RVU) as a potential disincentive to perform revision TKAs. This study evaluated the labor and time investment for each component-specific revision and assessed the disparities between procedural value billed and reimbursement. A retrospective review of 154 primary and revision TKA cases were thoroughly vetted using operative notes and internal billing data. Revision TKAs were stratified by single femoral component, single tibial component, polyethylene liner only, all-component, and spacer placement for prosthetic infection. Operative time, RVUs billed, total charges, deductions, and reimbursements were recorded. Mann-Whitney U tests compared final reimbursement per minute and per RVU between revision and primary TKAs. There were 28 primary TKAs, 11 femoral component revisions, 25 tibial component revisions, 25 liner exchanges, 37 all-component revisions, and 28 spacer placements. Revisions involving the tibial component, all-components, and placement of spacers were reimbursed less dollars per minute than primary TKAs (P < .05). Controlling for RVUs, liner exchanges and all-component revisions had fewer dollars per RVU than primary TKAs (P < .05). As revision complexity increases, physicians face less reimbursement per minute and per RVU. With reductions set by CMS and private insurers, revisions may be financially unfavorable and lead to restrictions and access to care problems. Our data supports the need for reevaluating RVU allocation amongst revision procedures with potential updates to the CPT coding system.

Human Thrombin–Gelatin Matrix With Rifampin: A Novel Technique for Treating Vascular Graft Infections

Approximately 1% to 6% of prosthetic vascular grafts will be complicated by infection. However, the mortality rates have ranged from 17% to 40%, and the morbidity is also high, including reinfection rates reported at 18% and limb loss close to 11%. Early aggressive surgical management, including graft excision and wide wound debridement with extra-anatomic bypass creation is the reference standard. Graft preservation techniques have been increasingly used, with high cure rates. Muscle flap, coverage, and antibiotic-coated absorbable and nonabsorbable beads have been reported to provide high cure rates but with associated technical difficulties and suboptimal graft salvage rates. We implemented a novel technique for localized antibiotic therapy using a human thrombin–gelatin matrix with rifampin (HTGM+R) at our institution for the past 5 years (Figs 1 and 2). We have described the rates of graft salvage, reintervention, limb salvage, and infection recurrence. We performed a retrospective cohort study of patients who had presented with prosthetic vascular graft infection from January 2016 through June 2021 and had been treated using our novel technique. Statistical analysis included descriptive frequencies of the demographic variables and outcomes of interest. A total number of 16 patients with a total of 32 interventions were included in the present study. Approximately 76.5% had required two or more interventions. HGTM+R was used for 15 interventions (46.9%) in 14 patients. Thrombectomy was the second most common intervention (n = 11; 34.4%). The mean age was 65.2 years, and the mean body mass index was 26.7 kg/m2. The common comorbidities are shown in the Table. The graft salvage rate was 80%, the limb salvage rate was 93.3%, and the freedom from infection rate was 86.7% for HGTM+R. However, the reintervention rate was 28.6%. Only four patients had required graft excision at an average follow-up of 12 months. Hypertension was the most common comorbidity, followed by diabetes and steroid use. Finally, no association with specific bacteria was seen. To date and to the best of our knowledge, the present study is the only study to describe this novel technique for treating prosthetic vascular graft infections. Moreover, it is the only study to describe the outcomes of HGTM+R in the treatment of prosthetic vascular graft infection.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A Case Series of Rifabutin Use in Staphylococcal Prosthetic Infections.

ABSTRACTThis case series describes seven patients who received rifabutin in place of rifampin combined with conventional antimicrobial therapy for treatment of hardware-associated staphylococcal infections. Infection recurrence, defined as need for unplanned surgical intervention within the evaluable follow up period after starting rifabutin, occurred in two patients. Two patients experienced possible treatment-associated adverse effects. Findings support future work to examine rifabutin use, when rifampin is not suitable, for adjunctive treatment of staphylococcal hardware infections.IMPORTANCE This work evaluates real-world data and clinical outcomes when rifabutin is used in place of rifampin for adjunctive management of staphylococcal hardware-associated infections. This is the second case study looking at this specific use of rifabutin, signifying the current lack of clinical data in this area. Assessing use of rifabutin in this capacity is clinically important given its lower propensity for drug interactions compared to rifampin.

Robotic-assisted closed-chest management of a fungal-infected prosthetic aortic graft: a case report

BackgroundFungal prosthetic graft infections are associated with high mortality, typically requiring aggressive surgical debridement. We present an alternative, minimally invasive approach to address these challenging clinical cases.Case presentationA 76-year-old Caucasian male with prior aortic root and arch replacement presented with localized chest wall tenderness after being hit by a car door. Computed tomography angiogram incidentally identified fluid in the anterior mediastinum, surrounding his ascending aortic graft. Rather than undertaking a high-risk reoperative sternotomy and redo complex aortic reconstruction, we elected to proceed with a robotic-assisted, minimally invasive debridement of the aortic graft, coupled with an omental wrap, entirely within the closed chest. Microbiology was positive for Aspergillus species. The patient made an uncomplicated recovery and was discharged home on antifungal therapy, likely to continue indefinitely.ConclusionsInfected prosthetic aortic grafts can be successfully managed with debridement and pedicled omental flap coverage via a minimally invasive approach within the closed chest, obviating the morbidity of a complex reoperative open procedure.

Preparation and Spectroscopic Characterization of Inclusion Complexes of 3D Ball-Milled Rifampicin with β-cyclodextrin and γ-cyclodextrin : 3D Ball-Milled Rifampicin with β-cyclodextrin and γ-cyclodextrin.

Rifampicin (RFP) solutions, intended to reduce incidence of prosthetic graft infection, were prepared as three-dimensional ground mixtures (3DGMs) using β-cyclodextrin (βCD) and γ-cyclodextrin (γCD) and characterized for their spectroscopic properties and solubility. Phase solubility diagrams revealed that 3DGMs (RFP/βCD and RFP/γCD) produced a complex at 1:1 molar ratio. Pulsed field gradient nuclear magnetic resonance experiments indicated that the diffusion coefficients for RFP/βCD and RFP/γCD were similar to the respective diffusion coefficients for βCD and γCD. Rotating-frame Overhauser effect spectroscopy NMR spectra revealed the existence of a new exchanger peak for RFP/γCD, suggesting an intermolecular interaction different from that of RFP/βCD. Differential scanning calorimetry confirmed the presence of endothermic peak at 191°C indicating the manifestation of RFP in the inclusion complex. Interestingly, molecular interactions from the complexes, RFP/βCD and RFP/γCD, revealed different patterns of inclusion in the 3DGMs. In RFP/βCD, nuclear Overhauser effect spectroscopy NMR spectra indicated cross peaks for the protons of the methyl group of RFP and the protons (H-5 and H-6) in the βCD cavity. The methyl group of RFP interacted with the narrow rim of βCD. With RFP/γCD, cross peaks were due to the protons of the methyl group of RFP and the protons of the cavity of γCD suggesting multiple inclusion patterns. The observed multiple cross peaks affirm the inclusion of RFP into the CD cavity which enhanced its solubility by 1.6-2.0-fold when prepared as 3DGMs as RFP/βCD and RFP/γCD, respectively.

Indication for Proximal Femoral Replacement Is Associated With Risk of Failure.

Proximal femoral replacement (PFR) is reserved as a salvage procedure after failed total hip arthroplasty (THA) or after wide margin resection of tumors involving the proximal femur. Although failure of the PFR construct remains a significant problem, indication has not previously been investigated as a risk factor for failure. This study retrospectively evaluated patients who underwent PFR over a consecutive 15-year period for primary sarcoma or metastatic disease of the proximal femur, compared with conversion to PFR after failed THA. PFR failure was defined as recurrent prosthetic dislocations, periprosthetic fracture, aseptic loosening, or infection that ultimately resulted in revision surgery. Overall, 99 patients were evaluated, including 58 in the neoplasm and 41 in the failed THA cohorts. Failed THA patients were older (P < .001), with a greater proportion having comorbid hypertension (P= .008), cardiac disease (P= .014), and history of prior ipsilateral and intracapsular surgeries (P< .001). The failure rate was significantly higher in failed THA patients (39.0% vs 10.3%; P < .001) with significantly shorter implant survivorship on Kaplan-Meier analysis (P= .003). A multivariate Cox proportional hazards model showed that THA failure was the only independent predictor for PFR failure (hazard ratio: 4.26, 95% confidence interval: 1.66-10.94; P= .003). This study revealed significantly worse PFR implant survivorship in patients undergoing PFR for the indication of failed THA compared with neoplasm. Although the underlying etiology of this relationship remains to be explicitly outlined, poor bone quality and soft tissue integrity, multiple prior surgeries, and comorbid conditions are likely contributing factors.

LES INFECTIONS SUR PROTHESES DE HANCHE : QUELLE STRATEGIE THERAPEUTIQUE ?

As prosthetic hip infection is one of the most feared complications of hip arthroplasty, the aim of our work was, on the one hand, to describe different possible therapeutic options for treating and managing PHI, and on the other hand, to establish a strategy according to the type of infection and the characteristics of each patient. This is a retrospective study concerning 12 cases of prosthetic hip infection, conducted at the Department of Orthopedic Surgery and Trauma (A) of the Ibn Tofail Hospital in Marrakech and the Grand Atlas Clinic, during a period ranging from January 2017 to December 2020. The average age of our patients was 63 years, with a predominance of women (66% of cases). The distinction of PHI from other causes of painful hip arthroplasties is not obvious, therefore its diagnosis is based on a cluster of arguments clinical, radiological and biological pre and intraoperative. We were able to divide our patients according to the type of infection, 41.6% had an early postoperative infection and 58.4% had a delayed chronic infection. This classification as well as the particularities of each patient allowed us to choose the optimal therapeutic strategy and to adapt it according to the evolution of the infection. Indeed, targeted antibiotic therapy, in association with surgery, is essential. Thus, preservation of the prosthetic implant is indicated in early infections (&lt; 4 weeks), while its change is reserved for delayed chronic infections. At the end of this study, we were able to establish a medico-surgical therapeutic strategy adapted to our service and the practical recommendations for the management of infections on prostheses.

Bioinspired TiO2/chitosan/HA coatings on Ti surfaces: biomedical improvement by intermediate hierarchical films

The most common reasons for hard-tissue implant failure are structural loosening and prosthetic infections. Hence, in this study, to overcome the first problem, different bioinspired coatings, including dual acid-etched, anodic TiO2 nanotubes array, anodic hierarchical titanium oxide (HO), micro- and nanostructured hydroxyapatite (HA) layers, and HA/chitosan (HA/CS) nanocomposite, were applied to the titanium alloy surfaces. X-ray diffraction and FTIR analysis demonstrated that the in situ HA/CS nanocomposite formed successfully. The MTT assay showed that all samples had excellent cell viability, with cell proliferation rates ranging from 120% to 150% after 10 days. The HO coating demonstrated superhydrophilicity (θ ≈ 0°) and increased the wettability of the metallic Ti surface by more than 120%. The friction coefficient of all fabricated surfaces was within the range of natural bone’s mechanical behavior. The intermediate HO layer increased the adhesion strength of the HA/CS coating by more than 60%. The HO layer caused the mechanical stability of HA/CS during the 1000 m of friction test. The microhardness of HA/CS (22.5 HV) and micro-HA (25.5 HV) coatings was comparable to that of human bone. A mechanism for improved adhesion strength of HA/CS coatings by intermediate oxide layer was proposed.

Repeated prosthetics of the ascending aorta and aortic arch with a homograft for prosthesis infection and ruptured aorta after Bentalla de Bono operation

Prosthetic vascular graft infection is a formidable complication after cardiac surgery. Until now, the question on the tactics of managing such patients remains open, as well as the timing of each of the treatment methods such as conservative antibiotic therapy and surgery. In addition, the choice of a method of surgical treatment in itself poses new questions for specialists in regard to what methods to adhere to including prosthesis-preserving technique, prosthesis explantation and its replacement with a synthetic or biological graft, and the use of omentum to cover the infected bed. We present a case of treating a patient with an infected synthetic valve-containing conduit after Bentall de Bono operation and aortic rupture with the formation of false aneurysms. Attention is drawn to the prolonged clinical patient condition manifesting with fever, and the lack of data suggesting an infectious process according to positron-emission tomography and blood cultures. We chose a homograft of the ascending aortic and aortic arch with aortic valve as a conduit. It is also of interest that cultures of infectious prosthesis and aortic valve did not reveal any infectious agent. Aggressive antibiotic therapy in combination with surgical replacement of the infected prosthesis with a cryoprepared allograft allowed for successful treatment of patient without complications.

Sub-Coronal Inflatable Penile Prosthesis Placement: Patient Satisfaction and Outcomes

ABSTRACT Introduction Placement of an inflatable penile prosthesis (IPP) is a common surgical treatment of multiple disorders of male sexual function, including erectile dysfunction (ED) and Peyronie's disease (PD). The infra-pubic and peno-scrotal approaches have classically been favored for IPP placement since the first description of IPP placement in 1973 given reliably good outcomes. A sub-coronal incision was then described in 2016 for the implantation of a multicomponent IPP. The benefits of a sub-coronal approach to IPP placement includes exposure and access to the entire pendulous penis back to the mid bulb to allow for additional reconstructive procedures, such as plaque incision and grafting for Peyronie's disease, which previously would require an additional incision. Objective Although the sub-coronal approach has been described to be operatively feasible with advantageous operating times, the aim of this project is to report outcomes of the sub-coronal approach, such as patient satisfaction, rate of revision, infection, and wound complications. Methods A retrospective chart review from 5/11/2012 to 12/28/2020 was conducted on IPP placements performed at a single, tertiary-care institution to identify patients with IPPs placed via a sub-coronal approach. Data was collected at most recent follow-up date to determine outcomes measures such as satisfaction and complication rates. Results Forty-six patients had IPPs placed through a sub-coronal incision. Mean time to follow-up was 9.81 months (0.46-45.6 months). Of these patients, 22 (47.8%) explicitly expressed satisfaction with the procedure at follow-up. Four (8.7%) had wound complications. Additionally, only one (2.2%) experienced a post-operative prosthetic infection. Revision was performed in 3 IPPs (6.5%). One revision was performed to primarily release prothesis tubing that had become adherent to the left base of penile shaft, which was causing patient discomfort. The same revision served additional cosmetic purpose to reduce redundant skin along the patient's circumcision line. The other two revisions were performed for prosthesis malfunctions: one prosthesis acquired “buckling” leading to a ventral curvature requiring release of scar contraction, and the other prosthesis developed a proximal aneurysm requiring removal and replacement. Conclusions The sub-coronal approach for placement of an IPP is a promising alternative to the infra-pubic and peno-scrotal incisions with high patient satisfaction, low complication, and low revision rates. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Methicillin‑sensitive Staphylococcus aureus prosthetic vascular graft infection after a Fontan procedure in an adult patient: A case report

Heart infections are not limited to infectious endocarditis. In fact, prosthetic vascular graft infections are among the most severe complications associated with vascular and cardiac surgery. The risk of developing an infection on prosthetic material is estimated to be ~5%. The mortality rate associated with the infection is estimated to be ~10‑25% within 30 days of infection and 50% after 1 year. The present article describes a case of a methicillin‑sensitive <em>Staphylococcus aureus</em> (MSSA) infection on the prosthetic material following a heart Fontan procedure. To the best of our knowledge, only one other case of extracardiac prosthesis‑related infection following Fontan surgery has been reported to date in adults. Prosthetic vascular graft infections (PVGIs) are a rare complication of heart surgery. However, PVGIs can seldomly occur and are burdened by a decreased survival rate. Therefore, physicians need to promptly suspect and recognize such cases. Further studies are required however, in order to determine the feasibility and long‑term survival rates of a conservative therapeutic approach.