Site-specific Complications Research Articles

Tissue Engineering Nasal Cartilage Grafts with Three-Dimensional Printing: A Comprehensive Review.

Nasal cartilage serves a crucial structural function for the nose, where rebuilding the cartilaginous framework is an essential aspect of nasal reconstruction. Conventional methods of nasal reconstruction rely on autologous cartilage harvested from patients, which contributes to donor site pain and the potential for site-specific complications. Some patients are not ideal candidates for this procedure due to a lack of adequate substitute cartilage due to age-related calcification, differences in tissue quality, or due to prior surgeries. Tissue engineering, combined with three-dimensional printing technologies, has emerged as a promising method of generating biomimetic tissues to circumvent these issues to restore normal function and aesthetics. We conducted a comprehensive literature review to examine the applications of three-dimensional printing in conjunction with tissue engineering for the generation of nasal cartilage grafts. This review aims to compare various approaches and discuss critical considerations in the design of these grafts.

Evaluating Predictive Value of Surgical Resected Proximal Bone Margins in Diabetic Foot Osteomyelitis With Clinical Outcomes at 1 Year.

Osteomyelitis of the diabetic foot remains a significant complication that may result in the need for amputation. Proximal surgical margin histopathology after limb-sparing amputation could be used to guide antimicrobial duration and prognostic management but remains debatable. Here we evaluate if negative proximal bone margins predict outcomes of diabetic foot osteomyelitis at 1 year. A retrospective study assessed adults with diabetes undergoing limb-sparing foot amputations from September 2016 to September 2019. Patients required histopathology confirmation of osteomyelitis, proximal margin histopathology report, and documented electronic medical record follow-up through 12 months. The primary outcome evaluated if no further amputation at the same site was required in the following 12 months. Of 92 patients, 57 (61.9%) had pathology-confirmed negative margins for osteomyelitis. Patients with negative margins required less frequent subsequent amputations at the same site within 12 months compared to positive margins (86.0% vs 65.7%; P = .003). Antibiotic duration was shorter in patients with negative margins (mean, 18 vs 30 days; P = .001). Negative-margin patients also noted lower rates of readmission at 12 months (26.3% vs 51.4%; P = .015) for site-specific complications. Staphylococcus aureus was more predominant in patients with positive versus negative margins (57.1% vs 29.8%; P = .017). Negative proximal bone margin by histopathology was associated with lower frequency of further amputations at the index surgical site within 12 months. This group also received shorter courses of antibiotic therapy. It was also associated with lower rates of readmission at 12 months for surgical-site complications. Proximal margin histopathology results potentially can be integrated to guide antimicrobial duration and decrease the frequency of further amputation at the original site.

Impact of site-specific metastases and clinical complications on outcomes of patients with metastatic renal cell carcinoma (mRCC).

e16527 Background: Prognostic models based on the heterogeneity of mRCC disease characteristics, including anemia, hypercalcemia, and neutrophilia, are routinely used in clinic. In an attempt to improve these models, we conducted a retrospective analysis of patients(pts) with mRCC to assess the association of overall outcomes with specific sites of metastasis (mets) and clinical complications. Methods: We extracted data from the SEER-Medicare database on pts diagnosed with RCC from 2004 to 2015. Study cohorts included patients who were > 65 years old and had at least 1 of following site-specific mets or complications: ascites, bone mets, brain mets, liver mets, lung mets, pancreatic mets, and hypercalcemia. To accurately delineate the relationship between site-specific/clinical complications and clinical outcomes, pts were stratified into 3 groups by the timing of site-specific mets and complications appearance : A1 (pts with a site-specific mets or complication at the initial diagnosis of mRCC); A2 (pts with a site-specific mets or complication any time after diagnosis of mRCC); and B (pts who have no site-specific mets or complication but have other mets or complications). Kaplan-Meier curves for overall survival(OS) were produced and median(m) OS were reported. Multivariable Cox modeling was performed to assess the association of individual mets or complications with OS between pre-specified subgroups(A1+A2 vs B, A1 vs A2+B and A1 vs B). Results: We identified 4640 RCC pts in the SEER-Medicare database who had at least 1 of the specified sites of mets or complications. At a median follow-up of 8 months(mons), ascites, brain mets and hypercalcemia were associated with worse mOS in all predefined subgroup analysis. In pts with liver mets, groups A1+A2 had shorter OS than B . In pts with lung mets, mOS in A1 was longer than in A2+B or B. bone mets did not show a statistically significant correlation with OS in any stratified analysis. Lastly, pancreatic mets was associated with longer mOS, but this did not reach statistical significance regardless of the comparison groups (table 1). Conclusions: Our data show that ascites, brain mets, hypercalcemia, and liver mets was associated with poor prognosis, and de novo lung mets was associated with better clinical outcome in patients with mRCC. Based on these findings, we are working on comparing the clinical outcome of mRCC pts treated with targeted therapy to that of pts treated with immunotherapy and building a new prognostic model.[Table: see text]

Trans-inguinal pelvic lymphadenectomy in vulvar cancer patients: TRIPLE pilot study

ObjectiveThe goal of this study was to assess the feasibility and safety of a retrograde extraperitoneal trans-inguinal novel approach to pelvic lymphadenectomy in vulvar cancer patients. The secondary objectives were...

Access site complications of postcardiotomy extracorporeal life support

ObjectiveTo assess the influence of primary arterial access in patients receiving peripheral postcardiotomy extracorporeal life support on associated complications and outcome. MethodsOf 573 consecutive patients requiring PC-ECLS between 2000 and 2019 at a single center, 436 were included in a retrospective analysis and grouped according to primary arterial extracorporeal life support access site. Survival and rate of access-site–related complications with special emphasis on fatal/disabling stroke were compared. ResultsThe axillary artery was cannulated in 250 patients (57.3%), whereas the femoral artery was used as primary arterial access in 186 patients (42.6%). There was no significant difference in 30-day (axillary: 62%; femoral: 64.7%; P = .561) and 1-year survival (axillary: 42.5%; femoral: 44.8%; P = .657). Cerebral computed tomography-confirmed stroke with a modified ranking scale ≥4 was significantly more frequent in the axillary group (axillary: n = 28, 11.2%; femoral: n = 4, 2.2%; P = .0003). Stroke localization was right hemispheric (n = 20; 62.5%); left hemispheric (n = 5; 15.6%), bilateral (n = 5; 15.6%), or infratentorial (n = 2; 6.25%). Although no difference in major cannulation site bleeding was observed, cannulation site change for bleeding was more frequent in the axillary group (axillary: n = 13; 5.2%; femoral: n = 2; 1.1%; P = .03). Clinically apparent limb ischemia was significantly more frequent in the femoral group (axillary: n = 12, 4.8%; femoral: n = 31, 16.7%; P < .0001). ConclusionsAlthough survival did not differ, surgeons should be aware of access–site-specific complications when choosing peripheral PC-ECLS access. Although lower rates of limb ischemia and the advantage of antegrade flow seem beneficial for axillary cannulation, the high incidence of right hemispheric strokes in axillary artery cannulation should be considered.

P45. The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for Severe Cage Subsidence among patients undergoing standalone lateral lumbar interbody fusion

<h3>BACKGROUND CONTEXT</h3> Methods to measure bone quality using opportunistic imaging have recently been developed, including quantitative computed tomography (QCT), which allows for site-specific volumetric bone mineral density (vBMD) measurement, such as pedicles or endplates. Studies have shown these site-specific QCT measurements had more predictive value for site-specific complications than standard L1/2 measurements. Recently, MRI-based assessments of the vertebral bone quality (VBQ), which measures trabecular bone quality, were also introduced. However, there have been few studies that investigate the association between site-specific MRI bone assessment and osteoporosis related complications in patients undergoing lumbar interbody fusion. In this work, we created a novel site-specific MRI-based assessment of the endplate bone quality (EBQ) and assessed its predictive value for severe cage subsidence following standalone lateral lumbar interbody (SA-LLIFF) fusion. <h3>PURPOSE</h3> The purpose is to introduce a novel MRI-based site-specific bone quality assessment, EBQ, and investigate the predictive value of EBQ for severe cage subsidence after SA-LLIF compared with standard VBQ. <h3>STUDY DESIGN/SETTING</h3> A retrospective observational study at a single academic institution. <h3>PATIENT SAMPLE</h3> Patients undergoing SA-LLIF between 2008-2019 with available preoperative CT and T1-weighted MRIs of the lumbar spine as well as postoperative lumbar radiographs or CTs. <h3>OUTCOME MEASURES</h3> Severe cage subsidence (Grade 2 or 3) within 5-14 month after SA-LLIF. <h3>METHODS</h3> We retrospectively reviewed the records of SA-LLIF patients. Cage subsidence was assessed using the classification of Marchi et al. and severe cage subsidence was defined as grade 2 or 3. We measured VBQ as shown in the original article by Ehresman et al. EBQ was measured using preoperative non-contrast T1-weighted MRIs of the lumbar spine. The regions of interest were the subchondral bones of upper and lower endplates at the operated level, and the average signal intensity of both endplates was divided by that of the cerebrospinal fluid space at the level of L3. As a confounding factor, vBMD was measured using asynchronous QCT. Bivariate and multivariable analysis with generalized linear mixed models were performed with setting binary severe subsidence as the outcome. Statistical significance was set at p=0.05. The quality of fit was assessed using Akaike's information criterion. <h3>RESULTS</h3> A total of 205 levels in 89 patients were included in the final analysis. There were 50 levels (24.4%) which demonstrated severe subsidence. QCT-vBMD was significantly lower in severe subsidence group (Mean (SD) 97.4 (34.4) vs 110.1(33.4), p=0.021). Both VBQ and EBQ were significantly higher in severe subsidence group (VBQ: Mean (SD) 2.67 (1.08) vs 2.39 (0.44), p=0.010; EBQ Mean (SD) 5.09 (2.20) vs 4.31 (1.09), p=0.001). In multivariate analyses adjusted with QCT-vBMD, EBQ showed significant association with severe cage subsidence (OR (95% confidential interval) = 1.94 (1.36-3.63), p=0.038), whereas VBQ only showed a marginal trend (p=0.071). The EBQ based prediction model for severe subsidence showed better goodness of fit compared to VBQ based model. (AIC EBQ 190 vs VBQ 192). <h3>CONCLUSIONS</h3> We introduced a novel MRI-based site-specific bone quality assessment. High EBQ was an independent factor for severe cage subsidence after SA-LLIF and the EBQ-based model showed better goodness of fit compared to VBQ-based model. Given the availability of preoperative MRIs, EBQ assessment prior to SA-LIFF may provide insight into a patient's risk for severe subsidence. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Large-bore arterial access in the era of structural cardiovascular disease.

Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. The definition of what constitutes large bore access is subject to discussion, however within the field it is generally accepted to reflect a catheter diameter exceeding 8-French. We sought in this review to explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.

A simple technique for easier anterior odontoid screw fixation

Background: Anterior odontoid screw fixation (AOSF) is an osteosynthetic technique used for fixation of type 2 and rostral type 3 odontoid fractures. Compared to other treatment modalities, it provides immediate stability, preservation of the majority of the remaining C1–2 motion and an achieved union rate of 80–100%. AOSF requires a stable and reduced odontoid to allow for placement of guide wire and cannulated screw. Image guidance with neuro-navigation or intraoperative fluoroscopy are used for accurate placement of instrumentation. Minimally invasive techniques have been described, such as endoscopic or percutaneous placement of odontoid screws and the use of tubular retractor system. Major site-specific complications include neural injury, esophageal or pharyngeal perforation, hemorrhage, and airway obstruction.Purpose: To assess safety and efficacy of a new simple technique developed by the Authors for insertion of the odontoid screw through a less invasive anterior approach.Study design: Prospective case seriesMethods: Eight patients, 7 males, with odontoid fractures were treated with AOSF under fluoroscopic guidance between January 2014 and October 2015. The operation was successfully completed without technical difficulties using a beveled bone marrow biopsy needle (Jamshidi needle) as a sleeve for guide wire insertion.Results: No soft tissue complications such as esophageal or neuro-vascular injury occurred. Intraoperative bleeding was 25 mL on average. The operation time averaged 75 min. All of the screws were placed in good positions. After a mean follow-up of 12.1 months (range 8–18 months), radiographic fusion was documented for 7 of 8 patients (87.5%). Neither clinical complications nor hardware loosening or breakage occurred.Conclusion: Our short term clinical results suggest that the new less invasive anterior odontoid screw fixation procedure using a Jamshidi needle and fluoroscopy is technically easy with good clinical and radiological results.

Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options.

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions.

Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC's were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

Complications in facial Mohs defect reconstruction.

To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit. Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered. A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.

Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go.

Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ablation therapies. IRE is performed in a nearly non-thermal fashion that circumvents the "heat sink effect" and allows for IRE application in proximity to critical structures such as bile ducts or neurovascular bundles, where other techniques are unsuitable. IRE appears generally feasible and initial reported results for tumor ablation in the liver, pancreas and prostate are promising. Additionally, IRE demonstrates a favorable safety profile. However, site-specific complications include bile leaking or vein thrombosis and may be more severe after pancreatic IRE compared to liver or prostate ablation. There is limited clinical evidence in support of the use of IRE in the kidney. In contrast, pulmonary IRE has so far failed to demonstrate efficacy due to practicability limitations. Hence, this review will provide a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and oncologic efficacy. The future role of IRE in the minimally invasive treatment of solid tumors will be discussed. • Preclinical findings of IRE have been successfully translated into clinical settings.• Non-thermal ablation is able to prevent the "heat sink effect" and collateral damage.• IRE should primarily be applied to tumors adjacent to sensitive structures (e. g. bile ducts).IRE efficacy appears promising in the liver, pancreas and prostate with tolerable morbidity.• In contrast, there are no evidential benefits of IRE in the lung parenchyma. Citation Format: • Savic LJ, Chapiro J, Hamm B et al. Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr 2016; 188: 735 - 745.

Endoscopic resection of advanced and laterally spreading duodenal papillary tumors.

Historically, neoplasia of the duodenal papilla has been managed surgically, which may be associated with substantial morbidity and mortality. In the absence of invasive cancer, even lesions with extensive lateral duodenal wall involvement, or limited intraductal extension may be cured endoscopically with a superior safety profile. Endoscopic papillectomy is associated with greater risks of adverse events such as bleeding than resection elsewhere in the gastrointestinal tract. Additionally site-specific complications such as pancreatitis exist. A structured approach to lesion assessment, adherence to technical aspects of resection, endoscopic management of complications and post-resection surveillance is required. Advances have been made in all facets of endoscopic papillary resection since its introduction in the 1980s; extending the boundaries of endoscopic cure, optimizing outcomes and enhancing patient safety. These will be the focus of the present review.

PD50-04 TRANSVAGINAL MESH INCREASES THE RISK OF BLEEDING AND ORGAN SURGICAL SITE INFECTION IN VAGINAL PELVIC RECONSTRUCTION SURGERY: RESULTS FROM A MULTI-INSTITUTIONAL PROSPECTIVELY MAINTAINED DATASET

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2015PD50-04 TRANSVAGINAL MESH INCREASES THE RISK OF BLEEDING AND ORGAN SURGICAL SITE INFECTION IN VAGINAL PELVIC RECONSTRUCTION SURGERY: RESULTS FROM A MULTI-INSTITUTIONAL PROSPECTIVELY MAINTAINED DATASET Devin Haddad, Louis Krane, Gopal Badlani, and Majid Mirzazadeh Devin HaddadDevin Haddad More articles by this author , Louis KraneLouis Krane More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Majid MirzazadehMajid Mirzazadeh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vaginal reconstructive surgery can be performed with or without mesh based on surgeon preference. To elucidate small differences in perioperative morbidity following vaginal reconstructive procedures, we elected to look at a national dataset to determine whether using mesh during vaginal pelvic reconstruction surgery impacts rates of various perioperative complications and readmission. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database we concatenated surgical data from multiple vaginal procedures, including anterior and posterior colporrhaphy, paravaginal defect repair, enterocele repair, and colpopexy using CPT coding. We stratified this data by the modifier associated with mesh usage at the time of the procedure. In measuring multiple covariates, we compared various 30-day perioperative outcomes, postoperative complications, and readmission rates. RESULTS We identified 5644 procedures without mesh and 1280 procedures using mesh in the NSQIP dataset from 2010 through 2012. Procedures using mesh had a higher rate of perioperative bleeding requiring transfusion than procedures not using mesh (2.11% vs 0.60%, p < 0.001). In the 27 cases using mesh that required blood transfusion, seven transfusions occurred the same day of surgery and 10 occurred on the first post-operative day. Procedures using mesh also had a higher rate of organ surgical site infection (0.55% vs 0.18%, p < 0.05). There were no significant differences in rates of readmission, superficial or deep surgical site infections, pneumonia, urinary tract infection, sepsis, pulmonary embolism, or renal failure. The data set does not capture surgeon or site specific complications or type of kits/trocars used with the mesh. CONCLUSIONS In a review of NSQIP data, vaginal pelvic reconstruction procedures using mesh have a higher rate of perioperative bleeding requiring transfusion and organ surgical site infection than procedures not using mesh. Patients undergoing these procedures should be counselled preoperatively concerning these risks. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1046-e1047 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Haddad More articles by this author Louis Krane More articles by this author Gopal Badlani More articles by this author Majid Mirzazadeh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective Analysis of Location of RhBMP-2 Use in Adult Spinal Deformity (ASD) Surgery Does Not Correlate with Site-Specific Complications and Generates Greater Fusion Rates at Minimum Two-Year Follow-Up

Prospective Analysis of Location of RhBMP-2 Use in Adult Spinal Deformity (ASD) Surgery Does Not Correlate with Site-Specific Complications and Generates Greater Fusion Rates at Minimum Two-Year Follow-Up

Illicit injections in bodybuilders: a clinicopathological study of 11 cases in 9 patients with a spectrum of histological reaction patterns.

The practice of self-injection of anabolic steroids (AS) in bodybuilders is common. AS are not the only materials used by bodybuilders for muscle augmentation or image enhancement. Other materials, for example, plant oils, silicon, Vaseline, and paraffin are also injected either in a pure form or mixed with AS. Muscle bulking is the main aim. However, bodybuilders undergo illicit injections for cosmetic, therapeutic, and sexual purposes. Even though the practice of unsupervised injection is probably common in the sports community, site-specific complications are underreported in the medical literature and mostly limited to case reports. Complications can be clinically and pathologically challenging because some can be confused with nonneoplastic and, more important, with neoplastic lesions. Bodybuilders are reluctant to disclose information because of stigma and legal issues. This study attempts to correlate the clinical manifestations and histomorphological features of different injected materials used for different purposes by bodybuilders in our region. A series of 11 cases out of 9 male bodybuilders was studied. A variety of clinical presentations and histological tissue reactions was identified, with some overlapping features between some cases. We identified 5 basic tissue reaction patterns depending on the injected materials, site, and duration of injection. Certain histological features provide useful hints in the absence of prior knowledge of injection history. However, in other cases, a retrospective enquiry by clinicians is warranted to avoid pitfalls. The medical and sports community should be aware of these injection-site complications. Bodybuilders should be discouraged from this practice by implementing appropriate educational and legislative measures.

Abstract No. 267 - Safety and efficacy of the angioseal closure device with antegrade superficial femoral artery (SFA) access

Purpose Retrograde contralateral common femoral access traditionally has comprised the majority of access sites for the endovascular treatement of infrainguinal arterial disease. As the volume and complexity of distal lower extremity arterial endovascular interventions have increased, nontraditional access sites have increased in use. Antegrade SFA access provides numerous advantages that include improved pushability of endovascular devices, decreased length requirements of devices used, and decreased angulation of the access sheath in obese patients. Antegrade SFA access in most patients requires the use of a closure device. The Angio-Seal device (St. Jude Medical, St. Paul, MN) is indicated for use in femoral artery puncture sites. Very little data exists regarding the safety and efficacy of the Angio-Seal device with antegrade SFA access sites. In this single-center retrospective study, we evaluate the safety and efficacy of the Angio-Seal closure device in SFA punctures in our patient population. Materials and Methods From August 2010 through August 2012, 50 limbs in a total of 30 patients with critical limb ischemia were treated in our practice with antegrade SFA access. Ultrasound was used for access in 100% of the cases. Analyzed patient data includes access site-specific complications, vessel size, sheath size, intraprocedural anticoagulation dose, and patient BMI. The mean value and range: vessel size 6.5mm (4mm-9mm); BMI 29.3 (15-43); sheath size 6Fr (5Fr-10Fr); heparin 5,400U (5000-14000U). Results In 50 antegrade punctures and closures, there were 5 access-related complications: 4 bleeding complications and 1 Angio-Seal migration resulting in additional stent placement. 75% (3/4) of the bleeding complications were classified as Minor class A hematomas with no clinical consequence. Overall, there was 1 (2%) Major Class D bleeding complication requiring >48 hour hospital stay with an increased level of care. Analysis of data revealed no statistically significant correlation between the tested variables with complications. Conclusion The Angio-Seal closure device is a safe and effective tool for use with antegrade SFA access.

Poster 76: Enhanced Mandibular Distraction Osteogenesis Using A Tissue Engineering Approach

Facial skeletal defects, a major clinical problem, occur from many different sources: surgery, trauma, or growth deficiencies. These defects often need surgical correction to improve vital functions and esthetics 1 Ruiz R.L. Ritter A.M. Turvey T.A. et al. Nonsyndromic craniosynostosis: diagnosis and contemporary surgical management. Oral Maxillofac Surg Clin N Am. 2004; 16: 447-463 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar . Generally, these defects are repaired with autogenous bone grafts 2 Panetta N.J. et al. Tissue Engineering in Cleft Palate and Other Congenital Malformations. Pediatr Res. 2008; 63: 545-551 Crossref PubMed Scopus (40) Google Scholar from sources like iliac crest, tibia/fibula, rib, calvarium, etc. This approach, however, has several major negatives such as donor site morbidity, unreliable bone volume, as well as site-specific complications. Distraction osteogenesis is becoming increasingly popular to treat some craniofacial defects, but unfortunately often involves long treatment time. Recent scientific advances in bone tissue engineering have introduced the prospect to speed it up. The present study was to test the feasibility of combing tissue engineering techniques into mandibular distraction osteogenesis in a large preclinical animal model.

Body Piercing

Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing. As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.

Osteophyte-Induced Rupture of a Scalp Tissue Expander

Tissue expansion is in widespread use for the reconstruction of congenital and acquired defects. Complications of tissue expansion are well documented, the most common being infection or extrusion of the expander. Although the complications associated with scalp tissue expansion are similar to those experienced elsewhere in the body, site-specific complications can occur. These include bone thinning and erosion of the cranial vault. In this study, we report an unusual case of multiple osteophyte formation beneath a scalp tissue expander, resulting in its rupture and necessitating removal.