Sling Technique Research Articles

Visualized immediate breast reconstruction with dermal flap and implant.

Immediate breast reconstruction with dermal sling and implant has been known for almost three decades, but has not gained as much popularity as biological or synthetic meshes. The technique is well suited for women with large ptotic breasts. Its pre-operative planning is based on the Wise pattern mammoplasty and the actual surgery is rather straightforward and relies on the patient's own tissue and a standard breast implant. The aim of this paper is to visualize the dermal sling technique for immediate breast reconstruction. A dermal flap in combination with an implant seems to be safe, simple and reliable for immediate breast reconstruction.

Infant-carrying techniques: Which is a preferred mother-friendly method?

Infant carrying is still trendy among African mothers than in other climes, however, carrying techniques vary mostly along cultural divides. Using a pretest–posttest quasi-experimental design, the authors evaluated the effect of three types of infant-carrying techniques on cardiopulmonary function, metabolic expenditure, fatigue demand, and locomotion. Front wrap infant-carrying technique led to a marginally higher cardiopulmonary demand. Hip sling technique resulted in greater metabolic expenditure and oxygen consumption with high rate of perceived exertion, while back wrap technique did not significantly decrease locomotion parameters. The authors recommend back wrap infant carrying technique based on its slightly lower effects on cardiopulmonary function, metabolic expenditure, fatigue demand, and locomotion.

Intraoperative Subluxation of the Ulnar Nerve: Use of a Triceps Sling Reconstruction Technique

To determine whether the triceps sling reconstruction technique is a safe and effective treatment of intraoperative ulnar nerve subluxation after in situ decompression. Twelve patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ release were retrospectively reviewed. The triceps sling technique consists of harvesting a small, distally based strip of triceps tendon and suturing the proximal end of the strip to the posterior aspect of the released Osborne ligament. Thus, a sling is created between the medial epicondyle and the olecranon, preventing the nerve from subluxating. Patients were clinically evaluated before and after surgery. Visual analog scale pain scores, static 2-point discrimination, strength, and Disabilities of the Arm, Shoulder, and Hand score were assessed. At a mean follow-up of 31 months (range, 24-38 months), there was a significant improvement in mean visual analog pain scores from 8.6 to 0.2. Static 2-point discrimination was improved from a mean of 9.1 mm before surgery to 5.7 mm afterward. Strength improved by a mean of 33% and 30% with grip and pinch, respectively. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 45.9 to 3.7. No subluxation of the ulnar nerve was noted after surgery. No other complications were noted. No reoperations were required during the follow-up period. Triceps sling reconstruction is a safe treatment in patients with intraoperative ulnar nerve subluxation after in situ decompression. Therapeutic IV.

Biomedical Glue Sling Technique in Microvascular Decompression for Trigeminal Neuralgia Caused by Atherosclerotic Vertebrobasilar Artery: A Description of Operative Technique and Clinical Outcomes

Microvascular decompression (MVD) is the most definitive surgical treatment for trigeminal neuralgia (TN). In the case in which an atherosclerotic vertebrobasilar artery (aVBA) offends the trigeminal nerve, the postoperative outcomes have been reported to be less satisfactory in terms of symptom recurrence and complications. In this study, the authors present their experience using a biomedical sling for MVD in patients with aVBA-associated TN. A retrospective study of 22 consecutive patients who underwent the biomedical glue sling technique in MVD for TN with aVBA was conducted between September 2016 and June2017. Intraoperatively, aVBA was regarded as the direct or indirect offending vessel in 22 patients. In addition to aVBA, other vessels involved in neurovascular conflict included superior cerebellar artery in 12 patients, veins in 1, and anterior inferior cerebellar artery in 6. All 22 patients underwent the biomedical glue sling technique. Postoperatively, TN was completely resolved in 20 (91%) patients and partially relieved in 2 (9%) patients. During the follow-up period of 18-27 months, pain developed severely in those 2 patients but could be relieved with carbamazepine. As for complications, postoperative hypoacusia occurred immediately in 1 case, with complete resolution in 2 months. The biggest advantage of the biomedical glue sling technique is its simplicity in achieving complete decompression, requiring relatively less space and time. Because the outcome of traditional MVD regarding aVBA-associated TN remains controversial, the biomedical glue sling technique in MVD provides an alternative decompressive method for patients with TN associated with aVBA. However, further studies with a larger series and control group are required to prove the high effectiveness of this method.

Prospective Analysis of the Dynamic Intraoperative Standing Sling Technique A Novel Method of Performing the Single-Incision Sling Procedure

Abstract Objective: The aim of this research was to assess the 1-year success of the Dynamic Intraoperative Standing Sling Technique™ (DISST™) for the management of stress urinary incontinence (SUI...

Application of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy

To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.

Long-term outcomes and quality of life effects of single incision mini sling procedure in stress urinary incontinence patients

ObjectiveWe aimed to evaluate the long-term outcomes and quality of life of patients who underwent single incision minisling (SIMS) procedure. Study design62 patients who were diagnosed with stress urinary incontinence (SUI) and received treatment with SIMS procedure (Ophira, Promedon, Argentina) were included in the study. Mean age was 50.73 ± 9.28 years and mean follow-up duration after surgery was 30.68 ± 7.52 months. Preoperative urological and gynecological features of the patients were recorded. Gynecological examination, pelvic ultrasonography, stress test, Q-tip test, cystometry were performed and incontinence and quality of life questionnaires (ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI) were completed by all patients before and after the operation. ResultsStress urinary incontinence was observed in all patients during pre-op evaluations. 62 patients aged between 35–85 (mean age 50.73 ± 9.28) years were included and follow up duration ranged between 12–44 (average 30.68 ± 7.52) months. In regard to patient evaluations, 27 patients (43.5%) felt that the surgery was very effective, 25 (40.3%) felt surgery was effective and 10 (16.1%) did not report any difference after surgery. In the long-term postoperative follow up; 2 (3.2%) patients had dyspareunia and 7 (11.3%) patients had vaginal tape erosions which were diagnosed 2–40 months postoperatively. According to Q-tip test results, proximal urethral mobility was significantly decreased after surgery. All questionnaire scores were also significantly improved at post-operative evaluations. (P < 0.001) ConclusionsOur study confirmed that the Ophira mini sling technique provided high subjective cure rate and improved symptoms and quality of life in patients with SUI. These results suggest that the single incision mini sling procedure is an advisable alternative to other surgical procedures due to its low complication rates and ease of learning and applying the procedure. This procedure also demonstrated excellent tolerability, minimal pain, low morbidity and increased quality of life scores, in ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI.

The Outcome of Sling Retraction Technique in Microvascular Decompression for Hemifacial Spasm.

This study explored the technical characteristics and effectiveness of sling retraction technique in microvascular decompression for hemifacial spasm. Between January 2008 and May 2016, 158 patients affected by hemifacial spasm underwent microvascular decompression. Among them, the traditional technique was performed in 86 patients (A Group) and the sling retraction technique was used in 72 patients (B Group). The authors conducted a retrospective study and compared the surgical outcome of the 2 groups. The authors measured cure rate at 3 months and 5 years after microvascular decompression. In the traditional technique group, the cure rate of microvascular decompression was 94.2% and 83.3%. While in the sling retraction technique group, the cure rate of microvascular decompression was 95.8% and 94.4%. Facial nerve palsy, hearing loss, meningitis, and ataxia were frequent complications in both 2 groups. The sling technique using biomedical glue is an effective and safe option for patients of hemifacial spasm. During the long-term follow-up, the sling retraction technique of microvascular decompression was more effective than the traditional technique, while there were no significant differences in the incidences of complications.

Excimer laser assisted complex inferior vena cava filter retrieval: a single institution's experience over 6 years

To investigate inferior vena cava (IVC) filter retrievals and the use of the excimer laser sheath to assist in complex cases. Retrospective analysis was undertaken of 181 attempted filter retrievals over a 6 year period. Pre- and perioperative imaging was analysed from both standard retrieval and complex retrieval techniques. One hundred and eighty-one IVC filter retrievals were attempted: 130 (72%) standard retrievals were successful and 51 (28%) failed due to device endothelialisation. Forty (23%) cases then had subsequent successful complex retrieval under general anaesthetic. Eighteen (45%) cases were removed with the sling technique and 22 (55%) cases using the excimer laser dissection technique. Where preoperative venography/computed tomography (CT) demonstrated embedding of the filter feet versus filter apex, this was predictive of requiring dissection techniques versus sling technique (13/18 patients; p<0.05 chi-squared test). The difference in device indwelling time was statistically significant between the successful standard retrieval group (134 days) versus patients who failed standard retrieval and required complex techniques (243 days; p=0.00018). Standard retrieval techniques failed in 28% of cases. This correlated with devices that were indwelling for longer. When imaging demonstrated filter-feet endothelisation/perforation, this was predictive of requiring dissection techniques with the excimer laser.

The Adjustable Locking Suspension Sling Technique for Fixation of the Tibial Eminence Fracture in Adolescents

Avulsion fractures of the tibial eminence, although generally a rare injury pattern, are more common in children and adolescents than in adults. Many open and arthroscopic techniques are available with variable degrees of satisfying results and incidence of complications and adverse effects. Arthroscopic fixation appeared to improve the functional outcomes with fewer complications than the open fixation. New techniques were reported using commercially available suspension sling devices for the acromioclavicular joint that offers an easy and rapid method of fixation. However, this technique has the disadvantages of the presence of hardware (button) over the tibial anterior cruciate ligament attachment inside the joint and the need to drill a relatively large tunnel through the center of the avulsed fragment that may increase the chance of fracture. So small-diameter tunnels need to be drilled that will decrease bone loss and growth plate injury in children and adolescents. We describe here a technique that offers a better 4-point fixation through the anterior cruciate ligament with fewer complications by avoiding drilling through the avulsed fragment, absence of hardware inside the joint, and decreasing bone loss in adolescents by drilling only smaller transosseous tunnels and allowing for correction of the fixation using a special configuration of knots and cortical button.

Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes.

Trigeminal neuralgia is a debilitating pain disorder most often caused by arterial compression of the trigeminal nerve, although there are other etiologies. Microvascular decompression (MVD) remains the most definitive treatment for this disorder, with cure rates reported between 60% and 80%. Traditional MVD techniques involve a retrosigmoid craniotomy with placement of an inert foreign material, such as Teflon, between the nerve and compressive vessel. Recurrence of trigeminal neuralgia after MVD has been associated with vessel migration, adhesion formation, and arterial pulsation against the Teflon abutting the nerve. Additionally, foreign materials such as Teflon have been reported to trigger inflammatory responses, resulting in recurrence of trigeminal pain. An alternative method for decompression involves the use of a sling to transpose the compressive vessel away from the nerve. Results of various sling techniques as a decompressive strategy are limited to small series and case reports. In this study, the authors present their experience utilizing a tentorial sling for MVD in patients with trigeminal neuralgia. Institutional review board approval was obtained in order to contact patients who underwent MVD for trigeminal neuralgia via the tentorial sling technique. Clinical outcomes were assessed utilizing the Barrow Neurological Institute (BNI) pain intensity score immediately after surgery and at the time of the study. The tentorial sling technique was performed in 45 patients undergoing MVD for trigeminal neuralgia. In 41 of these patients, this procedure was their first decompressive surgery. Immediate postoperative relief of pain (BNI score I) was achieved in 80% of patients undergoing their first decompressive procedure. At last follow-up, 73% of these patients remained pain free. Three patients experienced recurrent trigeminal pain, with surgical exploration demonstrating an intact tentorial sling. The complication rate was 6.6%. Transposition techniques for MVD have been described previously in small series and case reports. This study represents the largest experience in which the utilization of a tentorial sling for MVD in patients with trigeminal neuralgia is described. The technique represents a novel method for decompression of the trigeminal nerve by transposition of the offending vessel without the use of foreign material. Although the authors' preliminary results parallel the historical cure rate, further outcome data are required to assess long-term durability of this method.

Pubovesical sling for residual incontinence after successful vesicovaginal fistula closure: a new approach to an old procedure.

For decades, the pubovesical (PV) sling has been in the armamentarium of the fistula surgeon for treating persistent urinary incontinence after successful fistula closure. We report our early experience with slings, and then also introduce a new "tight" PV sling technique for management of post-fistula urethral leak. Our hypothesis is that performance of tight slings might result in improved continence for women with persistent urinary incontinence after obstetric fistula closure. Data from 120 patients in whom some type of sling procedure had been performed between 1996 and 2012 were extracted and labeled as "early slings." Beginning in October 2014, more complete data were recorded and a more uniform approach was undertaken in 40 patients. Data were extracted from their charts and recorded as "tight slings." This information was analyzed using Chi-squared analysis. Tight slings were more successful in patients who had less severe fibrosis and who had a shorter time since initial injury. Thirty percent of women who underwent tight slings had improved continence at follow-up. Persistent urinary incontinence despite successful surgical closure of obstetrical fistula remains a difficult problem. Tight slings may be warranted in an attempt to avoid urinary diversion.

Modified adductor sling technique: A surgical therapy for patellar instability in skeletally immature patients

BackgroundDue to open femoral physis the therapy of patellar instability in skeletally immature patients is challenging. We developed a modified surgical technique of the ‘Adductor-Sling-Approach’ by Sillanpää. The purpose of this study was to evaluate the clinical outcome of the operative technique and to analyse the reasons for failure. MethodsThirty ‘modified adductor sling’ reconstructions in 28 patients were included in the study. From 2010 to 2016 modified adductor sling reconstruction was performed by looping the gracilis or semitendinosus tendon around the adductor magnus tendon and attaching it at the medial facet of the patella. Clinical outcome was retrospectively evaluated at a mean follow up of 25.6months (range 12–43). The evaluation also included subjective International Knee Documentation Committee (IKDC), Lysholm Score, Kujala Score and Tegner Activity Score. ResultsThe average age at the time of operation was 15.10years (range 11–17). Eighty-seven percent of the patients, who underwent the modified adductor sling technique, gained a stable patella and excellent results in postoperative scores. Recurrent dislocation occurred in four of 30 cases (13%). Analysis showed that possible reasons for failure of the tendon graft could be maltracking of the patella due to patella alta, trochlear dysplasia or an elevated tibial tuberosity to trochlear groove distance. ConclusionThe modified adductor sling technique for MPFL reconstruction in children and adolescents showed elevated redislocation rates. Only in absence of additional patellofemoral maltracking, caused by elevated tibial tubercle to trochlear groove distance (>15mm), patella alta or especially severe trochlear dysplasia, the modified adductor sling technique could be recommended.

Macrovascular Decompression of the Brainstem and Cranial Nerves: Evolution of an Anteromedial Vertebrobasilar Artery Transposition Technique.

Tortuous and dolichoectatic vertebrobasilar arteries can impinge on the brainstem and cranial nerves to cause compression syndromes. Transposition techniques are often required to decompress the brainstem with dolichoectatic pathology. We describe our evolution of an anteromedial transposition technique and its efficacy in decompressing the brainstem and relieving symptoms. To present the anteromedial vertebrobasilar artery transposition technique for macrovascular decompression of the brainstem and cranial nerves. All patients who underwent vertebrobasilar artery transposition were identified from the prospectively maintained database of the Vascular Neurosurgery service, and their medical records were reviewed retrospectively. The extent of arterial displacement was measured pre- and postoperatively on imaging. Vertebrobasilar arterial transposition and macrovascular decompression was performed in 12 patients. Evolution in technique was characterized by gradual preference for the far-lateral approach, use of a sling technique with muslin wrap, and an anteromedial direction of pull on the vertebrobasilar artery with clip-assisted tethering to the clival dura. With this technique, mean lateral displacement decreased from 6.6 mm in the first half of the series to 3.8 mm in the last half of the series, and mean anterior displacement increased from 0.8 to 2.5 mm, with corresponding increases in satisfaction and relief of symptoms. Compressive dolichoectatic pathology directed laterally into cranial nerves and posteriorly into the brainstem can be corrected with anteromedial transposition towards the clivus. Our technique accomplishes this anteromedial transposition from an inferolateral surgical approach through the vagoaccessory triangle, with sling fixation to clival dura using aneurysm clips.

Outcome of Biomedical Glue Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery.

Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). In cases of vertebral artery (VA) compression of the facial nerve, MVD is often difficult. In this study, we compared the outcome of the biomedical glue sling technique with the traditional technique in MVD for HFS involving the VA. A retrospective study of patients with HFS treated by MVD was conducted between January 2013 and December 2015. A total of 327 patients with VA-associated HFS underwent their first MVD at our institution. Among them, the traditional technique was performed in 153 patients and the biomedical glue sling technique was performed in 174 patients. We measured effectiveness at 1 day, 7 days, 1 month, 3 months, and 1 year after MVD surgery. In the traditional technique group, the effective rates of MVD were 89.54%, 88.89%, 89.40%, 88.44%, and 86.71%, and the incidence rates of complication were 5.23%, 4.58%, 3.97%, 2.72%, and 0.70%. In the biomedical glue sling technique group, the effective rates of operation were 96.55%, 96.55%, 97.66%, 95.86%, and 95.76% (P < 0.05), and the incidence rates of complication were 8.62%, 8.62%, 7.60%, 4.73%, and 2.42% (P > 0.05). When the HFS were associated with the VA, the effective rate of biomedical glue sling technique of MVD was higher than the traditional technique, and there was no statistical difference between the 2 groups about the incidence of complication.

V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY

You have accessJournal of UrologyProstate and Renal Oncology1 Apr 2017V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY Yuji MAEDA, Toshimitsu MISAKI, Osamu UEKI, Tetsuyuki KUROKAWA, Yukinosuke OSHINOYA, Ken-ichi NAGANO, and Haruo HISAZUMI Yuji MAEDAYuji MAEDA More articles by this author , Toshimitsu MISAKIToshimitsu MISAKI More articles by this author , Osamu UEKIOsamu UEKI More articles by this author , Tetsuyuki KUROKAWATetsuyuki KUROKAWA More articles by this author , Yukinosuke OSHINOYAYukinosuke OSHINOYA More articles by this author , Ken-ichi NAGANOKen-ichi NAGANO More articles by this author , and Haruo HISAZUMIHaruo HISAZUMI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence after radical prostatectomy for localized prostate cancer strongly influences patients' quality of life. Postoperative urinary continence tends to recover early since robot-assisted radical prostatectomy has been introduced, but the results of the procedure are still not satisfactory. Various modifications of pelvic floor reconstruction during radical prostatectomy, including pelvic floor structure preservation with nerve-sparing technique, have been reported for the purpose of early recovery of urinary continence. However, wide excision without nerve-sparing is necessary depending on a case, such as high risk stratified group, while it may cause poor recovery of urinary continence. We modified the previously reported Milan vas deferens sling technique by adding reinforcement of under-anastomosis layers during robot-assisted radical prostatectomy, which significantly accelerates early recovery of postoperative urinary continence in cases without nerve-sparing. METHODS Modified sling technique; Sling suture was made from autologous vas deferens. After putting the vas deferens sling on the sub-urethral perirectal fat, three independent layers were constructed below the urethrovesical anastomosis, and a single anterior layer was made. Then, both ends of the sling were transfixed to Cooper ligaments bilaterally with adequate sling suspension. Between October 2015 and July 2016, consecutive 35 patients who underwent robot-assisted radical prostatectomy without nerve-sparing at our institution with a single surgeon were investigated. The patients were classified into two groups: 15 using the sling technique (sling group) and 20 using the non-sling technique with simple posterior reconstruction (nonsling group). Urinary continence defined as 0 or safety 1 pad use daily was compared between the groups. RESULTS Patients' characteristics were comparable between the groups. Urinary continence rate significantly improved in the sling group (60.0%, p=0.0365) as compared to the nonsling group (25.0%) at 1 month despite no difference at 3 months (86.7% in the sling group vs. 65.0% in the nonsling group, p=0.1467) postoperatively. Postoperative complications related to sling procedure were not detected. CONCLUSIONS Despite a small sample size in the single-institution study, this sling technique may improve early urinary continence recovery after robot-assisted radical prostatectomy even without nerve-sparing. A larger study is needed to confirm its efficacy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e908-e909 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yuji MAEDA More articles by this author Toshimitsu MISAKI More articles by this author Osamu UEKI More articles by this author Tetsuyuki KUROKAWA More articles by this author Yukinosuke OSHINOYA More articles by this author Ken-ichi NAGANO More articles by this author Haruo HISAZUMI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

ReMeEx device (External Mechanical Regulator) for female stress urinary incontinence: a critical review of a single-operator, long-term experience on implants and readjustments.

A single-operator, long-term (15 years) experience on a sling technique that allows a postoperative adjustment of its tension is presented to retrospectively report the objective and subjective outcomes in the treatment of female stress urinary incontinence (SUI). The readjustment option prevents the need of a reoperation in case of relapse with great compliance of the patients. Indications for surgical tratment of SUI by ReMeEx included patients affected with not only true intrinsic sphyncteric deficency (ISD) and fixed urethra but also mild urethral hypermobility, previous incontinence surgery and relapsing conditions such as diabetes and obesity. Fifty-five female patients with severe SUI underwent ReMeEx system positioning between 1998 and 2013. Before surgery, patients were evaluated by physical examination, translabial ultrasonography, urodynamics, pad-test and compilation of a specific incontinence quality of life questionnaire. Out of 55 patients treated, 50 were cured with readjustment in 10; in one case, the device was removed for infection. Complications as one transitory retention, two de novo urgency and one sovrapubic varitensor seroma were easily treated. In our experience, the ReMeEx system produced remerkable long-term results that showed the effective role of this device in obtaining an adequate sling tension, also confirmed in a worse prognosis patient group, as reported in the present study. The limitation of this study, based on a retrospective and not comparative analysis, suggests the need for randomized prospective studies comparing the ReMeEx procedure with other similar anti-incontinence techniques. ReMeEx system offers the possibility to modify the sling support whenever needed during patients' life. By this device, we can improve the outcomes of these patients leaving them completely dry without reoperations. The system produced remarkable 15 years results with a low complication rate. These outcomes have also been confirmed in a worse prognosis patient group as reported in the present study.

Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up.

The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it. This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique. Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap. Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P < .001), as shown by the distances measured between titanium clip locations. After 10 years of follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest. 2 Therapeutic.

"Modified Adductor Sling Technique"- a surgical therapy for patellar instability in children and adolescents

Aims and Objectives:Due to open femoral physis, the therapy of patellar instability in children and adolescents is challenging. We developed a surgical technique, modified form of the "Adductor-Sling-Technique" by Sillanpää which offers a surgical treatment to avoid damage to the femoral physis. The purpose of this study is to determine whether there is a benefit in the clinical outcome for patients operated by the "modified Adductor Sling Technique" in comparison to patients with other surgical procedures.Materials and Methods:Twenty "modified Adductor Sling" reconstructions in 19 patients (age 11-24) were included in the study until now, 15 patients with open physis and 4 patients with closed physis with special indications. Since 2010 "modified Adductor Sling" reconstruction was performed by looping the gracilis tendon around the adductor magnus tendon and attaching it at the medial facette of the patella. Clinical outcome was retrospectively evaluated at a mean follow-up period of 1.3 years (range 0.5-3.6). The evaluation also included Lysholm Score, Kujala Score and DGU score. Statistical analysis was performed using IBM®SPSS®Statistics Version 21. A P value less than 0.5 was considered significant.Results:The average age at the time of operation was 14.9 years (range 11.2-24.3). Recurrent dislocation occurred in 4 out of 20 cases (20%). It was noticeable that out of those 4 patients 2 patients had a lateral release in addition to the "modified Adductor Sling Technique" due to lateral hyperpression. No other patients had a lateral release in our patient population. Also, out of those 4 patients 3 patients had an additional maltracking of the patella, caused by a high TTTG, severe trochlea dysplasia or additional axial deformity. The overall Kujala Score was 87 (range 46-100) points, in patients without re-dislocation it was 94 (range 46-100) points. The overall Lysholm Score was 85 (range 39-100) points, in the group without re-dislocation 90 (range 39-100) points. The mean TTTG was 16,59 (range 11,7-21,4) mm, in the group without re-dislocation it was 16,24 (range 11,7-21,4) mm. There was no significant difference between the patients with or without re-dislocation(p=0,312).Conclusion:The "modified Adductor Sling Technique" offers relevant clinical improvements in knee function and pain. An advantage is the avoidance of damaging the femoral physis. Our Hypothesis of less recurrent dislocation rates could not be confirmed. The re-dislocation rate was even higher than in MPFL reconstruction using femoral fixation in adults. Patients with patellar instabilities without maltracking (no severe trochlea dysplasia, no axial deformity, moderately elevated TTTG) and open physis benefit from the "modified Adductor Sling Technique". This technique is not recommended in patients with patellar instability and additional maltracking.

Long-term results following polydioxanone sling fixation technique in unstable lateral clavicle fracture.

Neer type II (Edinburgh type 3B) fractures of the lateral clavicle are unstable fractures. The optimal management of these fractures remains controversial with many surgical techniques described in the literature. Our study reports the long-term results of a modified suture (1.5-mm polydioxanone cord) and sling technique for these fractures to avoid complications associated with current techniques in the literature. Over a 5-year period, 23 patients who were (12 males, 11 females; 14 left, 9 right) with a mean age of 42 years were treated with this technique. At last follow-up, the mean Oxford score was 45.1 (range 36-48); the mean SPADI score was 7.4 (range 0-32.3); and the mean Constant score was 91.5 (range 71-100). There were one non-union and no malunion. All patients in our series, except one, returned to their pre-injury activity level. This modified suture fixation technique is safe, technically simple to perform and cheap. It achieves excellent rates of fracture union without the complications associated with other fixation methods in the literature.