Tissue Reinforcement Research Articles

Carbonized Polymer Dot-Tannic Acid Nanoglue: Tissue Reinforcement with Concurrent Fluorescent Tracking, Insulin Delivery, and Reactive Oxygen Species Regulation for Normal and Diabetic Wound Healing.

Nanotizing biosealant components offer a multitude of chemical functionalities for superior adhesion-cohesion, delivering unique properties for comprehensive wound healing that are otherwise impossible to achieve using commercial variants. For the first time, a two-step controlled hydrothermal pyrolysis is reported to nanotize dopamine, phloroglucinol, and glutaraldehyde into carbon dot (CD) to be subsequently converted into carbonized polymer dot (CPD) with gelatin as a co-substrate. Chemical crosslinking of CD with gelatin through Schiff base formation before the second pyrolysis step ensures a complex yet porous polymeric network. The retention of chemical functionalities indigenous to CD substrates and gelatin along with the preservation of CD photoluminescence in CPD for optical tracking is achieved. A unique nanoformulation is created with the CPD through tannic acid (TA) grafting evolving CPD-TA nanoglue demonstrating ≈1.32MPa strength in lap shear tests conducted on porcine skin, surpassing traditional bioadhesives. CPD-TA nanoglue uploaded insulin as chosen cargo disbursal at the wound site for healing normal and in vitro diabetic wound models using HEKa cells with extraordinary biocompatibility. Most importantly, CPD-TA can generate reactive oxygen species (ROS) and scavenge simultaneously under ambient conditions (23W white LED or dark) for on-demand sterilization or aiding wound recovery through ROS scavenging.

Adaptive strategies based on shrub leaf-stem anatomy and their environmental interpretations in the eastern Qaidam Basin

BackgroundWater stress seriously affects the survival of plants in natural ecosystems. Plant resistance to water stress relies on adaptive strategies, which are mainly based on plant anatomy with following relevant functions: (1) increase in water uptake and storage; (2) reduction of water loss; and (3) mechanical reinforcement of tissues. We measured 15 leaf-stem anatomical traits of five dominant shrub species from 12 community plots in the eastern Qaidam Basin to explore adaptive strategies based on plant leaf-stem anatomy at species and community levels. and their relationship with environmental stresses were tested.ResultsResults showed that the combination of leaf-stem anatomical traits formed three types of adaptive strategies with the drought tolerance of leaf and stem taken as two coordinate axes. Three types of water stress were caused by environmental factors in the eastern Qaidam Basin, and the established adaptive strategy triangle could be well explained by these environmental stresses. The interpretation of the strategic triangle was as follows: (1) exploitative plant strategy, in which leaf and stem adopt the hydraulic efficiency strategy and safety strategy, respectively. This strategy is mostly applied to plants in sandy desert (i.e., Nitraria tangutorum, and Artemisia sphaerocephala) which is mainly influenced by drought stress; (2) stable plant strategy, in which both leaf/assimilation branches and stem adopt hydraulic safety strategy. This strategy is mostly applied to plants in salty desert (i.e., Kalidium foliatum and Haloxylon ammodendron) which aridity has little effect on them; and (3) opportunistic plant strategy, in which leaf and stem adopt hydraulic safety strategy and water transport efficiency strategy. This strategy is mostly applied to plants in multiple habitats (i.e., Sympegma regelii) which is mainly affected by coldness stress.ConclusionThe proposed adaptive strategy system could provide a basis for elucidating the ecological adaptation mechanism of desert woody plants and the scientific management of natural vegetation in the Qinghai-Tibet Plateau.

A Comparison of Ovine-Reinforced Hybrid Mesh (OviTex PRS) With Porcine Acellular Dermal Matrix (STRATTICE) in the Treatment of Advanced Breast Implant Capsular Contracture.

Tissue reinforcement techniques with porcine acellular dermal matrices (ADMs) have been widely adopted as standard care in treating capsular contracture. However, the application of alternative xenograft or mesh materials has not been widely studied. To examine the efficacy of OviTex PRS Reinforced Tissue Matrix (Resorbable) (TELA Bio, Malvern, PA), a hybrid ovine-reinforced mesh, in comparison with STRATTICE Reconstructive Tissue Matrix (Allergan, Irvine, CA), in patients with advanced capsular contracture. A retrospective review was conducted on patients who underwent breast revision surgery for Baker Grade III or IV capsular contracture. Patient data were reviewed for outcomes, complications, cost, and postoperative incidence of recurrent capsular contracture after treatment with each specific mesh. Fifty-nine of 89 breasts (66.3%) were treated with OviTex and 30 (33.7%) were treated with STRATTICE. All patients experienced a reduction in Baker grades. In patients treated with OviTex, 96.6% (n = 57) of breasts had a postoperative Baker Grade I with the remaining 3.4% (n = 2) breasts presenting with a Baker Grade II. In comparison, 73.3% (n = 22), 23.3% (n = 7), and 3.3% (n = 1) of the STRATTICE cohort presented with Baker Grades I, II, and III, respectively. This demonstrated a statistically significant improvement in Baker grade capsular contracture in the OviTex cohort (P < .05) compared with STRATTICE. Average cost was $27.37/cm2 for STRATTICE compared with $22.28/cm2 for OviTex PRS. OviTex may be successfully utilized to treat capsular contracture. Patient outcomes may be superior to STRATTICE in recurrent capsular contracture, particularly when a previous ADM had been utilized. Cost data show improved savings with the use of OviTex compared with STRATTICE.

Injectable, shear-thinning, photocrosslinkable, and tissue-adhesive hydrogels composed of diazirine-modified hyaluronan and dendritic polyethyleneimine.

In the present study, we report the first synthesis of diazirine-modified hyaluronic acid (HA-DAZ). In addition, we also produced a precursor polymer solution composed of HA-DAZ and dendritic polyethyleneimine (DPI) that showed strong shear-thinning properties. Furthermore, its viscosity was strongly reduced (i.e., from 5 × 105 mPa s at 10-3 s-1 to 6 × 101 mPa s at 103 s-1), substantially, which enhanced solution injectability using a 21 G needle. After ultraviolet irradiation at 365 nm and 6 mW cm-2, the HA-DAZ/DPI solution achieved rapid gelation, as measured using the stirring method, and its gelation time decreased from 200 s to 9 s as the total concentrations of HA-DAZ and DPI increased. Following UV irradiation, the storage modulus increased from 40 to 200 Pa. In addition, reversible sol-gel transition and self-healing properties were observed even after UV irradiation. This suggests that the HA-DAZ/DPI hydrogel was crosslinked in multiple ways, i.e., via covalent bonding between the diazirine and amine groups and via intermolecular interactions, including hydrogen bonding, electrostatic interactions, and hydrophobic interactions. A lap shear test showed that the HA-DAZ/DPI hydrogel exhibited strong adhesiveness as a fibrin glue following UV irradiation. Finally, the HA-DAZ/DPI hydrogel showed higher tissue reinforcement than fibrin glue in an ex vivo burst pressure test of the porcine esophageal mucosa.

Gradient myopic defocus causes scleral tissue reinforcement and structural scleral remodelling

Aims/Purpose: To determine histological effects of lens induced refractive change on scleral remodelling in chicks.Methods: 18 Ross‐Ross chicks were raised for 14 days on a 14 hr light/10 hr dark cycle. 6 chicks were allowed to develop normally. 6 chicks wore conventional ‐10D lenses for the full 14 days. 6 chicks wore conventional ‐10D lenses for the first 7 days and myopia progression control (MPC) lenses or the next 7 days. MPC lenses had a central power of ‐10D and a gradient power rise at pupil edge (+ 2.75D). Birds were euthanized after 14 days and eyes were routinely processed for histopathological evaluation. Whole mount H&amp;E‐stained tissue sections were microscopically analysed using bright field microscopy.Results: All lens treated birds developed significant myopia as expected Total scleral thickness was significantly reduced in the group wearing conventional ‐10 lenses (p &lt; 0.05), but remained comparable to the normal control group for the MPC lenses treated birds. New appositional growth of the cartilaginous sclera was observed in all MPC lenses treated eyes and only in those eyes. The thickness of the cartilaginous component of the sclera was 135 ± 6, 153 ± 5, 125 ± 8 μm for conventional myopic, MPC lenses treated, and control birds respectively. There was a significant increase in the cartilaginous scleral thickness in the MPC lenses treated birds compared to the other two groups (p &lt; 0.03), but not between the conventional ‐10D lens treated and control birds (p &gt; 0.05).Conclusions: It is possible to induce appositional growth in hyaline cartilage in the chick sclera. In our study, this has only been achieved by using MPC lenses to reverse previously induced experimental myopia with conventional minus lenses. Our finding suggests that gradient decrease in peripheral lens power and the resulting differential level of defocus it causes could be a potential trigger of scleral reinforcement through stimulation of cartilage growth in the chick sclera.

Implantable Biologics for Soft Tissue Surgery Reinforcement.

Soft tissue reinforcement focuses on medical grafts that are designed to support and regenerate soft tissue under or near suture lines. Soft tissue is defined as areas of similarly specialized cells that function to connect, support, and surround other structures and organs of the body. These tissues include skin, subcutaneous tissue, fascia, ligaments, tendons, fibrous tissues, fat, synovial membranes, and muscle. Most of the implantable devices used for this purpose are made of collagen, the most abundant protein in mammals and a key component of the extracellular matrix of soft tissues that allows for tissue repair. For suture line reinforcement, exogenous collagen from various sources is implanted under or in continuity with the suture line to allow for increased strength and better healing. First introduced in the field of breast reconstruction, this practice is now also used in hernia repair, dural repair, vaginal slings, amputation reinforcement, tendon repair reinforcement, and even dental soft tissue regeneration.

Is a soft tissue reinforcing mesh necessary in immediate prosthetic breast reconstruction for early breast cancer in patients with low-volume breast? A single-center, retrospective Chinese clinical study.

It is controversial as to whether soft tissue reinforcement mesh should be used for immediate prosthetic breast reconstruction after nipple-sparing mastectomy for low-volume breast early breast cancer (LVBEBC) in Chinese adult women. We collected data on 89 patients with LVBEBC who underwent such a surgery and divided them into two groups: 39 patients in the totally subpectoral prosthesis-only breast reconstruction group (simple group) and 50 patients in the prosthesis-combined titanium-coated polypropylene mesh (TCPM) group (or the so-called "dual plane" or "mesh-assisted partially subpectoral breast reconstruction group") (combined group). The results demonstrated no difference in operative time, intraoperative bleeding, and postoperative complications between the two groups; however, total drainage volume and extubation time were less and shorter, respectively, in the combined group. The median follow-up time was 18.6months without local recurrence or distant metastasis in both groups. At 24months after surgery, the excellent and good rates of breast reconstruction were higher in the combined group. However, patients' BMI, breast morphology, and breast volume of 300mL or more had an effect on the shape of the reconstructed breast; in addition, in patients with higher BMI, conical breast morphology, and breast volume over 300mL, the shape of the breast was more perfect with the prosthesis combined with TCPM reconstruction.Trial registration: This retrospective study was "retrospectively registered" in the Sixth Affiliated Hospital of South China University of Technology of China on March 15, 2022 (No. 2022018) and in the National Medical Research Registry filing system of China ( https://www.medicalresearch.org.cn ) (No. MR-44-22-003618).

Post-Maturation Reinforcement of 3D-Printed Vascularized Cardiac Tissues.

Despite advances in biomaterials engineering, a large gap remains between the weak mechanical properties that can be achieved with natural materials and the strength of synthetic materials. Here, a method is presented for reinforcing an engineered cardiac tissue fabricated from differentiated induced pluripotent stem cells (iPSCs) and an extracellular matrix (ECM)-based hydrogel in a manner that is fully biocompatible. The reinforcement occurs as a post-fabrication step, which allows for the use of 3D-printing technology to generate thick, fully cellularized, and vascularized cardiac tissues. After tissue assembly and during the maturation process in a soft hydrogel, a small, tissue-penetrating reinforcer is deployed, leading to a significant increase in the tissue's mechanical properties. The tissue's robustness is demonstrated by injecting the tissue in a simulated minimally invasive procedure and showing that the tissue is functional and undamaged at the nano-, micro-, and macroscales.

Age-dependent mechanical properties of tail tendons in wild-type and mimecan gene-knockout mice – A preliminary study

Mimecan, or osteoglycin, belongs to the family of small leucine-rich proteoglycans. In connective tissues mimecan is implicated in the development and maintenance of normal collagen fibrillar organization. Since collagen fibrils are responsible for tissue reinforcement, the absence of mimecan could lead to abnormal tissue mechanical properties. Here, we carried out a preliminary investigation of possible changes in the mechanical properties of tendons in mice lacking a functional mimecan gene, as a function of age. Tail tendons were dissected from mimecan gene knockout (KO) and wild type (WT) mice at ages 1, 4 and 8 months and mechanical properties evaluated using a microtensile testing equipment. Mimecan gene knockout resulted in changes in tendon elasticity- and fracture-related properties. While tendons of WT mice exhibited enhanced mechanical properties with increasing age, this trend was notably attenuated in mimecan KO tendons, with the exception of fracture strain. When genotype and age were considered as cross factors, the diminution in the mechanical properties of mimecan KO tendons was significant for yield strength, modulus and fracture strength. This effect appeared to affect the mice at 4 month old. These preliminary results suggest that mimecan may have a role in regulating age-dependent mechanical function in mouse tail tendon.

A Unique Approach to Neurosurgical Wound Closure With Porcine Urinary Bladder Matrix: An Illustrative Case Series

Introduction. PUBM is a non-synthetic, completely resorbable xenograft product with a myriad of uses, including management of burns, acute and chronic wounds, soft tissue reinforcement, and hernia repair. The material is available in both powder and sheet forms which allows for excellent coverage of irregularly shaped wounds. Case Report. The authors present 2 challenging neurosurgical wound cases. The first case is a large thoracolumbar wound secondary to a laminectomy complicated by a high output CSF fistula and dermal dehiscence. The second case is a deep postoperative surgical site infection in the setting of a large amount of surgical hardware. Both cases were successfully managed to complete wound healing with PUBM. Conclusion. Neurosurgical wounds can be technically challenging and difficult to manage. CSF fistulas lack evidence for standard treatment strategy, making complications and chronic wounds more likely. The application of PUBM in the closure of neurosurgical wounds has not been thoroughly studied and may lead to improved wound closure.

Evaluation of Xenograft Efficacy in Immediate Prosthesis-based Breast Reconstruction

INTRODUCTION: The advent of acellular dermal matrix (ADM) has revolutionized prosthesis-based breast reconstruction, conferring soft tissue reinforcement to the mastectomy skin flap. However, paucity of human cadaveric tissue has resulted in limitation of supply and increased associated costs, prompting concerted effort to identify alternatives to human ADM, such as xenograft surgical adjuncts, to minimize cost burden to the patient and institution, while maintaining adequate soft tissue support. Although various studies have examined the safety of Artia, a porcine-derived ADM, in prosthesis-based breast reconstruction, few studies have evaluated its clinical efficacy as soft tissue reinforcement. This study uniquely compares clinical efficacy of Artia with AlloDerm, a commonly used human-derived ADM, by examining objective parameters of initial tissue expander (TE) fill volume at the time of mastectomy, number of TE fills, and time interval between exchange of TE for final implant. METHODS: IRB approved retrospective chart review was conducted to identify 273 consecutive TE-based procedures performed at a tertiary academic medical center between March 2017 and March 2021. Of these, 89 cases utilized Artia and 184 utilized AlloDerm. Univariate and binomial logistic regression analyses were conducted to compare patient characteristics and clinical endpoints between Artia and AlloDerm groups. RESULTS: Patients who underwent Artia-based breast reconstruction achieved comparable initial TE fill volume relative to those who underwent AlloDerm-based breast reconstruction (335 ± 198 mL versus 289 ± 158 mL, p = 0.10) and similar time interval to TE-implant exchange (232 ± 124 days versus 242 ± 131 days, p = 0.70) via univariate analysis. However, patients who underwent Artia-based reconstruction experienced fewer number of tissue expansions (3.92 ± 2.97 fills versus 4.99 ± 2.98 fills, p < 0.01). When normalizing for final implant size, which serves as a surrogate for body composition, the Artia group exhibited significantly higher perioperative fill (0.65 ± 0.34 v. 0.49 ± 0.19, p < 0.01). Rates of explantation were higher in the AlloDerm group; however, when controlling for confounding variables, no statistical significance was observed following binomial regression analysis. Otherwise, rates of post-operative complication were similar among groups. CONCLUSION: This study demonstrates efficacy of Artia as an alternative to human-derived ADM in immediate TE-based breast reconstruction. Demonstration of clinical efficacy of non-human cadaveric surgical adjuncts is of paramount importance to facilitate widespread acceptance of these materials and further decrease healthcare costs. This work, therefore, serves as a framework for future studies evaluating xenograft efficacy in breast reconstruction and can guide development of emerging biomaterials and techniques.

OC-035 TEST METHODS FOR SURGICAL MESHES - AN INDUSTRY POINT OF VIEW

Abstract Aim No standardized test methods currently exist for the characterization of the synthetic surgical meshes used in hernia repair and soft tissue reinforcement. While each mesh manufacturer developed their own test methods for comparative analysis, these were never harmonized across industry. A subgroup of the European Association of the Surgical Suture Industry (EASSI) was constituted, the Standardization of Surgical Meshes Working Group (SSM WG) with the objective to reach alignment of surgical meshes test methods. Materials &amp; Methods The SSM WG agreed on the test methods that should be defined to provide a thorough in-vitro-characterization and comparison of surgical meshes. After several interlaboratory iterations, the group established common test protocols which may be performed by people with limited textile background. Extensive inter-laboratory test method verifications were then performed by conducting tests with different specimens by all manufacturers in a consistent manner. Results Common protocols were defined for the following test methods: Linear Tensile Test (Strength and elongation), Burst Test (Strength and displacement), Suture Pull-Out Test (Strength), Pore Size Measurement (Porosity and pore dimensions). 4 meshes were tested by each of the 4 involved manufacturers to assess the protocols validity. Despite methods harmonization, differences could be observed between laboratories. Conclusion The SSM WG recommends following the test protocols described and to maximize the sample size. Due to high sensitivity of specimen and difference in equipment used, only results of tests performed by a single testing center using identical testing features for all tested meshes should be compared.

Investigating the Psychosocial Dimension of Perinatality in Cameroon

Introduction: It is well known that events occurring during the prenatal period may affect the outcome of perinatality. Although the psychopathological theories that give account of psychological conflicts of the perinatal period are well described, these may be aggravated by a number of psychosocial factors which may vary according to context. Methodology: We investigated some of these factors through a case-control study among Cameroonian women who manifested psychic impairments few days after delivery. The study was conducted in two university teaching hospitals of Yaoundé, over a period of six months. Results: We observed that a number of psychosocial factors can effectively impact the quality of the perinatal period with serious maternal and neonatal repercussions. These factors are related with class distinctions, unequal distribution of wealth, health inequalities, and the poor quality of social relationships. Conclusion: We may therefore conclude that preventing psychosocial risk factors through the reinforcement of the socioeconomic tissue and health systems may ease perinatality with favorable outcomes. Keywords: Perinatality; Psychosocial Factors; Maternity; Postpartum

Supramolecular Tools to Improve Wound Healing and Antioxidant Properties of Abietic Acid: Biocompatible Microemulsions and Emulgels.

Abietic acid, a naturally occurring fir resin compound, that exhibits anti-inflammatory and wound-healing properties, was formulated into biocompatible emulgels based on stable microemulsions with the addition of a carbamate-containing surfactant and Carbopol® 940 gel. Various microemulsion and emulgel formulations were tested for antioxidant and wound-healing properties. The chemiluminescence method has shown that all compositions containing abietic acid have a high antioxidant activity. Using Strat-M® skin-modelling membrane, it was found out that emulgels significantly prolong the release of abietic acid. On Wistar rats, it was shown that microemulsions and emulgels containing 0.5% wt. of abietic acid promote the rapid healing of an incised wound and twofold tissue reinforcement compared to the untreated group, as documented by tensiometric wound suture-rupture assay. The high healing-efficiency is associated with a combination of antibacterial activity of the formulation components and the anti-inflammatory action of abietic acid.

Evaluation of Xenograft Efficacy in Immediate Prosthesis-based Breast Reconstruction.

Background:The advent of acellular dermal matrix (ADM) has revolutionized prosthesis-based breast reconstruction. However, paucity of human cadaveric tissue has resulted in limitation of supply and increased associated costs, prompting concerted effort to identify xenograft alternatives. Although studies have examined the safety of Artia, a porcine-derived ADM, few have evaluated its clinical efficacy as soft tissue reinforcement. This study uniquely evaluates the clinical efficacy of Artia in implant-based breast reconstruction.Methods:IRB-approved retrospective chart review was conducted to identify 243 consecutive TE-based procedures performed at a tertiary academic medical center between March 2017 and March 2021. Propensity matching was conducted to minimize differences between cohorts. Efficacy metrics, defined as initial tissue expander (TE) fill volume, number of TE fills, and time interval between exchange of TE for final implant, were compared between xenograft (Artia) and allograft (AlloDerm) groups.Results:Patients who underwent Artia-based breast reconstruction achieved superior initial TE fill volume relative to those who underwent AlloDerm-based breast reconstruction via univariate analysis (317.3 ± 185.8 mL versus 286.1 ± 140.4 mL, P < 0.01) when patient and operative characteristics were well-matched. However, linear regression analysis failed to demonstrate difference in efficacy metrics, such as initial TE fill volume (P = 0.31), ratio between initial TE fill volume and final implant size (P = 0.19), and number of TE fills (P = 0.76). Complication rates were comparable between groups.Conclusion:This study suggests that Artia can be used as a safe and efficacious alternative to human-derived ADM in immediate TE-based breast reconstruction.

Carbon Nanostructures for Ocular Tissue Reinforcement.

PurposeThe purpose of this study was to improve the biomechanical properties of the cornea through the incorporation of carbon nanostructures.MethodsHealthy Japanese rabbits were used to evaluate the effect of carbon nanostructures’ incorporation in the cornea. Rabbits were divided in two groups A and B. In each of these groups, the corneas were divided in (i) corneas not submitted to any treatment (the control group), (ii) corneas modified either with carbon nanostructures (group A), or with the traditional cross-linking technology (group B). After modification, rabbits were euthanized at different time intervals. The biomechanical properties of the treated corneas were evaluated using the inflation method.ResultsBiomechanical tests based on the inflation method show that the incorporation of carbon nanostructures to the cornea and their proper distribution within it gives rise to a large improvement in the mechanical properties and tangential elastic modulus (up to 155%). These results anticipate that this novel and easy approach based on nanotechnology is able to compete with the actual cross-linking technology applied in clinical ophthalmology using a photosensitive molecule, such as riboflavin and unpleasant UV-A radiation.ConclusionsThe incorporation of carbon nanostructures (single-walled carbon nanotubes and graphene) in corneal stroma is proposed as a promising alternative to improve the mechanical properties in the treated eyes. The proper dispersion of the carbon nanostructures a few days after implementation (down to 60 micrometers depth) explains the successful results achieved.Translational RelevanceNanotechnology applied to the eye constitutes a promising approach for ocular tissue reinforcement.

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study.

Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30- and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

Predictive Value of Tissue-induced Oxidative Stress on Urogynecology Synthetic Graft Reinforcement: An Experimental Animal Study

Background: The success of urogynecology synthetic grafts depends on adequate tissue reinforcement. This experimental animal study aimed to determine the abdominal wall reinforcement achieved by different urogynecology synthetic grafts, including the influence of inflammatory cells, collagen deposits, and tissue-induced oxidative stress. Methods: Electron microscopic analysis of six different grafts, all with Polypropylene as their major component, was performed to determine the primary mesh characteristics. Full-thickness abdominal wall defects were repaired using monofilament, multifilament, and coated grafts in male Wistar rats. After six weeks, the animals were sacrificed and the inflammatory response, collagen deposition, and oxidative stress levels were quantified. Using the digital acquisition system (Hottinger Baldwin Messetechnik (HBM) “Catman Easy”, Darmstadt, Germany), mechanical testing of the native grafts and of the reinforced abdominal wall was conducted and measured in a controlled environment. Multivariate analysis was performed to determine the predictive value of inflammatory cell numbers, collagen amount, oxidative stress, and native graft strength on the final abdominal wall reinforcement. Results: The inflammatory response was significantly more prominent with the multifilament polypropylene compared to the low-weight monofilament polypropylene (p &lt; 0.05). Collagen deposits varied between the groups, reaching statistical significance only for multifilament polypropylene vs. titanium-coated polypropylene (p &lt; 0.05). The oxidative stress results demonstrated a positive correlation with graft weight, regardless of coating or different graft structures (p &lt; 0.05). The number of inflammatory cells and collagen amount did not influence the final abdominal reinforcement, while tissue-induced oxidative stress presented with a negative influence in all groups. Conclusions: Tissue-induced oxidative stress negatively affected grafts in this animal experiment. This finding might be useful (at least partially) in predicting the effectiveness of urogynecology synthetic graft tissue reinforcement and also, in promoting this reinforcement.

Pharyngesophageal Diverticula Following Anterior Cervical Discectomy and Fusion.

Development of traction pharyngesophageal diverticula following anterior cervical discectomy and fusion (ACDF) is a rare but morbid cause of dysphagia and the optimal surgical management is unclear. PubMed, GoogleScholar, Embase database reviews of "traction diverticula/um + anterior cervical/ACDF." Patient demographics, presenting symptoms, surgical technique, and outcomes were compared. Seventeen manuscripts reported 21 cases of pharyngesophageal diverticulum (PED) following ACDF (10 F:11 M, mean age 45 years). Presenting symptoms included dysphagia (n = 18), regurgitation (n = 10), and weight loss (n = 6). The average interval to presentation was 4.5 years after ACDF (range: 6 months-18 years) and ACDF levels most commonly involved were C5-C6 and/or C6-C7 (n = 12). Open diverticulectomy with (n = 12) and without (n = 6) cricopharyngeal myotomy was the most common approach and reinforcement with vascularized tissue was used in 6 patients (29%). Attempted endoscopic diverticula repair was successful in 1 patient, was converted to open repair in 5 patients, and 1 patient did not have surgical repair. ACDF hardware was removed in 11 cases (52%) and was routinely removed when concomitant infection was present. Complications following repair were reported in 6 patients (30%). Traction pharyngesophageal diverticula are a rare cause of dysphagia which occur after a variable interval following ACDF. Open surgical diverticulectomy yields superior outcomes compared to the endoscopic approach. In the setting of infection hardware removal is recommended. Vascularized tissue reinforcement can limit potential esophageal leak; however, the risk of post-operative complications remains high.

792 Complete wound healing utilizing procine urinary bladder matrix in a serise of traumatic wounds with significant soft tissue loss

PUBM is a non-synthetic, completely resorbable xenograft product with a myriad of uses including management of burns, acute and chronic wounds, soft tissue reinforcement, and hernia repair. The material is available in both powder and sheet form allowing for excellent coverage of irregularly shaped wounds. We present three patients with significant soft tissue loss that underwent xenograft implantation utilizing PUBM. Despite challenging locations and severity of wounds, 100% healing and wound closure with excellent cosmetic results was achieved.