Type Of Repair Research Articles

8. Learning Curve of Wrist Level Tendon Repairs using a Novel Tendon Stapler Device vs. Traditional Suture Methods

Background: Tendon repairs in spaghetti wrists, wrist level replantation, or vascularized composite hand allotransplantations are time-consuming. Experience and skill greatly influence overall time in the operating room. A novel tendon stapler device (TSD) has the potential to mitigate these discrepancies among surgeons of varying levels of experience by enhancing the speed and consistency of primary tendon repairs. Methods: Participants of varying levels of surgical experience (novice, intermediate, expert) performed tendon repairs via suture method or TSD. Comparisons were performed on wrist level flexors and extensors from human cadaver arms. Suture repairs were performed using 3.0 braided polyester modified Kessler with horizontal mattress for a 4-strand repair. On matched, contralateral donor arms, TSD repairs were completed with a single simple 5.0 polypropylene stitch to approximate the tendon ends prior to device deployment. All repairs were timed by a non-participating data recorder. Learning curves were compared across repair types and surgeons with scatterplots fitted with Loess curves. Statistical analyses utilized one-way ANOVA, Tukey pairwise comparisons, two-sided independent samples t-test, and Fisher’s exact test. Results: A total of 228 tendon repairs from 12 donor arms were analyzed. Mean suture repair times were 3.25, 4.08, and 4.46 minutes for expert, intermediate, and novice, respectively with the expert being faster than the other two groups (p≤0.001). Mean TSD repair times were 1.32, 1.31, 1.28 minutes for expert, intermediate, and novice respectively, with no difference between groups. TSD repairs were significantly faster than suture repair (p<0.01). Suture repairs decreased to stable or “learned” level around repair #30, and then demonstrated small increases at the end of the session, suggesting user fatigue. TSD repairs showed faster, less variable time that stabilized around repair #23, consistent with a more efficient learning curve. Educational time required for both novice and intermediate groups to achieve competency was higher for the suture technique (106 and 54 minutes) than for the TSD (60 and 38 minutes). Conclusion: The TSD demonstrates tremendous potential for complex multi-tendon traumas by drastically reducing the learning curve, operative and warm ischemia times, overall cost, and surgeon variability based on experience and repair strength.

Comparative performance of three comorbidity scores in predicting survival after the elective repair of abdominal aortic aneurysms.

We aimed to study the discriminative power of 3 comorbidity scores for predicting 5-year survival after the elective repair of aorto-iliac aneurysms (AAA). 444 patients with AAA undergoing elective repair (33% open and 67% endovascular) between 2000 and 2020 were reviewed. The Charlson Comorbidity Index (CCI) and subsequent adjustments by Schneeweiss, Quan and Armitage, the Modified Frailty Index (MFI) and the American Society of Anesthesiologists Score (ASA) were calculated from preoperative data. Their association with 5-year survival was analyzed using Cox regression models and their discriminative power and its changes with C statistics and Net Reclassification Index (NRI). All comorbidity scores were associated with survival after adjusting by age, sex and type of surgical repair: original CCI HR=1.24, P<0.001; Schneeweiss CCI HR=1.23, P<0.001; Quan CCI HR=1.27, P<0.001, Armitage CCI HR=1.46, P<0.001, MFI HR=1.39, P<0.001 and ASA HR=1.68 (P=0.04) and 2.86 (P=0.01) for classes III and IV, respectively. Associated C statistics were of 0.64, 0.65, 0.65, 0.64, 0.61 and 0.59, respectively. Compared with the original CCI, models based on Schneeweiss CCI and Armitage CCI provided minor improvements in NRI (0.32 and 0.23), and the model based on ASA showed lower C statistics (P=0.014) and NRI (-0.30). Established comorbidity scores, such as CCI, MFI or ASA, are all associated with 5-year survival after the elective repair of AAAs, being ASA the worst of them. However, their predictive power is in no case sufficient to identify, by themselves, those patients who may not be eligible for intervention on the basis of life expectancy.

Penentuan Prioritas Perawatan Berdasarkan Hasil Track Quality Index (TQI) Jalur Kereta Api Antara Stasiun Semarang Poncol – Stasiun Alastua

PT. Kereta Api Indonesia (Persero) has a measuring train that is used to determine the condition of the railroad tracks. The output of measuring train is a railroad quality value called the TQI (Track Quality Index). The TQI value can used to determine priority rail road maintenance. This study aims to determine the TQI category of the railroad between Semarang Poncol - Alastua, then determine improvement priorities and maintenance programs. The results of the analysis of the Semarang Poncol-Alastua cross-section railway data have an average category II for 20 &lt; TQI ≤ 35. For priority treatment based on the results of the first point TQI on the SMT-ATA upstream track KM 0+156/188 Type Device LK (arch) with a TQI value of 48.1 categories III with an alert condition, an immediate corrective action program and track laying. Downstream track ATA-SMT KM 1+993/975 with a TQI value of 48.1 categories III with an alert condition, an immediate corrective action program and for the type of repair is track laying.

Does ketorolac administration at the time of hypospadias surgery increase unplanned encounters in the immediate postoperative period?

The opioid crisis has raised concerns for long-term sequela of routine administration of opioids to patients, particularly in the pediatric population. Nonsteroidal anti-inflammatory drug use is limited in hypospadias surgery due to concerns for post-operative bleeding, particularly with ketorolac. We hypothesize that ketorolac administration at the time of hypospadias repair is not associated with increased bleeding or immediate adverse events. A retrospective single institution study included all patients undergoing hypospadias surgery from 2018 to 2021. Outcomes measured include peri-operative ketorolac administration, opioid prescriptions, and unplanned encounters (i.e., emergency department or office visits). Comparative statistics using non-parametric and binary/categorical tests and a logistic regression were performed. 1044 patients were included, among whom there were 562 distal, 278 proximal and 204 hypospadias complication repairs. Ketorolac was administered to 396 (37.9%) patients and its utilization increased during the study period [Summary Figure]. Patients receiving ketorolac were older (p=0.002) and were prescribed opioids less often after surgery (2.0% vs 5.2%, p=0.009). There was no difference in unplanned encounters across repair types (p=0.1). Multivariate logistic regression showed ketorolac use was not associated with an increased likelihood of an unplanned encounter. The use of NSAIDs post-operatively has traditionally been limited due to concerns about bleeding risks, however the present study displayed no significant increases in unplanned patient encounters either in the ED or outpatient clinic after ketorolac administration. Our study has several limitations including its retrospective and single-institutional design, difficulties of pain assessment in pediatric population, and possibility of under estimation of unplanned encounters due to limited access to patients' records outside of our institution. The use of ketorolac is not associated with an increase in unplanned encounters in children undergoing hypospadias repair. It should be considered a safe agent for perioperative analgesia to decrease opioid utilization. Further studies will evaluate long-term surgical outcomes in children receiving ketorolac after hypospadias repair.

Evaluation of late cleft palate repair by a modified technique without relaxing incisions

ObjectiveTo evaluate the postoperative outcomes together with analyzing the associated influencing factors following a late cleft palate repair by the Sommerlad-Furlow modified technique (S-F). Materials and methodsIn a retrospective cohort, 320 consecutive patients with cleft palate, who received S-F technique between 2011 and 2017, were reviewed. The patients were divided into three age groups, less than one year (143), one to two years (113), and greater than 2 years (64). The postoperative outcomes included wound healing (complete/fistula) and velopharyngeal function (VPF). ResultsThe overall cleft width was 10 ± 3.07 mm. The overall rates of complete wound healing and proper velopharyngeal function were 96.6% and 81.56%, respectively. No significant difference was found between the age groups regarding wound healing, with an overall fistula rate of 3.4%. The VPF was significantly varied among the age groups (P<0.001). In context, the rates of velopharyngeal insufficiency (VPI) were 9.8%, 14.2%, and 45.4% among patients repaired at ˂1, 1–2, and >2 years old, respectively. The cleft type was the most potential factor associated with fistula. The age at repair was identified as the most implicating factor for VPI. ConclusionsThe S-F technique had achieved low fistula rate and satisfactory speech outcome, especially in early repair group and even in the wide cleft palate. The older age at repair and severe cleft type had a major impact on the postoperative outcomes.

The impact of race on outcomes following ruptured abdominal aortic aneurysm repair

ObjectivesRacial differences in elective abdominal aortic aneurysm (AAA) repair outcomes have been previously reported; however, data on racial differences in ruptured AAA (rAAA) repair outcomes remain limited. This study assessed in-hospital and long-term mortality after rAAA repair in Black versus White patients. MethodsThe Vascular Quality Initiative database was queried to identify all Black and White patients who underwent open or endovascular rAAA repair between 2003 and 2019. Baseline demographic and clinical characteristics were recorded, and independent t test and χ2 test were performed to assess differences between groups. In-hospital and 8-year mortality rates were the primary outcomes. Univariate and multivariate logistic regression and Cox proportional hazards analyses were conducted to analyze associations between race and outcomes. ResultsOverall, 310 Black patients and 4679 White patients underwent rAAA repair. A greater proportion of Black patients underwent endovascular repair (73.2% vs 56.1%). Black patients had a lower mean age and were more likely to be female, with a greater proportion being Medicaid insured (9.7% vs 2.1%) or uninsured (4.8% vs 3.3%). Although Black patients were more likely to be current smokers and have hypertension, diabetes, and congestive heart failure, they were not more likely to receive risk reduction medications. The time from symptom onset to incision or access was higher for Black patients (median, 12.0 hours vs 7.0 hours). Similarly, the time from hospital admission to intervention was higher for Black patients (median, 2.8 hours vs 1.3 hours). In-hospital mortality was lower in Black patients (20.0% vs 28.6%; odds ratio [OR], 0.63; 95% confidence interval [CI], 0.47-0.83); however, this did not persist after adjusting for baseline characteristics (adjusted OR, 0.58; 95% CI, 0.30-1.07; P = .09). Furthermore, the 8-year survival was not different between groups (50.4% vs 46.6%; hazard ratio, 0.85; 95% CI, 0.57-1.26; P = .42), even when stratified by repair type. ConclusionsThis study identified racial differences in demographic, clinical, and procedural characteristics for patients undergoing rAAA repair. In particular, the door-to-intervention time for Black patients of 2.8 hours does not meet the Society for Vascular Surgery recommendation of 90 minutes. Despite these differences, the 8-year mortality is similar for Black and White patients. These differences should be investigated further, and there are opportunities to improve rAAA care for Black patients.

Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Although hypospadias outcomes studies typically report a level or type of repair performed, these studies often lack applicability to each surgical practice due to technical variability that is not fully delineated. An example is the tubularized incised plate (TIP) urethroplasty procedure, for which modifications have been associated with significantly decreased complication rates in single center series. However, many studies fail to report specificity in techniques utilized, thereby limiting comparison between series. With the goal of developing a surgical atlas of hypospadias repair techniques, this study examined 1) current techniques used by surgeons in our network for recording operative notes and 2) operative technical details by surgeon for two common procedures, tubularized incised plate (TIP) distal and proximal hypospadias repairs across a multi-institutional surgical network. A two-part study was completed. First, a survey was distributed to the network to assess surgeon volume and methods of recording hypospadias repair operative notes. Subsequently, an operative template or a representative de-identified operative note describing a TIP and/or proximal repair with urethroplasty was obtained from participating surgeons. Each was analyzed by at least two individuals for natural language that signified specified portions of the procedure. Procedural details from each note were tabulated and confirmed with each surgeon, clarifying that the recorded findings reflected their current practice techniques and instrumentation. Twenty-five surgeons from 12 institutions completed the survey. The number of primary distal hypospadias repairs performed per surgeon in the past year ranged from 1-10 to >50, with 40% performing 1-20. Primary proximal hypospadias repairs performed in the past year ranged from 1-30, with 60% performing 1-10. 96% of surgeons maintain operative notes within an electronic health record. Of these, 66.7% edited a template as their primary method of note entry; 76.5% of these surgeons reported that the template captures their operative techniques very or moderately well. Operative notes or templates from 16 surgeons at 10 institutions were analyzed. In 7 proximal and 14 distal repairs, parameters for chordee correction, urethroplasty suture selection and technique, tissue utilized, and catheter selection varied widely across surgeons. Wide variability in technical surgical details of categorically similar hypospadias repairs was demonstrated across a large surgical network. Surgeon-specific modifications of commonly described procedures are common, and further evaluation of short- and long-term outcomes accounting for these technical variations is needed to determine their relative influence.

Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return.

Objectives: The surgical technique for right partial anomalous pulmonary venous return (PAPVR) depends on the location of the anomalous pulmonary veins (PVs). With this in mind, we sought to evaluate the impact of 3D heart segmentation and reconstruction on preoperative surgical planning. Methods: A retrospective study was conducted on all patients who underwent PAPVR repair at our institution between January 2018 and October 2021; three-dimensional segmentations and reconstructions of all the heart anatomies were performed. A score (the PAPVR score) was established and calculated using two anatomical parameters (the distance between the most cranial anomalous PV and the superior rim of the sinus venosus defect/the sum of the latter and the distance between the PV and the azygos vein) to predict the type of correction. Results: A total of 30 patients were included in the study. The PAPVR score was found to be a good predictor of the type of surgery performed. A value > 0.68 was significantly associated with a Warden procedure (p < 0.001) versus single/double patch repair. Conclusions: Three-dimensional heart segmentations and reconstructions improve the quality of surgical planning in the case of PAPVR and allow for the introduction of a score that may facilitate surgical decisions on the type of repair required.

Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury.

Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset. Patients undergoing operative repair for IAI were identified from the Trauma Quality Improvement Program database during a 5-year timespan, ending in 2019. Age, sex, race, severity of injury, severity of shock, type of iliac repair (open or endovascular), mechanism, morbidity and mortality were recorded. Patients with IAI were stratified by both type of repair and mechanism and compared. Multivariable logistic regression analysis was used to identify independent predictors of mortality. Operative IAI was identified in 507 patients. Of these injuries, 309 (61%) were penetrating and 346 (68.2%) involved the external iliac artery. The majority of patients were male (82%) with a median age and ISS of 31 and 20, respectively. Endovascular repair was performed in 31% of cases. For patients with penetrating injuries, the type of repair impacted neither morbidity nor mortality. For blunt-injured patients, endovascular repair was associated with lower morbidity (29.3% vs 41.3%; p = 0.082) and significantly reduced mortality (14.6% vs 26.7%; p = 0.037) compared with the open-repair approach. Multivariable logistic regression identified endovascular repair as the only modifiable risk factor associated with decreased mortality (odds ratio 0.34; 95% CI 0.15 to 0.79; p = 0.0116). Traumatic IAI causes significant morbidity and mortality. Endovascular repair was identified as the only modifiable predictor of decreased mortality in blunt-injured patients with traumatic IAI. Therefore, for select patients with blunt IAIs, an endovascular repair should be the preferred approach.

Risk Factors Associated with Spinal Cord Ischemia During Aortic Aneurysm Repair

The risk of spinal cord ischemia (SCI) with aortic aneurysm repair can cause significant neurological morbidity. Prevention of SCI is critical. We sought to identify risk factors that predispose to SCI that may guide strategies to mitigate the occurrence of SCI during and following these procedures. This study includes all adults who underwent atraumatic, unruptured, thoracic, and suprarenal aortic aneurysm repairs (endovascular or open) at our institution over 11years (2010-2020). Our database included patient demographics, aneurysm anatomic features, and operative characteristics and an extreme gradient boost (XGB) machine method was used to develop a predictive model for SCI. The model was trained on an 80% randomly stratified cohort of the data and tested on the remaining 20% testing cohort. Shapley values were used to determine the most important predictive factors of SCI and decision trees were used to identify risk factor threshold values and highest risk factor combinations. Information was collected for 174 adult patients undergoing thoracic and suprarenal aortic repair from 2010 to 2020. Fifty eight percent of the patients were male. Ninety seven (55.7%) patients had open aortic repair and 87 (44.3%) had endovascular repair. Twenty seven (15%) of all patients had major complications and were considered to have SCI. The XGB model converged over the training cohort with a testing cohort accuracy of 0.841 [Sensitivity=75%, Specificity=68%] and area under the curve of receiver operating characteristic of 0.774. The XGB model identified older age (> 65 years), history of neurologic disease, hyperlipidemia, diabetes, coronary artery disease, heart failure, poor renal function, < 6months since last aortic repair, chronic anticoagulant use, preoperational anemia (Hemoglobin < 9), thrombocytopenia (platelet < 90,000), coagulopathy (prothrombin time>15s and activated partial thromboplastin time > 40s), hypotension (mean arterial pressure < 70mm Hg), longer operations (> 100min), aneurysms longer than 5cm, and anatomic location of aneurysm caudal to T-11 as risk factors for SCI in all types of aortic repair. Diabetic and heart failure patients undergoing longer operations (> 100min) with thrombocytopenia or aneurysms longer than 5cm were at the highest risk. The XGB model accurately identified risk factors of SCI with aortic aneurysm repair that may guide patient selection, timing of surgery, and strategies to minimize the risk of SCI.

Учет затрат на ремонт сельскохозяйственной техники: практика применения новых стандартов

This article discusses the legal and methodological features of accounting for the costs of various types of equipment repair. Innovations in legislation have significantly changed approaches to the restoration of fixed assets. In particular, the repair costs can be differentiated into current and capital, it is required to evaluate and reflect information on the material values – received after the repair, and their disposal. Features of accounting for repair costs in tax accounting are defined. Directions of costs and their generalization on the accounts of accounting are systematized. An algorithm for accounting for repair costs, depending on the type of repair and the method of its implementation, was proposed.

MODERN VIEW OF THE PROBLEM OF RADIATION CARCINOGENESIS

Summary. Genetic and epigenetic determinants of radiation carcinogenesis are presented. Unlike genetic ones, changes arising from epigenetic modifications are potentially reversible. An increase in the power and dose of ionizing radiation leads to a decrease in the promoter and an increase in the initiating function of radiation in the development of radiation carcinogenesis. The problem of radiation carcinogenesis consists in understanding the mechanisms of action of radiation in small doses on the human genome. Small doses of absorbed radiation are statistically significant factors of increased risk of cancer. Preservation of the dose-effect relationship for radiochromosomal markers in the blood of liquidators with oncological pathology in the long term after the Chernobyl accident confirms the radiogenic nature of these diseases. Processes of various types of repair that eliminate radiation-induced DNA damage are discussed. The formation of the “bystander effect”, which is an important mechanism of radiation-induced instability of the genome, increases the carcinogenic risk in the area of action of small doses of ionizing radiation.

Post-circumcision urethrocutaneous fistulae: presentations, repairs and outcomes in a tertiary centre.

Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as urethrocutaneous fistula (UCF). Repair of these fistulae poses a great reconstructive challenge to the paediatric surgeon/urologist with varied outcomes. We seek to review the presentations, repair and outcome of post-circumcision UCFs managed in a tertiary centre. This is a retrospective review of all the consecutive cases of repaired post-circumcision UCFs in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria, over a period of 9 years (January 2012-December 2020). Data on demography, size of fistula, type of repair and outcome were retrieved from the Records Department and patients' case notes and were analysed using SPSS (version 22, Chicago, Illinois). A total of 22 boys had post-circumcision UCF repair within the period, and they were aged between 2 weeks and 108 months with a median age of 4 months at presentation and aged between 8 months and 144 months with a median age of 24 months at the time of surgery. Circumcisions were by freehand technique in 21 (95.5%). Nurses performed most of the circumcisions in 19 (86.4%), and most of the circumcisions were performed in private hospitals 7 (31.8%), maternity homes 3 (13.6%) and general hospitals in 10 (45.5%) each, respectively. Most 17 (77.3%) fistulae were coronal, and the size of defect ranged from 1 mm to 10 mm. The most commonly employed technique of repair was simple closure in 16 (72.2%). Meatal stenosis and re-fistulation occurred in 2 (9.1%) and 4 (18.2%), respectively. Only two (12.5%) required reoperation. There was no relationship between the size of defect and re-fistulation, P = 0.377. Majority of the Post-circumcision urethrocutaneous fistulae were from free hand technique of circumcisions . These were performed mostly by nurses in general, private hospitals and maternity homes. Hence, there is a need to ramp up training of providers of neonatal circumcision in our environment. Most UCF in children could be repaired with simple closure technique reinforced with dartos flap.

Methodology for improving the mechanical and operational properties of aircraft structural elements during its maintenance using gas pulse treatment

A methodology has been developed to ensure airworthiness by improving the reliability of structural elements of aviation and airfield equipment, which differs from the currently available ones by using new effective non-deformational technologies based on pulsating subsonic gas flows during all types of maintenance and repair. New technologies have been developed to improve the mechanical and operational properties of aircraft structural elements, applicable in the production of aviation equip-ment, in the process of its maintenance and repair, characterized by the ability to increase them in a complex, without deterioration of any parameters. The nature of the impact of unsteady subsonic gas flows on the structure and properties of aircraft structural elements made of metal and polymer materials, the stress states of products, and the corresponding physical model has been created. It is proposed to implement measures for the use of new non-deformational technologies for restoring operational properties, as well as improving the reliability and extending the life cycle of elements, parts and assemblies of aircraft, airfield equipment by transport companies that exceed the currently used efficiency, efficiency and envi-ronmental friendliness, making appropriate changes to the maintenance and repair regulations. The direction of improving the methodology for forecasting the technical condition of aircraft structural elements is indicated, which differs from the existing ones by taking into account data on the density of crystal structure defects in surface layers.

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At the present stage of development of the use of the Armed Forces and the National Guard, along with the improvement of means of destruction of troops, new methods of conducting operations have been developed and implemented in the leading countries of the world. Unlike in the past, when the most intense combat operations were conducted on the line of combat contact between the parties and in the near tactical depths, the maneuverable nature of combat operations causes intensive movement of vehicles in difficult road conditions with frequent overcoming of obstacles, which leads to increased wear of components and assemblies, which may result in the failure of weapons and military equipment. Obviously, during combat operations, weapons and military equipment will fail both as a result of enemy fire on troops and due to a decrease in the reliability of weapons and military equipment. In peacetime, the failure of weapons and military equipment in the Armed Forces and the National Guard of Ukraine is largely due to the duration of their operation and long-term storage, as the samples show deterioration of the technical condition of elements and materials due to their aging, corrosion, and the appearance of residual deformations in the details of components and assemblies. Storage of machinery and equipment is one of the main elements of operation. Reliability and constant readiness for use of machinery and equipment kept in storage is achieved by high quality of work on preparation of machines for storage, systematic monitoring of their technical condition, timely maintenance and testing during storage, as well as implementation of measures that ensure the removal and preparation of machinery and equipment for use after storage in a short time. Ensuring the serviceable condition and proper operation of technical means of food service intended for cooking and transportation of food in the field (for example, KP-125, KP-125M) is one of the main tasks facing the head of the food service now. Operation is the totality of all phases of a technical asset's existence from the moment it is taken into balance sheet accounting until it is written off, including periods of storage, transportation, intended use, as well as all types of maintenance and repair. Storage is the maintenance of serviceable and specially prepared (mothballed) technical means in a condition that ensures their storage, serviceability and readiness within the established timeframe. There are two types of storage: short-term storage for no more than three months and long-term storage for more than three months.

Incidence of endograft limb thrombosis in different types of endovascular aortoiliac aneurysm repair

Incidence of endograft limb thrombosis in different types of endovascular aortoiliac aneurysm repair

РАЗРАБОТКА МЕТОДИКИ ПРИНЯТИЯ РЕШЕНИЙ ПРИ ПЛАНИРОВАНИИ ОРГАНИЗАЦИИ РАБОТ ПО РЕМОНТУ ПРОМЫСЛОВЫХ ТРУБОПРОВОДОВ

The authors explore the topic of accident rates in field pipelines. To increase the efficiency of using the results of inline diagnostics, the authors have developed a decisionmaking technique that, based on an analysis of identified defects, allows one to identify the most suitable type of repair, including taking into account their relative position. The use of the methodology in preliminary planning of work makes it possible to optimize the schedule of repair work and reduce the cost of operating pipelines.

Problems of diagnosing fire alarm systems in transport facilities

The publication presents problems concerning to the implementation of the diagnosis process in the FAS with different functional structures supervising fire safety in transport facilities. The implementation of this process and the test results should be visualized at the FAC installation site (LCD panel) and sent via two independent ICT channels to the ARC. The results of diagnostic tests will enable immediate renewal of the system, and the remote service located in ARC has the ability to identify the type of inoperability and start repair using spare parts from a handy warehouse. This approach makes it possible to rationalize the value of the FAS readiness indicator in transport facilities.

Time to treatment and complexity of Mohs micrographic surgery.

The impact of time to treatment (TTT) on the surgical management of keratinocyte carcinoma, specifically the complexity of Mohs micrographic surgery (MMS), is incompletely understood. We performed a retrospective chart review of patients undergoing MMS for keratinocyte carcinoma between July 1, 2019 and February 28, 2021 to examine associations between TTT and surgical characteristics. The median TTT for the 1571 patients treated with MMS during the study period was 42days (interquartile range 28-61days). In adjusted analyses, increasing TTT was not associated with increasing utilization of flap or graft repairs. Although a 42-day increase in TTT was associated with a 17.6 mm2 increase in the post-operative surgical defect size after MMS, TTT was not associated with linear repair length or flap/graft repair area. In conclusion, TTT was not independently associated with the type of repair or repair length after MMS, suggesting that the complexity of Mohs reconstruction is not influenced by TTT within the time range studied in this cohort.

A Review of Covered Abdominal Wall Defects: Cord Hernias Are Associated With Major Anomalies

IntroductionCovered abdominal wall defects (CAWD) can be categorized into giant omphaloceles (GOs), nongiant omphaloceles (NGOs), and umbilical cord hernias (UCHs). We sought to evaluate differences in management and outcomes of the different CAWD, treated at a large tertiary children's hospital, with regards to survival and association with other major congenital anomalies. MethodsA retrospective review of CAWD patients between January 2010 and January 2021 was conducted. GO was defined as a fascial defect >5 cm or >50% liver herniation. UCH were defined as fascial defects ≤ 2 cm. All others were classified as NGO. Type of repair, time to fascial closure, index hospitalization length of stay (LOS), and survival rates were compared. Four major anomaly categories were identified: cardiac, midline, Beckwith-Weidemann Syndrome, and other genetic anomalies. ResultsWe identified 105 CAWD patients (UCH n = 40; GO n = 34; and NGO n = 31). Ninety percent of UCH underwent primary repair, 10% were never repaired. NGOs were repaired by primary or staged methods in 92.9% of cases and 7.1% by delayed repair. Primary or staged repair occurred in 32.4% of GOs and delayed repair occurred in 67.6%. The median days to repair was 181 [24,427] GO, 1 [1,3] NGO, and 1 [0,1] UCHs (P < 0.01). Index hospitalization median LOS (days) was 90 [55,157] GO, 23 [10,48] NGO, 9 [5,22] UCH, (P < 0.01). There were no statistical differences in survival rates, number of patients with major anomalies (GO 35.4%, NGO 51.5%, UCH 50%), or types of anomalies. ConclusionsUCHs and omphaloceles have similar incidences of major associated anomalies. Thus, all patients with a covered abdominal wall defect should undergo workup for associated anomalies.