Use Of Alloplastic Materials Research Articles

Aortic Complications Related to Mycobacterium bovis after Intravesical Bacille Calmette-Guérin Therapy - a Systematic Review

Aortic complications after intravesical Bacillus Calmette-Guérin (BCG) application are a rare complication of the treatment of non-muscle invasive bladder cancer. The aim of this systematic review was to perform a descriptive analysis of previously published studies and to discuss the particular challenges of diagnosis and treatment of this rare complication. A literature search was performed in PubMed (1949-2021) and Web of Science (1900-2021) using the search terms "mycobacterium" OR "bovis" OR "BCG" AND "aorta" OR "aneurysm". In a staged review process, publications with the following inclusion criteria were included in data analysis: original paper, full-text availability in English or German and aortic complication after intravesical BCG instillation. We focused on the analysis of BCG-specific medical history data as well as treatment strategies in relation to patient outcome and the occurrence of graft infections during follow-up. A total of 60 individual cases were described in 55 published articles. BCG-induced mycotic aortic aneurysms can occur in all segments of the thoracoabdominal aorta, but the infrarenal aortic segment was most commonly affected (65% of cases). The most common configuration was saccular outpouchings (65%). Concomitant infections in other tissues were typical (65%). Patients with mycotic aneurysm presented with or without consecutive aortic rupture in 28% and 63%, respectively. Diagnosis was based on a combination of pathological and microbiological examinations. A common treatment algorithm was surgical infection treatment (85%) and antitubercular therapy (83%). Performed simultaneously, they resulted in a long-term survival of 81%. Graft infection after initial aortic repair with alloplastic material (n=40) developed in ten patients (25%) during follow-up. Diagnosis of mycotic aneurysms or vascular complications after intravesical BCG application is exceptionally challenging and a high level of suspicion is required. Diagnosis is based on obtaining sample material of affected regions and the combination of patient's history, clinical presentation and pathological or microbiological examinations. Currently, no consensus guideline for optimal medical treatment options of aortic complications secondary to BCG instillation exists. The combination of surgical treatment and supportive antitubercular therapy seems to achieve the best results. Since the risk of prosthetic infection after the use of alloplastic materials remains high (25%), we strongly suggest evaluating autologous or allogenic aortic replacement during initial aortic repair.

Aptamers recognizing fibronectin confer improved bioactivity to biomaterials and promote new bone formation in a periodontal defect in rats

The use of alloplastic materials in periodontal regenerative therapies is limited by their incapacity to establish a dynamic dialog with the surrounding milieu. The aim of the present study was to control biomaterial surface bioactivity by introducing aptamers to induce the selective adsorption of fibronectin from blood, thus promoting platelets activation in vitro and bone regeneration in vivo. A hyaluronic acid/polyethyleneglycole-based hydrogel was enriched with aptamers selected for recognizing and binding fibronectin. In vitro, the capacity of constructs to support osteoblast adhesion, as well as platelets aggregation and activation was assessed by chemiluminescence within 24 h. Matrices were then evaluated in a rat periodontal defect to assess their regenerative potential by microcomputed tomography (µCT) and their osteogenic capacity by Luminex assay 5, 15 and 30 d postoperatively. Aptamers were found to confer matrices the capacity of sustaining firm cell adhesion (p = 0.0377) and to promote platelets activation (p = 0.0442). In vivo, aptamers promoted new bone formation 30 d post-operatively (p < 0.001) by enhancing osteoblastic lineage commitment maturation. Aptamers are a viable surface modification, which confers alloplastic materials the potential capacity to orchestrate blood clot formation, thus controlling bone healing.

Management of Pediatric Orbital Fractures.

Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients. A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test. The majority of patients were male (86%) and the mean age of patients was 12.09 ± 4 years. Mean follow-up time was 237 ± 72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect. The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.

Split Calvarial Graft Reconstruction for Growing Skull Fracture in Pediatrics

AbstractBackground: Growing skull fracture is a rare but well-known complication of skull fracture in infancy and early childhood. The definitive treatment is Duro-cranioplasty. The use of alloplastic material in cranial reconstruction has been well described in adult but in children it is hesitation about the safety of nonexpansible alloplastic material.Aim of Study: This is a retrospective study to evaluate autologous split thickness skull grafts and cranioplasty for treatment of growing skull fractures in pediatrics.Patients and Methods: This is a retrospective study of complicated calvarial fractures presented at Mansoura Uni-versity Hospital from 2015 to 2018 and included 10 patients with growing skull fractures. All patients underwent autologous cranioplasty of the skull defect secondary to growing skull fracture after duroplasty.Results: The age at injury ranged from 5M-6 years. The cause of these fractures included falls and vehicle accident. On average, progressive swelling was diagnosed 7 months after the initial injury. The size of the cranial defects was average 3 X 3cm after restoration of dural contour (duroplasty). Six patients (60%) needed blood transfusion. Follow-up for patients was an average of 6 months. All patients showed post-operative bone fusion without evidence of complications.Conclusion: The concern for growth restriction or implant instability in a growing pediatric skull also the cost, limit the use of alloplastic materials. Our data show that autologous bone grafting is the standard in pediatric population regarding the safety and cost with limited post-operative complications. Moreover, early recognition is crucial in the management of GSFs to avoid the progression of neurological consequences and skull deformities.

Abstract P5-16-16: Reconstructive breast surgery with partially absorbable bi-component Seragyn® BR soft mesh: An outcome analysis

Abstract Objective: Synthetic meshes and acellular dermal matrices are increasingly used in implant based breast reconstruction. The objective of this study was to determine the incidence and severity of complications following the implantation of the partially absorbable bi-component soft mesh SERAGYN ® BR and assess risk factors for adverse operative outcomes. Methods: A retrospective clinical study was performed: The SERAGYN ® BR soft mesh was utilized in 148 operations (skin-sparing mastectomy, nipple-sparing mastectomy, breast conserving surgery, secondary reconstruction after mastectomy) in four different institutions in Germany from June 2012 to February 2014. We analyzed whether the results were affected by tumor morphology (e.g. grading), patient characteristics and co-morbidities, previous surgery or therapies and use of alloplastic materials. Results: The SERAGYN ® BR soft mesh was successfully implanted in 131 of 148 operations. The rate of reconstructive failure was 11.5 %. The most common complication was seroma (25.7 %), followed by hematoma and skin infection (each 14.2%). Wound healing issues were detected in 13.5% cases, secondary wound infections in 10.8%. 83.8% of operations had no severe complications. Independent predictors for reconstructive failure were wound healing issues, nipple- or skin necrosis, wound- or skin infections, a high volume of excised tissue, hematomas, seromas and sentinel lymph node excisions. A higher body mass index was correlated with a higher rate of infection. Conclusion: SERAGYN ® BR mesh can be used successfully in breast reconstructive surgery. Rates of major complications or reconstructive failure are comparable to the use of other synthetic or biological meshes. Citation Format: Machleidt A, Schmidt-Feuerheerd N, Blohmer J-U, Ohlinger R, Küper J, von Waldenfels G, Dittmer S, Paepke S, Klein E. Reconstructive breast surgery with partially absorbable bi-component Seragyn® BR soft mesh: An outcome analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-16.

Histologic analyses of flapless ridge preservation in sockets with buccal dehiscence defects using two alloplastic bone graft substitutes.

To investigate whether one of two synthetic bone substitute materials used for ridge preservation in the extraction sockets with buccal dehiscence defects was superior regarding new bone formation and ridge preservation and to compare it to sites left for spontaneous healing. In sixteen dogs, P3 and P4 were hemi-sectioned and the respective distal roots were extracted. Following the preparation of a mucoperiosteal flap without vertical releasing incisions, 50% of the buccal bone was carefully removed. The extraction sites were randomly assigned either to a ridge preservation procedure (alloplastic bone substitute material (two test groups)) or to spontaneous healing (control group). Descriptive histology and histomorphometric analyses were performed at healing times of 4, 8, and 16weeks. In case of homogeneous variances, the results were analyzed by one-way ANOVA, followed by Tukey's post-hoc test. If inhomogeneous, the data was analyzed using Welch-type ANOVA, followed by the Games-Howell post-hoc test. The use of bone substitute material led to significantly greater horizontal dimensions amounting to 3.3mm (SD = 0.67; test 1) and 3.5mm (SD = 0.72; test 2) compared to spontaneous healing (1.7mm, SD = 0.23) at 16weeks of healing (p < 0.0001). A significant difference was observed between spontaneous healing and the test groups in terms of newly formed bone tissue at 4, 8, and 16weeks (p = 0.001), with values reaching 7.9, 21.8, and 36.8% (test 1), 5.0, 10.4, and 29% (test 2), and 26.2, 43.5, and 56.4% (control), but there were no significant differences between the test groups (p > 0.05). The final ridge profile was more favorable after ridge preservation (p < 0.001) as demonstrated by a loss of 28.8% (spontaneous healing) and an increase in both test groups at 16weeks (test 1 = 60.5% and test 2 = 31.2%). The use of alloplastic materials rendered greater horizontal dimensions and a more favorable maintenance of the ridge profile. Alloplastic bone substitute materials can successfully be used for ridge preservation procedures.

Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications.

An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.

Reconstructive breast surgery with partially absorbable bi-component Seragyn® BR soft mesh: an outcome analysis.

Synthetic meshes and acellular dermal matrices are increasingly used in implant-based breast reconstruction. The objective of this study was to determine the incidence and severity of complications following the implantation of the partially absorbable bi-component soft mesh SERAGYN® BR and assess risk factors for adverse operative outcomes. A retrospective clinical study was performed: The SERAGYN® BR soft mesh was utilized in 148 operations (skin-sparing mastectomy, nipple-sparing mastectomy, breast-conserving surgery, and secondary reconstruction after mastectomy) in four different institutions in Germany from June 2012 to February 2014. We analyzed whether the results were affected by tumor morphology (e.g., grading), patient characteristics and comorbidities, previous surgery or therapies, and use of alloplastic materials. The SERAGYN® BR soft mesh was successfully implanted in 131 of 148 operations. The rate of reconstructive failure was 11.5%. The most common complication was seroma (25.7%), followed by hematoma and skin infection (each 14.2%). Wound-healing issues were detected in 13.5% cases, secondary wound infections in 10.8%. 83.8% of operations had no severe complications. Independent predictors for reconstructive failure were wound-healing issues, nipple- or skin necrosis, wound- or skin infections, a high volume of excised tissue, hematomas, seromas, and sentinel lymph node excisions. A higher body mass index was correlated with a higher rate of infection. SERAGYN® BR mesh can be used successfully in breast reconstructive surgery. Rates of major complications or reconstructive failure are comparable to the use of other synthetic or biological meshes.

Large-volume breast fat transfer: technical evolutions and safety aspects based on over 800 cases and 26 years of follow-up

Current techniques for augmentation mammoplasty involve the use of alloplastic materials and an open approach. The former may not be well tolerated and often can be the origin of undesirable effects such as capsule contracture. The latter implies residual scars, which can sometimes be less than satisfactory from an esthetic point of view. Considering all the problems mentioned above and seeking to find safe and reliable alternatives to implants, we focused our attention on the possibility of using fat tissue as filling material for breast augmentation. Autologous adipose tissue has been used to correct soft tissue defects for more than a century. Its soft and natural texture, the absence of a line, and its versatility have always made adipose tissue the ideal physiologic filling material. The author describes his surgical experience with breast fat transfer. The clinical outcome described in this Article is based on over 800 patients with a follow-up period of over than 26 years. The surgical techniques described by the author evolved constantly and steadily aiming to achieve more consistent results and trying to increase at the same time patient safety and satisfaction. Analyzing the clinical data clearly appears that complications are strictly related to the oily content of the transplanted tissue, where more TGs in the recipient site is clearly at the origin of a higher level of complications. In order to improve patient’s safety and to limit risk of side effects, the author developed a new “oil-free” fat transfer technique. All the technical steps are described in details. An important part of this work is dedicated to a careful evaluation of safety aspects and oncologic concerns. The total oncologic safety of fat transfer in breast reconstruction and in esthetic augmentation has been clearly proved and confirmed. Level of Evidence: Level IV, therapeutic study.

Abstract: Outcomes in Reconstruction of Composite Scalp and Calvarial Defects – Revisiting the Role of Alloplastic Cranioplasty in High Risk Patients

INTRODUCTION: Advances in cranioplasty have enabled repair of increasingly complex defects.1–4 This led to widespread use of alloplastic materials in high-risk patients, including those with previous history of osteomyelitis, radiation, frontal sinus involvement, and soft–tissue deficits. The long-term outcomes of these reconstructions have been largely understudied. The aim of this study was to evaluate the natural history of cranioplasty in high-risk patients with soft-tissue defects requiring flap coverage. MATERIALS AND METHODS: A retrospective review of patients treated with 466 cranioplasties between 2002 and 2014 was performed. RESULTS: Materials used for reconstructions included non-titanium alloplastic cranioplasty in 52% (n=243), titanium mesh in 38% (n=177), and autologous bone in 10% (n=46). Mean cranial defect size was 59 ± 60cm2. Sixteen percent (n=74) of the reconstructions included full-thickness scalp defect with a mean area of 22 ± 74cm2. Mean follow-up was 3.9 ± 3.0 years. Cumulative revision rate was 22% (n=104) and the cumulative reconstructive failure rate (defined as removal of the cranioplasty) was 13% (n=60). When soft-tissue reconstruction was needed, 2-year failure rate for autologous bone was 14%, for non-titanium alloplastic cranioplasty 29%, and for titanium mesh 39%. At the end of follow-up, failure rate remained stable for autologous bone – 14%, and for non-titanium alloplastic cranioplasty – 37% (p>0.05). The failure rate for titanium mesh continued to increase over time to 53% (p<0.05). CONCLUSION: Simultaneous scalp and calvarial reconstruction is associated with significantly worse outcomes than calvarial reconstruction alone. Composite reconstruction with a locoregional flap and alloplastic cranioplasty, in particular titanium mesh, is associated with surprisingly high failure rate of over 50% and should be either discouraged, or used as a temporary treatment until more permanent coverage option is available. We advocate the use of autogenous tissues in these scenarios to achieve more durable repairs. If this is not an option and alloplastic material needs to be utilized, scalp reconstruction with a free tissue transfer should be done early as it yields better results than a locoregional flap. DISCLOSURE/FINANCIAL SUPPORT:The authors have no financial interest to declare in relation to the content of this manuscript. REFERENCES: 1. Chao AH, Yu P, Skoracki RJ, Demonte F, Hanasono MM. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: a 10-year experience. Head Neck. 2012;12:1759–1764 2. Afifi A, Djohan RS, Hammert W, Papay FA, Barnett AE, Zins JE. Lessons learned reconstructing complex scalp defects using free flaps and a cranioplasty in one stage. J Craniofac Surg. 2010;4:1205–1209 3. St–Hilaire H, Mithani SK, Taylor J, Simmons OP, Singh N, Rodriguez ED. Restoring the failed cranioplasty: nonanatomical titanium mesh with perforator flap. Plast Reconstr Surg. 2009;123:1813–1817 4. Wang HT, Erdmann D, Olbrich KC, Friedman AH, Levin LS, Zenn MR. Free flap reconstruction of the scalp and calvaria of major neurosurgical resection in cancer patients: lessons learned closing large, difficult wounds of the dura and skull. Plast Reconstr Surg. 2007;119:865–872

THE EXPERIENCE OF THE USE OF SYNTHETIC PROSTHESES FOR TREATMENT OF SEVERE GENITAL PROLAPSE IN ELDERLY FEMALES

Актуальность. Пролапс гениталий – одна из наиболее трудно решаемых проблем в гинекологии. Частота рецидива заболевания после его хирургической коррекции достигает 33–40%.

FEATURES OF DIAGNOSTICS AND PLASTY OF LARGE LEFT-SIDED POSTTRAUMATIC DIAPHRAGMATIC HERNIA

Post-traumatic diaphragmatic hernia often develop as a result of an open or closed chest and abdomen injury, thoracoabdominal and iatrogenic. A clinical observation of successful diagnosis and treatment of patient with major post-traumatic diaphragmatic hernia, developed after laparoscopic splenectomy, accompanied by technical features, is exampled. Operative treatment of large post-traumatic diaphragmatic hernia is a complex reconstructive operation and requires the use of alloplastic materials for adequate correction.

Correction of Sunken Upper Eyelids by Anchoring the Central Fat Pad to the Medial Fat Pad during Upper Blepharoplasty.

BackgroundMany methods have been proposed for the correction of sunken upper eyelids. These methods include surgical treatments, such as micro-fat, dermofat, or fascia-fat grafts, or the use of alloplastic materials. Here, we present our experience of sunken upper eyelid correction involving the simple addition of anchoring the central fat pad to the medial fat pad during upper blepharoplasty.MethodsWe performed 74 cases of upper blepharoplasty with sunken upper eyelid correction between October 2013 and September 2014. The lateral portion of the central fat pad was partially dissected to facilitate anchoring. The medial fat pad was gently exposed and then pulled out to facilitate anchoring. After the rotation of the dissected lateral portion of the central fat pad by 180° to the medial side, it was anchored spreading to the medial fat pad. Photographs taken at 6 months postoperatively were presented to three physicians for objective assessment. Of the 74 patients, 54 patients followed at 6 months postoperatively were included in this retrospective, objective assessment.ResultsSunken eyelids were effectively corrected in 51 of the 54 patients, but 3 had minimal effect because preaponeurotic fat pads had been removed during previous upper blepharoplasty. In addition to correcting sunken eyelids, lateral bulging was corrected and a better definition of the lateral portion of upper lid creases was obtained.ConclusionsAnchoring the central fat pad to the medial fat pad provides an effective means of correcting sunken upper eyelids during upper blepharoplasty.

Clinical effectiveness and safety of collagen sheet for dorsal augmentation in rhinoplasty.

In Asian rhinoplasty, dorsal augmentation often requires the use of alloplastic materials because sufficient amounts of autograft are difficult to harvest. Given considerations of aesthetics, costs, and the characteristics of the oriental nose, silicone or Gore-Tex is commonly used when augmenting the nasal dorsum to a great extent. Such materials can often result in postoperative complications and foreign-body sensations. Moreover, extrusion or visualization of the implant may occur because of thinning of the skin over time. Permacol collagen implants are specifically indicated for soft tissue reinforcement and repair of the head and face in plastic and reconstructive surgery. The handling versatility of the flexible collagen sheet allows it to be layered over itself until the requisite thickness and desired shape are obtained. A total of 50 patients who underwent nasal augmentation rhinoplasty between December 2007 and May 2011 were observed for at least 24 months. Depending on the nasal dorsum, we layered the collagen sheet up to a maximum of 4 times and we have not seen any case of severe resorption or overcorrection in the nasal configuration. Collagen implant material is safe for use in select rhinoplasty patients because of its low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic because of the low quality or lack of available autologous grafts.

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects

Combination of Autologous Protein-Rich Fibrin and Bone Graft: An Invaluable Option for Reconstruction of Segmental Mandibular Defects

Failures and complications in pelvic floor surgery

To review current literature on the failures of different surgical approaches in pelvic floor surgery, in particular the use of alloplastic materials, and to analyze complications related to them. A Medline search was performed to retrieve English language literature (from the year 1995 to 2011) on the success rates, failures, and complications profiles of pelvic floor surgery. Search terms used are "pelvic organ prolapse," "stress urinary incontinence," "complications," "vaginal mesh," "mid-urethral slings," and "colposuspension." The review includes surgical techniques for the correction of pelvic organ prolapse and stress urinary incontinence. Failure rates and complications in different studies are compiled and analyzed. Use of synthetic materials in pelvic organ prolapse surgery has reduced surgical failures but it is associated with an increased risk of complications compared to traditional surgical repairs. Synthetic mid-urethral slings for stress urinary incontinence seem to have good success rates over long term, but they have unique complication profile including de novo development of overactive bladder, voiding dysfunction, sling exposures, dyspareunia, and long-term pain. However, some of these complications seem to be related to wrong surgical indications and improper surgical techniques, although some complications may be directly related to the use of synthetic material itself. Use of synthetic materials in pelvic floor surgery has definitely reduced surgical failures, but at the same time, it is associated with an increased risk of complications (some of which are unique to synthetic materials) compared to traditional surgical repairs.

Retrobulbar Lipofilling to Correct the Enophthalmos

In this article, we describe an alternative procedure to restore the retrobulbar volume in enophthalmic patients. We report the case of a patient with a late enophthalmos we submitted to retrobulbar lipofilling to correct the defect. The preoperative assessment and the surgical technique are described in detail. The volume of fat injected was 3.2 mL, with a satisfying increase in exophthalmometry measurements. The procedure was well tolerated without complications. Retrobulbar lipofilling for enophthalmos appears to be a safe alternative technique for orbital volume enhancement. It avoids the use of alloplastic materials and allows to obtain good cosmetic results with an easy technique and minimal donor-site morbidity.

The use of Medpor © alloplastic material in rhinoplasty: Experience and outcomes

Surgeons often avoid the use of alloplastic materials in functional rhinoplasty due to potential complications. The aim of the present study is to present the outcomes following the use of alloplastic materials in a large series of patients, to identify and document the possible complications and to offer insight regarding the safety and the indications of the method. Between February 2005 and August 2009, 58 patients underwent functional rhinoplasty using Medpor(®) alloplastic materials by a single surgeon (A.S). The majority of the alloplastic materials were used to reconstruct defects of the nasal dorsum as well as to augment the columella and support the nasal tip. Medpor(®) was used in the nasal dorsum in eight patients and in the columella in 50 patients. There were 10 cases of primary and 48 cases of secondary rhinoplasty. Follow-up time ranged from 1 to 5 years (mean: 3 years). Complications concerned three cases of postoperative infection and material rejection. All cases were successfully re-operated. The use of Medpor(®) alloplastic material in functional rhinoplasty comprises a safe method in selected patients due to the low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic due to low quality or lack of available autologous grafts.

Mesh complications following prolapse surgery: management and outcome

ObjectiveThis is a description of complications following prolapse surgery with the use of alloplastic materials, the management and outcome. Study design54 women have been referred to Mainz, urogynecology referral center due to complications following mesh-augmented prolapse surgery. ResultsThe complaints who lead to the admission are expressed by the new terminology and standardized classification for complications arising directly from the insertion of prostheses and grafts in female pelvic floor surgery [1]. Pain (66.7%), mesh erosion (55.6%) and vaginal discharge (48.1%) were the most frequent complaints. Revision was performed after a median time of 27.2 months post mesh implantation. Nine patients underwent limited excision of the mesh, 49 had a vaginal revision with wide mesh removal and 10 had a laparotomy with wide mesh removal. After 3 months 48 patients had a follow-up, 25 could have been relieved from their complaints. ConclusionAlthough the incidence is low, complications after prolapse repair with mesh use are difficult to prevent, affect quality of life and often require a new surgical intervention, which should be performed by an experienced and competent surgeon.

Partner dyspareunia—a report of six cases

One of the rarely cited complications of the use of alloplastic materials in pelvic floor surgery is dyspareunia of the partner caused by prominence or vaginal exposure of the sling material. Even though this entity is real and an important problem, it is rarely reported in literature. We report six cases of partner dyspareunia, in which there were two incidences of partner penile injury, occurring as a complication of synthetic midurethral sling surgery. There were three tension-free vaginal tapes, two transobturator tapes and one anterior intravaginal sling in the series. Time interval between tape insertion and the presentation of complications ranged from 3 to 48 months. Vaginal exposure was seen in five of the six cases and in one patient prominence of sling material without exposure was noted. Recognizing partner dyspareunia as an important complication of the vaginal use of alloplastic prosthesis is not only important in preoperative counseling of patients but also to avoid legal implications.