Vicryl Mesh Research Articles

Massive Aortic Pseudoaneursym and Hemoptysis Following Delayed Migration of Methylmethacrylate for Chest Wall Reconstruction

INTRODUCTION: Chest wall defects greater than five centimeters generally require skeletal reconstruction to prevent flail physiology.1, 2 Autologous bone and fascia lata have been replaced with rigid prosthetics such as the methylmethacrylate mesh “sandwich.” This permanent, rigid framework can be contoured to any defect and avoids donor site morbidity. It is more malleable than metal hardware and obviates need of metal fixation that can erode into tissues or fracture ribs. Furthermore, it is radiolucent and easily seen on imaging. We report the first case of delayed methylmethacrylate migration causing significant cardiopulmonary injury and discuss post-operative management considerations. MATERIALS AND METHODS: A 58-year-old woman with a 15-centimeter left posterior chest wall mass underwent posteriolateral thoracotomy with elevation of a latissimus dorsi flap. The underlying mass was resected en bloc with ribs 5-9 and scapula tip. A sandwich of outer Vicryl mesh and inner methylmethacrylate was contoured to the chest wall and affixed with bilayer mesh to the thoracic wall. The muscle flap and overlying tissues were inset over the defect. RESULTS: Pathology revealed a benign spindle cell tumor. The patient had an uncomplicated recovery until fourteen months post-operatively, when she developed new chest pain following back massage. CT scan revealed minor plate migration, which was stable on four serial follow-up images. Two years later, she presented with sudden hemoptysis. Computed tomography revealed further plate migration, a massive descending aortic pseudoaneurysm, and aortic branch fistulization with pulmonary vasculature (Figures 1, 2). An endovascular aortic stent was placed emergently, and her hemoptysis resolved. She later underwent elective methylmethacrylate removal. She is doing well greater than 3 months postoperatively.Figure 1: Three dimensional sagittal view showing large bony defect including resected scapula (thin arrow). The methymethacrylate plate in yellow and surrounding hematoma (not shown) displace aorta anteriorly, while plate erosion caudally result in pseudoaneurysm (thick arrow) posterior to plate.Figure 2: Axial image showing pseudoaneursym (thick arrow) posterior to plate and contrast blush of aorto-pulmonic branch fistulization (thin arrow).CONCLUSION: Published complications with methylmethacrylate reconstruction relate to possible increased infection rate compared with autologous grafts or mesh alone.3 Only one series reported plate migration in two patients, which occurred immediately post-operatively.4 This first reported case of delayed migration highlights the consideration of permanent mesh fixation and long-term patient follow-up. If migration is noted, early operative repair may prevent erosion into vital intra-thoracic structures. Endovascular intervention when indicated averts the need for emergent chest wall reconstruction.

Laparoscopic pelvic mesh placement with closure of pelvic floor entrance to prevent small intestine radiation trauma – A retrospective cohort analysis

BackgroundIn most pelvic malignancies radiation therapy is a main part of the treatment concept. The main dose limiting organ is the small intestine. Different mechanical methods to prevent radiation damage to the small intestine have been described. We herein report a retrospective study of laparoscopic placement of an absorbable vicryl mesh in patients requiring pelvic radiotherapy displacing the bowel out of the radiation field. Patients/MethodsThe study included 6 consecutive patients requiring definitive radiotherapy due to locally advanced prostate cancer. All patients had small intestine within the radiation fields despite the use of non-invasive displacement methods. ResultsAll patients underwent laparoscopic small bowel displacement from the pelvis and closure of the pelvic floor entrance using vicryl mesh placement. Peri- or postoperative complications were not seen. Postoperative radiotherapy planning CT scans confirmed displacement of the small intestine allowing all patients to receive the planned radiotherapy volume. ConclusionLaparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. As an alternate to native tissue, the vicryl mesh is a safe, effective substitute for small bowel exclusion from external-beam radiation therapy.

Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review

Mastectomy and breast reconstruction are essential parts of the treatment of breast cancer. Acellular dermal matrices (ADMs) have been used for the reconstruction of the lower pole due to many advantages; however, its cost is seen as a major drawback in this era of concern for the allocation of health-care funds. Recently, polyglactin 910 (Vicryl; Ethicon, Somerville, NJ, USA) mesh has been published as an alternative. We assessed the published literature, in particular investigating for studies that compare Vicryl mesh with ADM. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searched databases included Medline/PubMed, Cochrane Reviews, Embase, Web of Science, ClinicalTrials, and SCOPUS. Search criteria were as follows: (1) reporting of clinical data using Vicryl mesh in breast reconstruction, (2) reporting of original data, and (3) outcome of interest reported. We retrieved 290 de-duplicated articles. After title and abstract screening, we dismissed 258 articles, and thus full text was reviewed for 32 articles; only three retrospective articles met inclusion criteria. The total population included 112 patients and 156 breasts. The reported incidence of complications was as follows: infection 2.6% (confidence interval (CI): 0.7-6.6%), reconstruction failure 3.2% (CI: 1.0-7%), and seroma 1.3% (CI: 0.2-4.6%). A seven- to 12-fold cost difference was reported. Follow-up length ranged from 1.2 to 3.6 years. No studies directly compared Vicryl mesh with ADM. Although the evidence is limited, polyglactin 910 (Vicryl) mesh for immediate breast reconstruction appears to be a potentially safe, effective, and less expensive alternative to ADM. Prospective studies are needed to further compare mesh with ADM.

Salvage stereotactic body radiotherapy for locally recurrent non-small cell lung cancer after sublobar resection and i(125) vicryl mesh brachytherapy.

Locally recurrent non-small cell lung cancer (LR-NSCLC) remains challenging to treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-irradiation. In order to better establish the impact of re-irradiation in patients with LR-NSCLC following high-dose radiotherapy, we report outcomes for patients treated with prior sublobar resection and brachytherapy that subsequently underwent stereotactic body radiotherapy (SBRT). A retrospective review of patients initially treated with sublobar resection and I(125) vicryl mesh brachytherapy, who later developed LR-NSCLC along the suture line, was performed. Patients received salvage SBRT with curative intent. Dose and fractionation were based on tumor location and size, with a median prescription dose of 48 Gy in 4 fractions (range 20-60 Gy in 1-4 fractions). Thirteen consecutive patients were identified with median follow-up of 2.1 years (range 0.7-5.6 years). Two in-field local failures occurred at 7.5 and 11.1 months, resulting in 2-year local control of 83.9% (95% CI, 63.5-100.0%). Two-year disease-free survival and overall survival estimates were 38.5% (95% CI, 0.0-65.0%) and 65.8% (95% CI, 38.2-93.4%). Four patients (31%) remained disease-free at last follow-up. All but one patient who experienced disease recurrence developed isolated or synchronous distant metastases. Only one patient (7.7%) developed grade ≥3 toxicity, consisting of grade 3 esophageal stricture following a centrally located recurrence previously treated with radiofrequency ablation. Despite high-local radiation doses delivered to lung parenchyma previously with I(125) brachytherapy, re-irradiation with SBRT for LR-NSCLC results in excellent local control with limited morbidity, allowing for potential disease cure in a subset of patients.

Repair of Partial Thickness Articular Hyaline Cartilage Injuries with Multipotent Mesenchymal Stromal Bone Marrow Cells Transplantation in Rabbits

Possibility of hyaline cartilage integrity restoration using multipotent mesenchymal stromal cells (MMSC) was studied on the rabbit model of partial thickness articular hyaline cartilage defect without subchondral plate damage. Size of defect made up 0.5 cm in diameter and 1.5 mm deep. Autologous bone marrow was harvested from the resected upper flaring portion of the ilium, single cell suspension was prepared and cultured in matrasses. Grown MMSC were centrifuged and the sediment was transferred into the cartilage defect. The cells were covered with either vicryl or gelatin sponge, or vicryl mesh. Histologic examination was performed in 4 months. It was shown that the most active regeneration of hyaline cartilage tissue, that substituted the largest part of a defect, was noted when MMSC were covered with vicryl mesh. One of the advantages of vicryl mesh use was that it neither protruded above the cartilaginous plate nor compressed the cells, and slowly resolved.

Repair of Partial Thickness Articular Hyaline Cartilage Injuries with Multipotent Mesenchymal Stromal Bone Marrow Cells Transplantation in Rabbits

Possibility of hyaline cartilage integrity restoration using multipotent mesenchymal stromal cells (MMSC) was studied on the rabbit model of partial thickness articular hyaline cartilage defect without subchondral plate damage. Size of defect made up 0.5 cm in diameter and 1.5 mm deep. Autologous bone marrow was harvested from the resected upper flaring portion of the ilium, single cell suspension was prepared and cultured in matrasses. Grown MMSC were centrifuged and the sediment was transferred into the cartilage defect. The cells were covered with either vicryl or gelatin sponge, or vicryl mesh. Histologic examination was performed in 4 months. It was shown that the most active regeneration of hyaline cartilage tissue, that substituted the largest part of a defect, was noted when MMSC were covered with vicryl mesh. One of the advantages of vicryl mesh use was that it neither protruded above the cartilaginous plate nor compressed the cells, and slowly resolved.

P308 Comparison of implant-based immediate breast reconstruction with and without vicryl mesh

P308 Comparison of implant-based immediate breast reconstruction with and without vicryl mesh

Beyond Biologics

There is an intense push to decrease overall healthcare costs in the United States. Although the use of acellular dermal matrix in implant-based reconstruction has grown significantly over the past decade, potential drawbacks remain a source of debate. Matrices are costly and not universally available across institutions, whereas Vicryl mesh is widely available, relatively inexpensive, and resistant to bacteria biofilm formation. With the intent of maximizing the reconstructive and economic advantages of direct-to-implant breast reconstruction, the authors report the first experience in the literature using an absorbable mesh as an inferolateral sling. A retrospective review was performed of the first 50 consecutive patients (76 reconstructions) who underwent implant-based breast reconstruction with Vicryl mesh from August of 2011 until June of 2012. Fifty patients underwent 76 direct-to-implant reconstructions with Vicryl mesh between August of 2011 and June of 2012 (mean follow-up, 1.2 years). Five breasts (6.6 percent) had complications, with only one complication resulting in implant loss (1.3 percent). Implant positioning and contour were excellent, with only two patients [three breasts (3.9 percent)] undergoing revision procedures, for size enlargement. Using costs available at the authors' institution, use of Vicryl mesh instead of acellular dermal matrix resulted in a direct material cost savings of $172,112 in 10 months. Results to date have been encouraging, with a low complication rate (6.6 percent) and excellent aesthetic results. The technique has resulted in $172,112 in direct material cost savings over 10 months. Continued follow-up is planned to evaluate long-term results. Therapeutic, IV.

National patient dose survey in dental CBCT and elaboration of national DRLs

National patient dose survey in dental CBCT and elaboration of national DRLs

Early abdominal closure improves long-term outcomes after damage-control laparotomy

The impact of initial clinical decisions on the long-term quality of life and functional outcome of patients who undergo damage-control laparotomy (DCL) is unknown. We hypothesized that early abdominal closure after DCL improves long-term outcomes. Patients (2005-2011) who underwent DCL (n = 140) at our Level I trauma center were identified. A total of 108 patients survived their hospitalization, and 15 died following discharge. Of the remaining 93 survivors, 59 were unreachable and not present in the social security death index. Our final study population of 34 survivors prospectively completed a standardized study questionnaire, the SF-36 health survey, and inpatient and outpatient records were reviewed. Survivors were compared on the basis of time with final abdominal closure (early, <7 days vs. late, >7 days; either primary closure or Vicryl mesh), and study variables were analyzed. A p < 0.05 was considered significant. Our study population was primarily male (82%) of varying age (36 [13]) and mechanism (blunt 56%, penetrating 44%) with severe injuries (mean [SD] Injury Severity Score [ISS], 17 [8]). Despite no differences in age, sex, mechanism, ISS, admission Glasgow Coma Scale (GCS) score, or admission systolic blood pressure, early-closure patients (n = 13) had shorter hospital (25 days vs. 57 days) and intensive care unit (12 days vs. 20 days) stays and, upon long-term follow-up, higher physical (54 vs. 18), emotional (86 vs. 44), and general health (66 vs. 50) SF-36 scores than late-closure patients (n = 21) (all p < 0.05). Early-closure patients had less daily pain (38% vs. 95%), had higher overall SF-36 scores (66 vs. 46), and were more likely to return to work (54% vs. 10%) than late-closure patients (all p < 0.05). Early clinical decisions impact the lives of critically injured patients. Abdominal closure within 7 days of DCL improves long-term quality of life and functional outcome. Therapeutic study, level IV.

Three-dimensional surgical simulation-guided navigation in thoracic surgery: a new approach to improve results in chest wall resection and reconstruction for malignant diseases

Oncological surgery of the chest wall should be performed to achieve free margins of at least 2 cm for metastasis or 4 cm for primary tumours. When the lesion is not visible or palpable, difficulty in identification may lead to a larger incision and a resection wider than is necessary. We report three cases of non-palpable metastatic chest wall lesions in which the preoperative surgical planning and the intraoperative identification of the tumour, and thus the subsequent chest wall reconstruction, was supported using computer-based surgery. The application of high-resolution three-dimensional imaging technology and navigational systems is used in preoperative surgical planning to provide virtual simulations of a patient's skeletal changes and new soft tissue profile. Intraoperatively, a mobile navigation probe was used to identify the lesion, matching surgical landmarks and the preoperative computed tomography imaging, achieving the radical resection of the tumour with correct but not excessive surgical margins. Two patients underwent partial sternectomy followed by sternal allograft reconstruction. The third patient underwent chest wall resection followed by reconstruction using titanium bars and vicryl mesh. In all cases, the postoperative period was uneventful. After a follow-up period of 13.9 and 8 months, respectively, all patients are disease free, without complications. Application of navigation technology in thoracic surgery should be encouraged because it is easy to use and requires a limited learning curve.

Suture-Free and Mesh Reinforced Small Intestinal Anstomoses: A Feasibility Study in Rabbits

ABSTRACTIntroduction: Anastomotic leakage still remains a major complication in general surgery. Beside general risk factors, the ideal method of anastomotic technique has not been found until now. The aim of the present study was to analyze wound healing in suture-free small intestine anastomoses using fibrin glue with and without mesh-reinforcement. Methods: Laparotomy and four different types of small bowel anastomoses were performed in 32 chinchilla rabbits. Standard hand-sewn anastomoses (CG), suture-free glued anastomoses (FG) with and without mesh reinforcement using two different types of meshes [Vicryl-mesh (VM) and Surgisis (SM)]. Animals were sacrificed after 5 and 21 days. Bursting pressure, collagen type I/III ratio, and matrix-metalloproteinase 2, 9, and 13 were analyzed. Results: None of the animals died due to an anastomotic leakage. All animals in the long term group with Surgisis mesh died due to a mechanical bowel obstruction based on a distinctive stenosis of the anastomosis. The bursting pressures did significantly differed in animals with fibrin glue alone compared to animals with Vicryl-mesh reinforcement (p < 0.05). Histological examination revealed statistically significant differences (p < 0.05) in the values for MMP-2 (VM < SM), MMP-9 (VM < CG), and MMP-13 (CG < SM, VM < FG, and VM < SM). However, collagen type I/III ratios were not significantly different between groups. Conclusions: Our results suggest that a mesh reinforced glued anastomosis is technically feasible. Furthermore, mesh-reinforcement using VM increased the integrity and simplified the technique of suture-free anastomoses.

P-236THE OPTIMUM SHEET FOR COMBINED APPLICATION OF FIBRIN SEALANT AND BIOABSORBABLE SHEET AGAINST ALVEOLAR AIR LEAKAGE

The combination of fibrin sealant (FS) and bioabsorbable sheet (BS) is known to provide a better sealing effect on alveolar air leakage compared to the single use of FS. Previously, we studied the optimum techniques for their combination. This time, we studied on what BS is optimum. Tachosil was also compared with them. Standardized pleural defects produced by electric cauterization in retrieved swine lungs. Experiment I: The 2x3 cm defects were covered with the following BS (3 pieces) by the abovementioned Rub + Soak B technique: 0.15mm polyglycolic acid (PGA) felt (Neoveil) (Group I), 0.3 mm PGA felt (Neoveil) (Group II), 0.5 mm PGA felt (Neoveil) (Group III), oxidized cellulose sheet (OCS) (Surgicel absorbable hemostat) (Group IV), woven PGA sheet (woven Vicryl mesh) (Group V), knitted PGA sheet (knitted Vicryl mesh) (Group VI), knitted OCS (Interceed) (Group VII). Experiment II: The defects were covered with one piece of 0.15 mm PGA felt (Neoveil) by Rub + Soak B technique (Group VIII), Tachosil alone (Group IX), and thrombin applied Tachosil after rubbing with fibrinogen solution (Group X). The minimum seal-breaking airway pressure was compared among the groups. The seal-breaking pressure (SBP) was significantly higher in Group I than in Groups III, IV, V and VII, in Group VI than in Groups III, IV and VII, and in Group X than in Groups III, IV and VII. The SBP was significantly lower in Group IX than in Groups VIII and X (P < 0.05). Histologically, clot penetration into the tissue was significant in Groups I, VIII and X. 0.15 mm PGA felt was the optimum sheet in Rub + Soak B technique, followed by knitted Vicryl mesh. Tachosil with FS was comparable to them in this model. Further studies are needed to determine responses in living tissue and SBP over time in vivo. This study was supported by CSL Behring Co.

Impact of brachytherapy on local recurrence after sublobar resection: Results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small cell lung cancer (NSCLC).

7502 Background: Prior studies suggest that adjuvant brachytherapy reduces local recurrence (LR) after sublobar resection (SR) for NSCLC. A multicenter randomized study was undertaken in patients (pts) with stage I NSCLC ≤3cm comparing SR to SR with brachytherapy (SRB). Methods: High-risk operable patients with NSCLC were randomized to SR or SRB. Brachytherapy involved placement of I125 seeds incorporated into Vicryl sutures or into Vicryl mesh placed over the staple line. Wedge or segmental resection was allowed. The primary endpoint was time to local recurrence (LR) defined as recurrence within the primary tumor lobe at the staple line (local progression), away from the staple line or within hilar nodes. The trial was designed to have 90% power to detect a hazard ratio (HR) of 0.315 in favor of the SRB arm using a one-sided α of 0.05 with a sample size of 100 eligible pts per arm. Follow-up CT scans were obtained serially for 36 months. Results: 224 pts were randomized; 213 (109 SR,104 SRB) were eligible. Median (range) age was 71 (49-87) yrs; 94 (44%) were male. No differences were found in baseline characteristics. Adverse events, previously reported, were not different between arms. Median (range) follow-up was 4.06 (0.04, 5.0) yrs. There was no difference between arms in time to LR (HR = 0.87; 5% CI: 0.41, 1.86, p=0.72) or to LR or death (LRD) (HR = 0.81, 95% CI: 0.50, 1.32, p=0.40). There was no difference between arms in pattern of LR (table). In subgroups of pts with potentially compromised surgical margin (margin &lt; 1cm; margin:tumor ratio &lt;1; positive staple line cytology) SRB did not reduce LR or LRD at 3-yrs. Overall 3-yr survival was similar for SR (71%) and SRB (72%) (p=0.81). Conclusions: LR remains a concern after sublobar resection. However, local progression at the staple line was low. This trial demonstrated that adjuvant brachytherapy does not impact oncologic outcomes. Clinical trial information: NCT00107172. [Table: see text]

Splenic torsion after congenital diaphragmatic hernia repair: Case report and review of the literature

Wandering spleen with torsion, a rare clinical diagnosis, was found to be the cause of chronic abdominal pain in an 11-year-old female with a history of congenital diaphragmatic hernia repaired at three days of age. Doppler ultrasound revealed patent vessels with splenomegaly, and computed tomography (CT) showed an absence of the spleen in the left subphrenic space with torsion at the splenic hilum. Due to the chronicity of pain and risk of ischemia from torsion, open splenopexy with Vicryl mesh was performed. This case report/review of the literature discusses the rarity of this condition, and the importance of timely diagnosis and intervention.

Damage Control Abdomen

Damage control laparotomy has become an accepted approach for patients with life-threatening abdominal conditions. This method compromises fascial integrity creating functionally and aesthetically debilitating hernias. The purpose of this study is to present our technique and outcomes with these complex abdominal wall reconstructions. A retrospective review was conducted on 56 patients with previous damage control laparotomies who underwent elective single-stage abdominal wall reconstruction between 1999 and 2006. Mean age was 42 years. Reconstruction consisted of a double-layer, subfascial Vicryl mesh buttress, combined with components separation and rectus muscle turnover flaps. Hernia recurrence and function were evaluated by clinical examinations and telephone surveys. The major etiologies of abdominal hernias were gunshot wounds, motor vehicle accidents or blunt trauma, and sepsis or perforated bowel. The mean abdominal wall defect was 865 cm, and the average interval time to definitive repair was 17 months. The average length of follow-up was 29 months. Most patients (88%) had successful repair of their abdominal wall, with no hernia recurrence. There were 7 cases of hernia. Of these, 2 cases were from reopening of abdomen because of compartment syndrome that was not repaired, 3 were small asymptomatic hernias for which patients elected not to undergo further repair. Other complications include superficial skin dehiscence, all of which healed secondarily with daily wound care 12% (7 patients) and abdominal compartment syndrome 7.1% (4 patients), resulting in 2 postoperative mortalities in the initial part of the series. There were no mesh exposures, seromas, or fistulas. In all, 29% or 52% of patients were reached by telephone. Of those, 90% surveyed and who worked full-time prior to injury returned to their jobs, and 92% were functioning at premorbid activity levels. Massive abdominal hernia following damage control laparotomy poses a great challenge to the reconstructive surgeon. This patient population is at significant risk for mortality and morbidity. We believe the use of a Vicryl mesh buttress is an important adjunctive tool in complex abdominal wall reconstruction. Functional results are excellent with most returning to work and preinjury activity levels.

Chest-wall reconstruction in case of infection of the operative site: is there any interest in titanium rib osteosynthesis?†

To describe the management of thoracic reconstructions in the presence of primary chest-wall infection (PCWI) or secondary deep chest-wall infection (SCWI), focussing on local tolerance of a titanium rib osteosynthesis system. PCWI included infected chest wall tumours (CWT), infected T3 non-small-cell lung carcinoma (NSCLC) and open flail chest. SCWI was defined by deep infection of previous thoracic-wall reconstructions. Infection was identified by preoperative bacterial analysis of the tumour or surgical site. In PCWI, a one-step procedure combined extensive resection of infected tissues and rigid reconstruction of the defect; skeletal rigidity was achieved using titanium implants. In SCWI, we removed all synthetic material except titanium implants. In both groups, the surgical field was thoroughly cleaned and implants were wrapped or covered by flaps. From January 2005 to December 2011, 11 patients (54 ± 10.2 years) with either PCWI (3 CWT, 3 T3 NSCLC, 1 open flail chest) or SCWI (3 CWT, 1 funnel chest) were treated. Infection was polymicrobial in all but 1 case. Bacteria observed in PCWI patients were multidrug resistant. In PCWI, we resected 4.2 ± 0.6 ribs en bloc with the lung (n = 5), the skin and the pectoralis major and then used mesh and 2.1 ± 1.2 titanium implants for reconstruction (n = 6). The mean defect was 1154.4 ± 318 cm(3). Surgical SCWI management removed polytetrafluoroethylene-mesh and preserved the titanium implants. A Vicryl mesh (n = 3) and greater omentum flap (n = 3) were added. One of the 2 postoperative deaths in the PCWI group was related to infection recurrence. No other patient had infection at the 6-month follow-up with leucocyte-labelled scintigraphy. Titanium rib osteosynthesis is reliable in two complex and life-threatening situations: PCWIs and SCWIs. In combination with a flap, this allows rapid, reliable, rigid reconstruction of infected full-thickness chest-wall defects in a single-step procedure.

The Impact of Vicryl Mesh Sheet Placed on Pelvic Wall for Reducing the Irradiated Bowel Volume in VMAT of Cervical Cancer: Planning Study

The Impact of Vicryl Mesh Sheet Placed on Pelvic Wall for Reducing the Irradiated Bowel Volume in VMAT of Cervical Cancer: Planning Study

Outcomes of Breast Conserving Surgery With Immediate Vicryl-Mesh Insertion: Is It Safe And Effective?

Although breast-conserving surgery (BCS) has become a standard for breast-cancer surgery with improved cosmetic outcomes, there have been many attempts to achieve superior results. Vicryl-mesh insertion, one such method, is a simple technique involving a relatively short period of time. However, doubts regarding its safety and efficacy remain. Therefore, we attempted to analyze the aesthetic outcomes, patient satisfaction, and safety with respect to Vicryl mesh. From May 2007 to March 2009, 38 patients underwent BCS with immediate Vicryl-mesh insertion at Ewha Womans University Mokdong Hospital, Seoul, Korea. In the same period, 31 patients who underwent BCS for breast cancer were randomly selected as a control group. Five patients who underwent BCS with Vicryl-mesh insertion were excluded because they were lost to follow-up shortly after surgery. Retrospective analysis of patient records and oral interviews were performed. We analyzed patients' overall satisfaction, postoperative satisfaction with breast shape, pain, and postoperative complications in the two groups. The mean age, body mass index, follow-up period, specimen size, and ratio of benign to malignant tumors did not differ significantly between the two groups. With regard to tumor location, more tumors were in the upper and lower inner portions of the breast among patients who underwent BCS with Vicryl mesh. There were no significant differences in overall satisfaction or satisfaction with breast shape (p > 0.05), but differences in pain scores were significant (p = 0.016). In terms of the complication rate, four cases with complications (11.8%) were observed in the Vicryl-mesh group and no complications in the BCS-only group. Vicryl-mesh insertion showed a higher complication rate and no cosmetic gain. Therefore, we believe that Vicryl-mesh insertion should be performed carefully. In addition, studies involving many more cases and longer follow-up periods are needed.

A Novel Cranioplasty Technique Incorporating Cancellous Femoral Bone and Recombinant Bone Morphogenic Protein 2

Large calvarial defects in the setting of chronic infection and limited autologous donor sites present challenging problems for the reconstructive surgeon. We report on a novel osteogenic implant as a potential calvarial reconstruction solution. Two patients with an extensive history of severe traumatic brain injury and multiple cranial operations desired delayed calvarial reconstruction subsequent to removal of infected acrylic and titanium implants. These patients underwent harvesting of cancellous femoral bone and bone marrow, which was placed between 2 layers of recombinant bone morphogenic protein 2 impregnated in acellular collagen sponges and an outer layer of sturdily pliable Vicryl mesh to create a moldable osteogenic implant construct. The construct was molded into the shape of the defect and secured with sutures to the skull surrounding the defect. The osteogenic implant showed evidence of bone formation and maintained coverage over the original calvarial defect at 26 months postoperatively as well as subjective satisfaction by both patients and the senior surgeon. This technically straightforward technique with acceptable functional and aesthetic outcomes may be useful to reconstructing selected calvarial defects.