Wire Removal Research Articles

Arthrodesis of the digital joint using intraosseous wiring in patients with rheumatoid arthritis

Objective Digital joints affected by rheumatoid arthritis often have severe deformity and/or dislocation, and arthrodesis in a functional position is required. Methods Arthrodesis was performed using intraosseous wiring (modified Lister’s method) from January 2011 to December 2015, and we investigated the union rate, postoperative complications, and patient satisfaction with the operation at the final follow-up. The DASH score, grip power, and pinch power were also investigated before the operation and at the final follow-up. Results Arthrodesis was performed for 90 digital joints in 56 patients. Bone union was obtained in 85 of 89 joints (96%). Wire removal was needed due to subcutaneous protrusion in 20 joints and superficial infection in five joints. The mean preoperative DASH score of 50.5 improved to 45.2 at the final follow-up. The pulp pinch power of the index fingers through the little fingers changed significantly. In the questionnaire regarding the operated digit using a visual analogue scale (VAS, 0 [worst] to 100 [best]), the overall satisfaction was 70. Conclusion With this approach, we achieved painless stability as well as deformity correction. A restored prehensile pattern and improvement in the activities of daily life can thus be expected after surgery.

Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry

ObjectivesThe aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BackgroundCoronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. MethodsData were collected retrospectively from a multicenter international registry between April 2011 and February 2019. ResultsAmong 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in “valve-in-valve” procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). ConclusionsIn patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.

Percutaneous pinning for treating distal radial fractures in adults.

Background Fracture of the distal radius is a common clinical problem. A key method of surgical fixation is percutaneous pinning, involving the insertion of wires through the skin to stabilise the fracture. Objectives To evaluate the evidence from randomised controlled trials for the use of percutaneous pinning for fractures of the distal radius in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2006), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Selection criteria Randomised or quasi-randomised controlled clinical trials involving adults with a fracture of the distal radius, which compared percutaneous pinning with conservative treatment, or different aspects of percutaneous pinning. Data collection and analysis Two authors independently assessed and extracted data from the included trials. Some pooling of data was undertaken for one comparison. Main results Thirteen trials, involving 940 generally older adults with dorsally displaced and potentially or evidently unstable distal radial fractures, were included. Methodological weaknesses among these trials included lack of allocation concealment and inadequate outcome assessment. Factors affecting the applicability of trial evidence included inconsistent fracture classification, variations in outcome assessment and incomplete reporting. Six heterogeneous trials compared percutaneous pinning with plaster cast immobilisation. Across-fracture pinning, used in five trials, was associated with improved anatomical outcome and generally minor complications. There was some indication of similar or improved function in the pinning group. One quasi-randomised trial found an excess of complications after Kapandji pinning. Three trials compared different methods of pinning. Two trials found a higher incidence of complications after Kapandji fixation compared with two methods of across-fracture fixation. The third trial provided inadequate evidence for modified Kapandji fixation versus Willenegger fixation. Two small trials comparing biodegradable pins versus metal pins found a significant excess of complications associated with biodegradable material. Two small trials compared plaster cast immobilisation for one week versus for six weeks after surgery. One trial found duration of immobilisation after trans-styloid fixation did not have a significant effect on outcome. More complications occurred in the early mobilisation group after Kapandji pinning in the second trial. Authors' conclusions Though there is some evidence to support its use, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use.

Effect of buried vs. exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures: A systematic review and meta-analysis

BackgroundDuring Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures, a key clinical decision is whether to leave a Kirschner wire exposed or bury it beneath the skin. Therefore, we conducted a meta-analysis to evaluate the clinical effect of buried and exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures.MethodsPubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched and clinical trials that evaluated buried and exposed Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures were identified. Methodological qualities of studies were assessed by using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Publication bias was detected using Begg’s test and Egger’s test. Sensitivity analyses were performed by excluding one study at a time to determine whether overall results were reliable.ResultsTwo randomized controlled trials (RCT) and five case-controlled studies involving 1446 patients were included in the analysis. Sensitivity analyses indicated that the results of each study were statistically robust. Begg’s test or Egger’s test revealed no significant publication bias. Our meta-analysis indicated that exposed Kirschner wire osteosynthesis had a significantly higher infection rate than its buried counterpart. Additionally, buried Kirschner wire osteosynthesis resulted in a significantly higher rate of Kirschner wire removal in operating room than the exposed one. Our meta-analysis exhibited no statistical differences between the two procedures in the rate of early pin removal.ConclusionsMeta-analysis of available RCTs and case-controlled studies demonstrated that buried Kirschner wire osteosynthesis had a lower infection rate but tended to lead to more frequent Kirschner wire removal in the operating room as compared to its exposed counterpart.Trial registrationPROSPERO (CRD42018105249).

Improving Multimodal Localization Through Self-Supervision

Modern warehouses utilize fleets of robots for inventory management. To ensure efficient and safe operation, real-time localization of each agent is essential. Most robots follow metal tracks buried in the floor and use a grid of precisely mounted RFID tags for localization. As robotic agents in warehouses and manufacturing plants become ubiquitous, it would be advantageous to eliminate the need for these metal wires and RFID tags. Not only do they suffer from significant installation costs, the removal of wires would allow agents to travel to any area inside the building. Sensors including cameras and LiDAR have provided meaningful localization information for many different positioning system implementations. Fusing localization features from multiple sensor sources is a challenging task especially when the target localization task’s dataset is small. We propose a deep-learning based localization system which fuses features from an omnidirectional camera image and a 3D LiDAR point cloud to create a robust robot positioning model. Although the usage of vision and LiDAR eliminate the need for the precisely installed RFID tags, they do require the collection and annotation of ground truth training data. Deep neural networks thrive on lots of supervised data, and the collection of this data can be time consuming. Using a dataset collected in a warehouse environment, we evaluate the performance of two individual sensor models for localization accuracy. To minimize the need for extensive ground truth data collection, we introduce a self-supervised pretraining regimen to populate the image feature extraction network with meaningful weights before training on the target localization task with limited data. In this research, we demonstrate how our self-supervision improves accuracy and convergence of localization models without the need for additional sample annotation.

The TrkB agonist 7,8-dihydroxyflavone improves sensory-motor performance and reduces lipid peroxidation in old mice.

7,8-Dihydroxyflavone (7,8-DHF) is a natural flavonoid compound that act as Trk-B agonist. 7,8-DHF is also a potent antioxidant. When applied systematically, 7,8-DHF can pass through blood-brain barrier and exhibit potential therapeutic effects in several animal models of neurodegenerative disorders. This study investigates the remedial effects of 7,8-DHF on behavioral impairments and biochemical changes associated with aging with a species emphasis on cortex. For this purpose three experimental groups were formed which are young control group, old group and old-DHF groups. 5 mg/kg 7,8-DHF was administered intraperitoneally to old-DHF group for 3 weeks. We assessed the hang wire and adhesive removal performances of mice. Also, oxidative stress, neuroinflammation and synaptic protein levels in the cortex were measured. We observed that chronic administration of 7,8-DHF improved behavioral performance of old mice. Besides, 7,8-DHF reversed MDA level which was increased in old control animals. However, 3 weeks application of 7,8-DHF failed to recover the levels of neuroinflammation markers (TNF-α and IL-6) and synaptic proteins (PSD-95 and Synaptophysin) which were reduced in old group. These findings demonstrate that improvement of age-dependent behavioral impairments and MDA levels by 7,8-DHF could be attributed to its antioxidant actions.

To evaluate Clinico-radiological and functional outcome of “early mobilization” after stable internal fixation with k-wires in displaced fracture of lateral condyle humerus in children

Background: Lateral condyle fractures are the second most common pediatric elbow fractures, after those of the supracondylar region. They account for approximately 16.9% of those occurring in the upper limb. Most of them need to be managed operatively by open reduction and internal fixation with Kirschner wires followed by Splintage in an above elbow slab for at least 4 to 6 weeks. The present study was conducted to evaluate the functional outcome of early mobilization after stable internal fixation with 3 Kirschner wires. Methods: A prospective study was conducted including 30 patients having displaced fracture of lateral condyle humerus in children over a period of one year. All the patients were followed up for a minimum of 6 months. Age incidence, sex distribution, mode of injury, side involved, fracture classification, complications and functional outcomes were noted. Results: There were 22 males and 8 females. Average age was 6.18 years. 22 of them were Jakob III and 8 were Jakob II. Early mobilization was started in all patients from first post operative day. All fractures united by 6 weeks at time of wire removal. At the final follow up Dhillon functional score was evaluated and was found to be excellent in 24 patients, good in 5, fair in one and there was no patient with poor outcome. Conclusion: Our results demonstrate that displaced fractures of lateral condyle humerus managed operatively by open reduction and stable fixation with 3 K-wires can be mobilized immediately after surgery without any risk of loss of reduction and with good final functional results.

1348. Mycobacterium Chimera Infection Following Cardiac Surgery: A Review of a Large Cohort of Cases in the United States

BackgroundMycobacterium chimera (MC) is a nontuberculous mycobacterium associated with infections originating from heater-cooler devices following cardiac surgery globally from 2012 to 2016. Twenty-eight cases occurred within our health system in Southern California, the largest number of cases in the United States to date. We aim to summarize the clinical features, diagnosis, treatments, and outcomes of these cases.MethodsWe reviewed the electronic health records of 28 patients with identified MC infection who had index coronary artery bypass (CABG) and/or valve replacement surgery between 2014 and 2016. All diagnoses were confirmed by cultures speciated to MC by 16S partial DNA sequencing or Karius testing, except for one case. Patients were grouped by clinical presentation of disseminated disease (n = 18) or localized disease (n = 10). Treatment delay was calculated from the time of initial presentation to the start date of antibiotics and evaluation for surgical intervention.ResultsAll patients who underwent CABG alone (n = 5) developed localized sternal wound infections, whereas patients who had valve replacement surgery (n = 23) developed either localized or disseminated disease. Disseminated disease carried a mortality rate of 40% in those with surgical source control vs. 72% in patients who were not surgical candidates (OR 6.6, 95% CI 0.8–55). The mortality rate of patients with localized sternal wound infections was 11% after incision/drainage and sternal wire removal (n = 9). Delay of antimicrobial treatment greater than 6 months in all 28 patients was associated with a mortality rate of 54% compared with 35% in patients who started treatment within 6 months (OR 2.2, 95% CI 0.47–10.35). Overall mortality rate of patients with MC infection was 42%.ConclusionDisseminated MC infection should be considered early in at-risk patients presenting with constitutional symptoms. In this review of 27 confirmed and 1 probable case of MC infection, disseminated infection only occurred in patients who underwent valve surgery while localized disease occurred in patients who underwent CABG. Surgical source control with early initiation of antimicrobial therapy is associated with improved outcomes. Optimal duration of antimicrobial treatment is still unknown.Disclosures All authors: No reported disclosures.

Influence of guide wire removal on tip location in peripherally inserted central catheters (PICCs): a retrospective cross-sectional study

ObjectivesThe aim of this study was to identify the prevalence of peripherally inserted central catheter (PICC) malposition and the influence of guide wire removal on tip location in PICCs and...

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

Lumbar laminotomy for the intrathecal administration of nusinersen for spinal muscular atrophy: technical note and outcomes.

Nusinersen (Spinraza) is a US Food and Drug Administration-approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions.Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time identification of instruments. Hardware was contoured with a carbide drill bit to develop the surgical window. Fiducial screws were placed along the perimeter for demarcation. Sublaminar wire removal caused dural defects that were repaired with a layer of dural substitute onlay and sealant. All patients successfully received nusinersen thecal injections via lumbar puncture by an interventional radiologist. Fluoroscopy time ranged from 6 to 36 seconds. No postoperative pseudomeningoceles, cerebrospinal fluid leaks, or wound complications occurred.For patients with SMA and posterior fusion from prior scoliosis treatment, lumbar laminotomy is an effective method for creating thecal access for the administration of nusinersen.

Review of the Use of Stainless Wires in Craniosynostosis Surgery.

Controversy exists as to the ideal form of bone fixation in craniosynostosis surgery with the use of resorbable plates predominating in most craniofacial units. However, the use of stainless steel wires has been the preferred fixation method at the Oxford Craniofacial Unit (OCU) since its establishment. Wires have the advantage of being malleable, inexpensive, and quick and easy to use. A retrospective review of all patients who underwent craniosynostosis surgery at the OCU between February 1995 and February 2017 was undertaken. Average follow-up period was 141 months (11.7 years), with a minimum of 6 months. A total number of 1226 craniosynostosis procedures were performed. A minimum of 16,160 wires were inserted. No complications were identified resulting from transdural migration of wires. One hundred fifty-six wires were removed in 92 patients during 109 general anesthetic day-care procedures. This was due to discomfort on palpation in the majority of cases. The average time from primary surgery to removal of wires was 37 months (3.1 years). The most common site for wire removal was in the supraorbital and lateral forehead regions, and occurred most frequently in children who had undergone fronto-orbital advancement and remodeling. The use of wires in craniofacial surgery is safe. One percent of all wires that were inserted had to be removed. Children undergoing primary craniosynostosis surgery have a 9% chance of needing a subsequent day-care procedure to have a wire removed. Taking into account the cost of this additional surgical procedure, the primary use of wires in craniosynostosis surgery is still significantly cheaper than the use of resorbable plates.

Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Background:&#x0D; Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability.&#x0D; Materials and Methods:&#x0D; This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture.&#x0D; Result:&#x0D; Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups.&#x0D; Conclusion:&#x0D; Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.

Prakash versus figure of eight technique in sternal closure in CABG patients

Background: Median sternotomy was recommended in 1957 by Julian for complete exposure of the heart. Despite the high importance of correct sternotomy, proper sternal closure is vital to ensure fewer post-operative complications. The sternum can be closed by wires and other methods. Sternal closure using the most suitable technique can dramatically reduce the risk of development of such complications.Methods: It is a prospective randomized comparative study of two patient groups, each included 30 patients, diagnosed of ischemic heart disease and underwent CABG. Group A with the patients’ sterna closed by figure of eight method and group B with multi-twist (Prakash) technique. Both groups were compared regarding postoperative pain and complications as superficial and deep sternal wound infections (SSWI, DSWI), wire removal and rewiring within six months of follow up.Results: The mean of minimum post sternotomy pain in group A patients was 24.50±11.7, whereas in patients of group B, it was 27±10.1. Only two patients (group A) suffered sternal dehiscence within six months follow up. The incidence of SSWI and DSWI among both groups was almost similar with only two patient of group A needed wire removal and one of them required rewiring.Conclusions: The multi-twist sternal closure provides better sternal stability after CABG especially in patients who are vulnerable to sternal dehiscence.

Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

This is a rare case of surgical removal of intrahepatic retained broken wire of percutaneous transheaptic biliary catheter, which caused cholagitis and severe pain in a 59-year-old female who had undergone percutaneous transhepatic biliary dilatation of stricture hepaticojejunostomy in past. This is rare case ever reported of surgical removal of a broken PTBD wire retained inside left biliary system, post percutaneous transhepatic biliary dilatation of biliary stricture. Patient also underwent redo-hepaticojejunostomy for treatment of stricture hepaticojejunostomy in same sitting. This guidewire was put by interventional radiologist for dilatation of hepaticojejunostomy stricture. Patient had developed stricture in hepaticojejunotostomy which was done in year 2007 along with choledochal cyst excision by some other Gastrosurgeon. But one reoperation as well as one interventional approach had failed to retrieve the wire retained in biliary system. After that we successfully operated this challenging case and cured her of stricture hepaticojejunostomy, cholagitis and removed the foreign body in one surgery. Postoperatively we followed her up of 2 yrs. Patient is afebrile ,free of jaundice and has normal LFT on 2 yrs of follow up.Broken guidewire during percutaneous intervention in obstructed biliary system is an emergency as it acts as foreign body, removal with reansatomosis gives a fair chance of cholangitis free survival to patient.

Safety of temporary pacemaker wires.

It is routine practice to insert temporary pacemaker wires in cardiac surgery patients. In selected patients, temporary pacemakers are helpful in the management of cardiac surgery patients intra- and postoperatively. Although this practice is generally safe, a small percentage of patients may have complications at the time of insertion, during pacing postoperatively, at the time of pacemaker wire removal, or if temporary wires are retained inside the body. This review will shed some light on the safety issues of temporary pacemaker wire usage.

Comparison of conventional and laser-aided fiberotomy in relapse tendency of rotated tooth: A randomized controlled clinical trial

The aim of the present study was to compare the tendency of mandibular incisor rotation relapse after conventional circumferential supracrestal fiberotomy (CSF) with Er,Cr:YSGG laser-aided CSF. In this three-arm parallel study, the patients with one lower incisor rotation greater than 30 degrees before treatment were selected. The patients were randomly assigned to three groups in a 1:1:1 ratio. Rotational relapse tendency was measured on a digitized model one month after arch wire removal. Probing depth, clinical crown height and pain levels were also measured. A total of 46 patients were recruited. Relapse tendency in conventional CSF and laser-aided CSF groups were 5.09±1.59° and 4.87±2.08°, respectively, and significantly lower than 11.28±2.93° in the control group (P<0.001). Relapse tendency was not different between the conventional CSF and laser CSF groups. Probing depth, clinical crown height, and experienced pain levels exhibited negligible differences. Er,Cr:YSGG laser-aided CSF in one month was as effective in reducing rotational relapse tendency of mandibular incisor teeth as conventional CSF.

An unusual case of penetrating trauma with a copper wire causing a traumatic subluxated cataract

A 22-year-old male presented with injury with a copper wire to left eye at the workplace. Visual acuity was reduced to finger counting with severe ocular pain. Slit lamp examination showed that the intraocular foreign body entered the anterior chamber through a 0.5 mm scleral wound and pierced through iris and lens causing a traumatic cataract. The patient was taken to operatingtheater with a removal of the copper wire and primary closure of the scleral wound. Two weeks' postoperatively, the patient was taken up for a cataract surgery but left aphakic. He is to be posted for a scleral-fixated intraocular lens at a later date.

Interventions for treating wrist fractures in children.

Interventions for treating wrist fractures in children.

Double Supercharged Jejunal Interposition for Late Salvage of Long-gap Esophageal Atresia.

A variety of surgical techniques exist to manage long-gap esophageal atresia (LGEA), including gastric pull-up (GPU), colonic interposition (CI), jejunal interposition (JI), and distraction lengthening. Salvage reconstruction for late failure of any conduit type is a complex surgical problem fraught with technical difficulty and significant risk. Jejunal interposition can be used as a salvage procedure in the management of LGEA. However, the opposing requirements of conduit length and adequate perfusion make the procedure technically challenging. Chronic comorbidities and abdominal and thoracic adhesions may further complicate these cases. We report a technique for the management of 3 late treatment failures of LGEA using pedicled JI in conjunction with 2 additional arterial and venous anastomoses, or double supercharging. For 2 patients who presented with failed CI, pedicled JI was performed and supercharged to internal mammary vessels as well as vasculature preserved from the prior colonic flap mesentery. The third patient presented with failed GPU and underwent pedicled JI that was supercharged caudally to the gastroepiploic vessels and cranially to the left common carotid artery. No flaps were lost in any patients. Median operation time was 16.5 hours. Patients were monitored postoperatively in the intensive care unit for a median of 23 days, extubated after 14 days, and discharged at 41 days. Postoperatively, all patients tolerated an oral diet by discharge and continue to enjoy oral intake of all food consistencies without dysphagia or aspiration. Follow-up time spanned 2 to 4 years (average, 3.3 years). One patient required dilatations and temporary stent for stricture, and another required removal of prominent sternal wires; otherwise, no additional procedures were performed. Although technically difficult, double supercharged JI should be considered as a salvage operation to restore esophageal continuity after CI or GPU failure for LGEA, when there are otherwise limited reconstructive options.