Search

Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of onlay resorbable biosynthetic mesh against underlay biologic mesh in contaminated VHR with AWR. A single-center retrospective review from 2015 to 2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (Centers for Disease Control wound class II-IV). A matched paired analysis based on age, body mass index, and Centers for Disease Control wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion. A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm2, required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (SSOs) (46.8% versus 72.3%, P < 0.05) and fewer SSO procedural interventions (19.1% versus 38.4%, P < 0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use; however, was not statistically significant (14.9% versus 30.4%, P = 0.07), with a mean follow-up of 25.73 ± 18.66 mo. Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of SSOs and interventions, ultimately reducing the postoperative clinical and financial burden for this patient population. • Biosynthetic mesh in contaminated VHR significantly reduces surgical site occurrences compared to biologic mesh. • Patients using biosynthetic mesh required fewer procedural interventions postsurgery. • Biosynthetic mesh demonstrated a trend toward lower hernia recurrence rates compared to biologic mesh. • Study suggests biosynthetic mesh may reduce both clinical complications and financial burden. • Matched analysis highlights biosynthetic mesh as a preferable option in contaminated surgical fields. [ABSTRACT FROM AUTHOR]

Transradial approach for neuroangiography is becoming increasingly popular because of the advantages demonstrated by interventional cardiology. Many advantages of radial access could be applied to intraoperative angiography.To report our institutional experience with transradial and transulnar intraoperative angiography, and evaluate its safety and feasibility.Intraoperative angiography through upper extremity vessels was attempted in 70 consecutive patients between April 2019 and December 2022. Data on patient characteristics and surgical indications, procedural variables, and complications were collected.Of the 70 patients who underwent intraoperative angiography, 58.6% were female, and the mean age was 52.9 ± 14.0 years. The reason for surgery was aneurysm clipping in 42 (60.0%) cases. In total, 55 patients (78.6%) were positioned supine, 13 (18.6%) prone, and two (2.9%) were positioned three-quarters prone. Access was attempted via the radial artery in 60 (85.7%) patients and the ulnar artery in 10 (14.3%) patients. The procedure was successful in 69 of 70 cases (98.6%), as one required conversion to transfemoral approach due to significant spasm in the proximal right radial artery. The median fluoroscopy time was 8 min. No procedure was aborted, and no patient experienced access-site or angiography-related complications. Intraoperative angiography altered the surgical management in 3 (4.3%) cases. Re-access for follow-up angiography was unsuccessful in three (13.6%) of 22 due to radial artery occlusion.Our institutional experience supports that transradial and transulnar intraoperative angiography is safe and feasible during neurovascular procedures for various indications and positions. [ABSTRACT FROM AUTHOR]