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Purpose To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone. Methods We performed AMT with “contact lens sandwich technique” (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures. Results The procedures were performed successfully with no complications. CLS-AMT showed significantly shorter healing time than BCL (24.0 ± 19.1 vs 42.9 ± 14.6 days; P Conclusion CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

Purpose The aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management. Methods Study group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed. Results LFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440). Conclusion “Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.

Yong Liu,1,2 Qinxin Zhao,3 Feiya Yang,3 Mingshuai Wang,1 Nianzeng Xing1,3 1Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People’s Republic of China; 2Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People’s Republic of China; 3Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of ChinaCorrespondence: Nianzeng XingDepartment of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Li, Chaoyang, Beijing, 100021, People’s Republic of ChinaEmail xingnianzeng@126.comBackground: Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP.Methods: During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated.Results: There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49± 4.72 minutes in Group A and 20.16± 5.75 minutes in Group B (P< 0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P< 0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2± 2.8 m/s and 15.4± 3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0– 20) mL and 0 (0– 12.5) mL, respectively (P=0.107).Conclusion: Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.Keywords: Sandwich, urethral reconstruction, laparoscopic radical prostatectomy, urinary incontinence, urodynamic tests

Background Acquired ventricular septal defect (VSD) is a life-threatening condition that occurred after a myocardial infarction (MI). The timing of the intervention remains very debated but it is crucial to choose the right surgical technique to obtain a stable and complete repair. Methods We report the case of an acquired VSD that occurred after a MI without obstructions of coronary arteries (MINOCA). The defect was promptly treated with a double patch plus glue sandwich technique. Results At the end of the procedure, echocardiographic data showed no residual shunt, and no major adverse cardiac and cerebrovascular events were reported during postoperative days or 6 months follow-up. Conclusion Our report suggests that MI's mechanical complications can occur even after a MINOCA.

In the present study, an aero pneumatic fatigue testing machine for complete dentures was designed, fabricated, and tested for the evaluation of the fatigue life of reinforced complete upper denture (CUD). On completion and testing, it was observed that the machine has the potential of generating reliable number of cyclic data. The machine’s performance was evaluated using test specimens of identical CUDs that were machined in conformity with standard procedures. The fatigue machine compressed the lower dental arch over the upper denture-specimen in centric occlusion, in the same way that the two masticatory muscles pull the lower jaw over the upper jaw during chewing. The incorporation of glass fibres into the CUD using a sandwich technique quadruples the lifespan of the denture (P = 0.004). The low standard deviation, along with the low coefficient of variation (CV) of the group of unreinforced dentures shows the repeatability of the results and the reliability of the machine. The high standard deviation and coefficient of variation of reinforced dentures was expected, since a high variation of results is usually recorded in fibre reinforcement cases. This research confirmed the view that the crack during denture fracture initiates in the anterior palatal area and propagates to the posterior.

The success of dental restorations depends mainly on the ability to bond to other filling materials and tooth substances, in order to resist the multitude of forces acting on the bond within the oral cavity. Although the shortcomings of composite resins have been significantly reduced over the past three decades, microleakage due to shrinkage under masticatory loads is unavoidable. In order to overcome such problems, two materials laminated with matched properties can be used to achieve optimum results. The sandwich technique is an approach in which dentine is replaced by glass ionomer cement (GIC), and enamel is replaced by composite resin. In the past, numerous materials have been proposed with adequate properties to be used in this manner, but the results are conflicting in terms of bonding to the various forms of GIC, and the appearance of microcracks or gap formation during functional loading. This study aimed to evaluate the shear bond strength (SBS) and mode of failure between the following core materials: composite resins (CR) (Methacrylate Z350™, Ceram X™, and Spectrum™) with a base material of glass ionomer cement (GIC, Ketac Molar™). Eight samples were made with the help of polytetrafluoroethylene sheets (TEFLON, Wilmington, DE, USA). Each sheet consisted of holes which were 4 mm in diameter and 2 mm in thickness. The combination of materials was sandwiched. The samples were stored in distilled water and then placed in an incubator for 24 h in order to ensure complete polymerization. The samples were thermocycled for 500 cycles between 5–55 °C/ 30 s. Following thermocycling, SBS testing was performed using a universal testing machine. Additionally, scanning electron microscopy (SEM) was performed on representative samples for the bond failure analysis between GIC and the composite resins. The Ceram-X™ nanocomposite showed significantly higher bond strength than Methacrylate Z350™ or Spectrum™ (p = 0.002). The Methacrylate Z350™ and the Spectrum™ composite specimens demonstrated a similar SBS (p = 0.281). The SBS of the Ceram X™ to GIC was the highest compared to Methacrylate Z350™ and Spectrum™. Therefore Ceram X™ may produce a better bond with GIC, and may protect teeth against recurrent caries and failure of the restoration. Methacrylate Z350™ is comparable to Spectrum™ CR and can be used as an alternative. A combination of adhesive and mixed failure was observed in Methacrylate Z350™ CR and GIC, while adhesive failure was predominantly found in both Ceram X™ and Spectrum™ with GIC restorations.

Introduction: aortic aneurysms involving the renal and visceral arteries are endovascular challenges, especially for emergencies. We report a case of ruptured thoracoabdominal aortic aneurysm (TAAA) in a morbidly obese 71-year-old man. The patient was admitted with a stable hemodynamic state. A computed tomography angiogram (CTA) revealed a contained ruptured TAAA with an occluded celiac trunk and left renal artery due to previous nephrectomy. Due to the emergency and his comorbidities, we performed an endovascular aortic repair with the sandwich technique and 2 chimneys. Two bridging stents (chimneys) were deployed between the aorta and the target vessels (superior mesenteric and right renal arteries) in a space created in-between 2 aortic straight endografts. Ten days postoperative, acute renal failure appeared and right renal stent occlusion was diagnosed on CTA. Unfortunately, no adequate kidney revascularization could be obtained, requiring permanent hemodialysis. At a 3-month follow-up visit, the patient did well with stable aneurysm dimensions. Conclusions: encouraging outcomes of chimney-EVAR techniques, comparable to those in published reports of fenestrated-EVAR and branched-EVAR, support this procedure as a valid off-the-shelf available alternative in emergency situations. Nevertheless, only few midterm results achieved are actually available and long-term outcomes are actually unknown.

Objective The aim of this study was to investigate the shear bond strengths (SBS) of different nano-resin-based composites (RBCs) to resin-modified glass-ionomer cement (RMGIC) after the application of different adhesion protocols. Material and Methods Three RBCs (Filtek One Bulk Fill [FOBF], Tetric N-Ceram Bulk Fill [TNCBF], and Filtek Z350 XT [Z350XT]) were used as layering materials over GC Fuji II LC RMGIC. Three adhesive systems - Total-etch (OptiBond Solo Plus [OB]), self-etch (CLEAR FIL SE Bond 2 [CFSE]), and a universal bond (Single Bond Universal [SBU]) - were used. In total, 160 RMGIC blocks were prepared. Ten samples (n = 10) were layered with the same material to form a reference-cohesive control group. The remaining samples were distributed among the following groups: No treatment [NT]; Total-etch [OB]; Self-etch [CFSE]; Universal bond in the "total-etch" mode [SBU-TE]; and Universal bond in the "self-etch" mode [SBU-SE]. Samples were stored, and aged by thermocycling (5000 cycles at 5 °C / 55 °C, 30 s) and then prepared for SBS testing. Fracture modes were examined by stereomicroscopy. Data were collected and analyzed statistically at a significance level of P

This study aimed to analyze the outcomes of the sandwich technique for repair of parastomal hernia and provide laparoscopic intracorporeal visualization of a case 1 year following repair of parastomal hernia using the sandwich technique. Laparoscopic repair for parastomal hernia was performed using the sandwich technique. Patients characteristics and surgical outcomes were analyzed. The sandwich technique was performed in 13 patients. The mean body mass index was 29.3 kg/m2. No complications or adverse events were noted during the perioperative period. Mean hospital stay after surgery was 4 days. There were no signs of recurrence during follow-up period. In addition, we present a case of laparoscopic view after performing sandwich technique in a patient with parastomal hernia. The sandwich technique is useful and feasible for the treatment of parastomal hernia. It is necessary to understand of the characteristics of the mesh to treat parastomal hernia.

Background Excessive concavity of the lower lateral crura can cause significant aesthetic problems for the nasal tip and can be associated with significant functional problems, such as insufficiencies in the external nasal valve. Objectives The aim of this study was to develop a novel technique for the improvement of several alar concavities that preserve the scroll area. Methods In this retrospective study, 51 primary rhinoplasty patients with unoperated alar concavity deformities were assessed. Alar concavities were repaired with alar strut grafts and a superior transposition flap or superior-based sliding flap, which were designed with the “sandwich” technique. Additionally, the scroll ligament was completely preserved in the 2 variants of the technique. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their 1-year follow-up appointment. Results The median age of patients was 29.2 years (range, 19-49 years). The ROE scores ranged between 90 and 100 points after 1 year. The median score was 91.2 points, and this was significantly increased at the 1-year follow-up appointment (P = 0.002). Patient satisfaction was found to be excellent in 92% of the included patients. Patients were also evaluated in terms of functionality. The patients’ patency scores increased to 9.4 from 6.1 (out of 10) after a 12-month follow-up (P = 0.003). Conclusions This “sandwich” technique involves a combination of superior transposition flaps, superior-based sliding flaps, and alar strut grafts. Thus, patients who receive this treatment may also benefit from new flap techniques and vertical and longitudinal scroll ligament preservation. This new technique presents a novel and easy method for the reconstruction of severe alar concavities. Level of Evidence: 4

Aim The purpose of this in vitro study was to determine the effect of different composite placement techniques on gingival microleakage of giomer restorations. Materials and methods Sixty class II preparations were created in 30 extracted molar teeth with cervical margins 1 mm below the cementoenamel junction. The teeth were divided into three groups of 10 teeth each. In group I, teeth were restored with open sandwich technique using Beautifil II and Beautifil II Flow. In group II, teeth were restored with snowplow technique using Beautifil II and Beautifil Flow. In group III, teeth were restored with oblique increment technique using Beautifil II. After thermocycling and immersion in 2% methylene blue, the teeth were sectioned and dye penetration was evaluated. Results Statistically significant reduction in microleakage was found along the gingival walls in snowplow restorations compared to sandwich restoration and oblique increment restorations. Clinical significance Microleakage was reduced along the gingival walls in snowplow restorations. Conclusion Microleakage was significantly lower in the snowplow restorations.

Vertical alveolar bone deficiency after traumatic tooth extractions or cysts and tumor removal is still being a big challenge for implant rehabilitation. For this purpose, inlay bone grafting and distraction osteogenesis are the main techniques has been used. On the other hand, the price of the distractors and close clinical follow requirements and deviations of the transport segments are the leading problems of this method. To overcome these disadvantages inlay bone grafting can be used as a alternative vertical augmentation method, especially in the anterior mandibular region, for implant rehabilitation. The aim of this report is to assess the efficacy of the sandwich osteotomy for vertical augmentation in the atrophic segment of anterior mandible through clinical studies.

A simple sandwich technique using buttons to compress grafted tissue combined with a tie-over technique for intraoral split-thickness skin grafts (STSGs) is introduced. This technique yielded an excellent engraftment rate (90.5%) and no instances of total graft failure were recorded. This simple sandwich technique for STSGs is readily applicable and inexpensive, and the present results show that it would be potentially useful for repair of defects in the oral cavity.

Alveolar cleft bone graft in the second stage of surgery was a crucial part of the cleft palate treatment protocol with many advantages: reconstructing bone for tooth eruption, supporting the periodontal structure for the teeth adjacent to the cleft, supporting and lifting the arch and preventing from collapsing of maxillary arch. Grafting technique and material are selected based on the treatment purpose that for orthodontic moving tooth into the arch or for dental implant rehabilitation. Cancellous material provides rapid vascularization and healing facilitating for tooth moving into the cleft site but easy to resorb that unsuitable for dental implant placement. While dense material is difficult to move teeth into the cleft but increase initial stability. Therefore, we offered a method that limit bone resorption, easily obtain the implant initial stability, quick osseointegration called two iliac cortical bone blocks sandwich technique for a purposes of dental implant rehabilitation. Treatment protocol started with orthodontic treatment prior alveolar bone grafting to create proper space for implant restoration. Our clinical experience with 32 cleft sites using two iliac cortical bone blocks sandwich had shown potential clinical application in follow-up time up to 96 months. Evaluation criteria of bone grafting for alveolar cleft included soft tissue condition of graft area, nasal fistula closure, bone grafting outcome, success in osseointegration and implant prosthesis. This chapter described in detail treatment procedure and outcomes of a new technique of two iliac cortical bone blocks sandwich for alveolar cleft in patients with unilateral cleft palate.

The usage of natural geotextile has been effective in improving geotechnical characteristics of soil and is being extensively used due to its several distinct advantages such as cheap, locally available, eco-friendly, and reinforcement material. In this study, jute geotextile is used as reinforcement for increasing the strength properties of soil. In the sandwich technique, sand is used as coarse material. This study presents the results of unconsolidated undrained triaxial compression tests for determining the shear strength and stiffness behavior of geotextile reinforced clay and the effects of sandwiching geotextile in a thin layer of sand on improving the shear strength and stiffness of reinforced clay. The test variables include confining pressures, number of geotextile layers and thickness of sand layers. The test results showed that reinforced clay’s shear strength and stiffness behavior considerably increased as the number of geotextile layers was increased. The test results showed that layers of sand encapsulating the geotextile could effectively enhance the soil–geotextile interaction regarding the sandwich technique. The shear strength and stiffness behavior of reinforced clay considerably increased as the thickness of the sand layer was increased.

Identification of an intramyocardial left anterior descending artery remains challenging and many techniques have been proposed for its identification. The exposure technique depends on the surgeon's familiarity and experience with it, and inadvertent right ventricular perforation during exposure on off-pump surgery results in bleeding, which requires urgent cardiopulmonary support and repair. Inadequate repair may result in continued bleeding, closure of the left anterior descending artery, and myocardial infarction. We describe a sandwich technique using the native left anterior descending artery and the bypass graft to repair right ventricular perforation, avoiding closure of this main artery and preserving graft patency.

Background: If the pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence cannot be diagnosed and treated, it can lead to significant morbidity and mortality.Aim: To assess the sandwich...

Re-appearance of trigeminal neuralgia (TN) pain following microvascular decompression (MVD) is a challenging issue. A selective ablation with MVD provides the best response in such recurrences. The absence of intra-operative indicator for immediate correction of sub-optimal decompression is the primary factor for failure. We analysed the effectiveness and safety of awake MVD in minimizing failure, by tailoring the procedure according to intra-operative response with re-exploration or additional procedure like internal neurolysis in the same setting, especially in patients without vascular compression and those unfit for General Anesthesia (GA). The prospective study from June 2016 to June 2017 includes one glossopharyngeal neuralgia (GPN) and 6 trigeminal neuralgia (TN). Five cases responded with immediate complete pain relief but in 2 cases, incomplete pain relief resulted in alteration of intraoperative decision. In one case, a partial pain relief, mandated an additional internal neurolysis in the same setting, resulting in complete pain relief while in the other, re-exploration revealed a hidden venous conflict, not identified on MRI following which an additional IN was performed. All cases were followed up with BNI PIS for a minimum of one year without recurrence. Awake MVD is safe and reliable intraoperative neurophysiological prognostic marker of immediate pain relief and provides a window for an immediate correction of sub-optimal decompression with Internal Neurolysis when needed, in the same setting, especially in neuroimaging negative and elderly cases unfit for GA. It has the potential to reduce the rate of re-intervention and increase the overall effectiveness of MVD by specifically ameliorating the pain burden and quality of life.

Aim: The purpose of the study was to evaluate the functional and radiological results of bone grafting combined with cementing with a gel foam mettle (sandwich technique) in osteolytic lesions around the knee, which include Giant cell tumors and Chondromyxoid fibroma, and Chondroblastoma. Materials and Methods: We had 14 patients of such tumours who were evaluated and treated with extended curettage phenol painting followed by reconstruction of the cavity using a layer of gel foam followed by bone graft and bone cement. The modified technique which we followed included gel foam followed by bone graft followed by another layer of gel foam then bone cement. The period of study was from 2015 to 2019. With average follow up of 2 years. Result: The results were evaluated using the musculoskeletal tumor society scoring (MSTS) and average score in our patient was 24. There were no recurrence noted as lysis of more than 5mm at bone cement interface. Conclusion: We conclude that Modified Sandwich technique provided better prognosis and early resuming of activity. This technique with low rate of recurrence can be applied to all juxta articular tumors with good to excellent results. The only drawback of series was a short follow up. Keywords: Chondromyxoid fibroma, Chondroblastoma, Giant cell tumors, Modified Sandwich technique.

Hemicraniectomy is a commonly performed neurosurgical procedure used in the setting of medically refractory malignant intracranial hypertension. Complications from cranioplasty following hemicraniectomy can be significant, including infection and wound issues. Difficulty with scar tissue during exposure for cranioplasty can be challenging and can lead to prolonged surgical time and increased bleeding. We describe a surgical technique, termed the "dural sandwich", that could provide a significant benefit during cranioplasty as compared to traditional single-layered dural closure.A retrospective analysis was conducted that included 14 patients who underwent a hemicraniectomy procedure over a four-year period. Seven patients were identified who received a cranioplasty following dural sandwich technique during craniectomy. They were compared to a similar patient group of seven patients who received cranioplasty following conventional hemicraniectomy with single-layered dural closure. Surgical time, estimated blood loss, and complication rates were compared between the two groups. Analysis of variance measures was performed to assess for statistically significant differences in blood loss and operative time between the dural sandwich and control groups. Statistical significance was defined as p0.05.Mean estimated blood loss was 82.1 mL in the dural sandwich craniectomy group versus 150 mL in the conventional hemicraniectomy group (p0.05). Mean estimated surgical time was 91.7 minutes in the dural sandwich craniectomy group versus 127.5 minutes in the conventional craniectomy group (p0.05). There was no evidence of neurologic deterioration, cerebral spinal fluid leak, or post-operative hematoma requiring evacuation in either group. In the conventional craniectomy group, a single report of a wound infection was noted that was treated conservatively with antibiotics.By layering bovine pericardium above and below the dura during initial hemicraniectomy, an artificial plane is created that improves ease of exposure during cranioplasty. This technique could reduce surgical time and blood loss during subsequent cranioplasty, and potentially reduce recovery time and postoperative complications.

The study aimed to introduce a perspective of the essential reason behind why marginal microleakage develops regardless of the composite type, the technique, or the bonding system applied, especially in gingival floor of class II cavities. Materials and Methods: Three types of composite resin materials (CharmfilTM, ParaFillTM, and ProMedica®) were used to evaluate microleakage of class II restorations using two restorative approaches. Twenty four newly extracted bicuspid teeth were divided into two main groups (n=12 each) according to the restoration technique (open or closed sandwich techniques). Teeth of each group were then divided into 3 groups (n= 4 each) according to the type of the composite resin used. The restorations were then subjected to a thermocycling process and then were immersed into methylene blue solution for 12 hours. Mesiodistal sectional cuts were made along the central grooves and assessed under stereomicroscope for marginal microleakage. The data were statistically analyzed with a p-value 0.05). Under the microscope, the marginal microleakage was more obvious at the cervical region than at the occlusal region. Conclusion: There was no effect of the composite type or the application technique used on the occurrence of marginal microleakage. The first portion of the material applied against the cavity floor is the primary factor involved in possibly minimizing marginal microleakage.

Hypogastric artery aneurysms (HAA) necessitate repair due to significant morbidity and potential mortality associated with rupture. Coverage or coiling of HAA are not always possible, as the risk of pelvic and spinal cord ischemia become especially significant in bilateral hypogastric disease as well as with prior extensive aortic coverage. We report 2 cases of endovascular HAA exclusion using parallel stent grafts for preservation of flow through the distal hypogastric artery branches and external iliac artery in patients with prior thoracic and abdominal aortic repairs, contralateral hypogastric disease, and significant anatomic constraints.

OBJECTIVES: To describe imaging assessment, procedural and follow-up outcome of patients undergoing left atrial appendage (LAA) occlusion (LAAO) using a "sandwich" technique.BACKGROUND: The presence of a LAA with chicken wing morphology constitutes a challenge that sometimes requires specific occlusion strategies like the "sandwich" technique. However, procedural and follow-up data focusing on this implanting strategy is scarce.METHODS: This multicenter study collected individual data from eight centers between 2012 and 2019. Consecutive patients with chicken-wing LAAs defined as an early (90°) who underwent LAAO with Amplatzer devices and using the "sandwich" technique were included in the analysis.RESULTS: Overall, 190 subjects were enrolled in the study. Procedures were done with the Amulet device (85%) and the Amplatzer Cardiac Plug (15%). Successful implantation was achieved in 99.5% with ≤1 partial recapture in 80% of cases. Single (46.2%) and dual antiplatelet therapy (39.4%) were the most used antithrombotic therapies after LAAO. In-hospital major adverse events rate was 1.5% with no deaths. One patient (0.5%) had cardiac tamponade requiring percutaneous drainage. With a mean follow-up of 19.6 ± 14.8 months, the mortality and stroke rates were 7.7%/year and 2.5%/year, respectively. Follow-up transesophageal echocardiography (TEE) at 2-3 months showed device-related thrombosis in 2.8% and peri-device leak ≥3 mm in 1.2% of patients.CONCLUSIONS: In a large series of patients with chicken wing LAA anatomies undergoing LAAO, the use of the "sandwich" technique was feasible and safe. Preprocedural imaging was a key-factor to determine specific measurements.

Bone quality and quantity play an essential role in dental implant success. Therefore, bone augmentation to restore bone width and height is necessary. For vertical bone augmentation, several techniques have been introduced: guided bone regeneration with various bone substitutes and membranes, onlay bone grafting, inlay bone grafting or sandwich technique, and alveolar distraction osteogenesis. Tent pole and ringbone graft techniques are described in this chapter. Alternative procedures for ridge augmentation, such as short implants, nerve lateralization or transposition, and tilted implants, are discussed. The prognosis and outcomes of the main techniques are discussed.

Objective There is a direct fistulous connection between the cavernous segment of the internal carotid artery and cavernous sinus in cases of direct carotid–cavernous fistula (CCF). Endovascular embolization is the mainstay of management in this condition. This study is about the evolution of endovascular treatment methods and the development of a cost-effective technique for embolization of direct CCF at a tertiary care center. Materials and Methods A retrospective analysis was performed of all the cases of direct type CCF embolized by endovascular techniques in our department from 2008 to 2018.Clinical follow-up of these patients was done at 1 week, 3 months, and 6 months. Results A total of 45 patients with 40 having a prior history of head trauma were included in this study. All cases were treated with a transarterial route except one which was treated with the transvenous approach. Detachable balloons were used in 12 (26.67%) patients, only detachable coils in 14 cases (31.11%), both detachable balloons and coils in 9 cases (20%), and both detachable and push coils, that is, sandwich technique in 8 cases (17.78%). Parent arterial occlusion was performed in 10 patients (22.22%). There was complete resolution of chemosis and bruit in all the patients. Conclusion Endovascular treatment is the mainstay of management in direct CCF. Using more fibered thrombogenic coils in a sandwich manner decreases the cost of the treatment significantly.

Introduction: Surgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. Objective: The aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. Methods: We retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2cm, Group B: ≥ 2 cm). Results: We reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). Conclusion: This study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

Aim The aim of present study was to assess and compare different conditioning methods (laser, PDT and conventional) on shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) bonded to composite (sandwich technique). Material and methods Fifty specimens were prepared from RMGIC and were packed in a teflon mould placed on glass slab. Through each of the glass slab the cement was light cured for 20 s. Now samples were randomly allocated into five groups (n = 10) according to pre-treatment protocols. In group 1 RMGIC were conditioned with MBP using PDT, Samples in group 2 treated with Er,Cr:YSGG (ECYL), group 3 pre-treated with Nd:YAG laser (NYL), samples in group 4 surface conditioned with air abrasion (AA) and group 5 conditioned with 37 % phosphoric acid (PA). Specimens after conditioning were rinsed with distilled water. Adhesive Adper Single Bond 2 was applied on treated surface of RMGIC and cured. Teflon mold was utilized to hold the composite Filtek Z250 in an incremental technique. For SBS testing all specimens were placed under shear knife edge at 1 K N at a speed of 0.5mm2 until bond failure. Optical microscope was used to evaluate failure pattern at 10x magnification. The data of SBS in Megapascal were subjected to statistical test. Analysis of variance was followed by Post hoc test with level of significance at 5 %. Result The maximum SBS was found in group 5 RMGIC conditioned with 37 % PA (16.45 ± 0.32 MPa). Whereas, group 1 (MBP, PDT) demonstrated significantly lower bond integrity (9.82 ± 1.08 MPa) compared to all experimental groups. Bond integrity of RMGIC surface treated with MBP, PDT (9.82 ± 1.08 MPa), group 3 lased with NYL (11.47 ± 0.53 MPa) and samples in group 4 conditioned with AA (11.23 ± 0.47 MPa) were comparable (p > 0.05). Conclusion ECYL has a potential to be used for conditioning of RMGIC prior to composite restoration (sandwich technique). MBP at 100 mg/L deteriorates SBS of composite to RMGIC.

Nearly 50% of patients with an ostomy will develop a parastomal hernia (PSH). Its repair remains a surgical challenge. Both laparoscopic “modified Sugarbaker” (SB) and Keyhole (KH) repair are currently in use, frequently with unsatisfactory results.‘‘Sandwich Repair’’ (SR) may be an alternative to reduce recurrence rates. We present the change of our technique from KH to SR. We collected data from all consecutive laparoscopic PSH repairs at our institution from 2004 until now (from 2004 to 2013 treated with KH, from 2014 with SR) and compared the results of the two groups. Primary endpoint was recurrence rate at 1 year. Secondary outcomes were operative time, PO length of hospital stay (LOS), and short and long-term complications. 13 patients underwent SR. Main changes in surgical technique concerned primary defect closure, no stay sutures, use of glue for first mesh fixation, and partial lateral covering of the underlying mesh with a peritoneal flap. Early postoperative course after SR was uneventful and no recurrence at 1 year was recorded. In the KH group (19 patients), short-term complications occurred in two cases (10%), with one parietal hematoma and one case of intensive pain; we had four recurrences at 1 year (21%). LOS was shorter in the SR group (mean 4 days vs 6, p = 0.004). The KH group had 2 (10%) occurrences of chronic seroma and one bowel perforation (5%), while the SR group had one (8%) occurrence of chronic pain. Median follow-up was 26 months (range 13–78) for the SR group and 47 months (12–105) for the KH group. SR is safe and effective in expert hands and provides promising preliminary results.

Alveolar bone deficiency is a very common problem encountered by the practitioner when planning dental implants. The severity of the deficiency is variable. Many practitioners perform augmentation using the method they feel comfortable with and do not necessarily use the most appropriate method. This is a retrospective study on 21 patients between the ages of 25 and 63 years exhibiting moderate vertical alveolar bone deficiency and treated by the sandwich technique. Mean vertical bone gain was 7.5mm. Sixty-one dental implants were inserted showing a survival rate of 96.7% with a median of 3.1 years follow-up. Main advantages of the method include minimal relapse, single operation and preservation of the native cortical bone in the occlusal surface. We believe the surgeon should maintain the capability of using different augmentation techniques and utilize them appropriately for different severities of deficiency. We wish to establish a paradigm for using different augmentation methods We recommend using the sandwich technique in the moderate deficient cases as described in this work, using alveolar distraction osteogenesis for the severe cases as described in our previous work, where lack of soft tissue for proper closure is a major limitation, and using guided bone regeneration for minor deficiencies.

A 12-year retrospective review of severe burn patients who received cultured epithelial autografts (CEA) at the Singapore General Hospital Burns Centre from January 2005 to December 2016 was carried out. During this period, two different surgical modalities were employed to manage these burn injuries. In the earlier period, following early excision of the burn wounds, exposed surfaces were covered with a combination of split thickness skin autografts (STSG) and allografts. Surfaces covered with skin allografts were subsequently debrided of the allo-epidermis in about 3 weeks later, exposing the allodermis with granulating tissues for grafting of CEA; a technique known as the Cuono's method. In the later period, allograft-autologous micrograft sandwich technique was used to graft on the early excised burns with subsequent CEA grafting. The former and latter groups represented by STSG/C (n=10) and M/CEA (n=14) respectively, were compared in terms of clinical profiles, outcomes, allograft/CEA usage and total graft cost. No significant differences were found based on mean age and presence of inhalation burns between the two treatment methods However, percentage total body surface area (TBSA) and Revised Baux Score were significantly higher (p

Background: Common benign bone lesions around elbow joint include giant cell tumors, chondroblastoma, simple bone cysts, fibrous dysplasia and osteoid osteoma. These lesions can be managed either by observation and follow up, curettage with bone-grafting or combined bone grafting and cementing (sandwich technique). In some cases wide excision is indicated. We conducted this prospective study to find out the functional outcomes after curettage and reconstruction using bone graft sandwich technique with or without internal fixation. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 25 patients diagnosed with benign osseous lesions around the elbow joint and who were managed with extended curettage and reconstruction using either bone grafting or sandwich technique. Patients having any exclusion criteria were excluded from the study. Patients were followed up at least for 1 year. Functional Outcomes were assessed according to Mayo Elbow Performance Score (MEPS) and Quick DASH scores. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 25 studied cases there were 16 males and 9 females with a M: F ratio of 1:0.56. The benign lesions in the studied cases included Giant cell tumors (80%), chondroblastoma (12%) and simple bone cysts (8%). All patients were treated by curettage and reconstruction with bone grafting or combined bone graft and cement. Postoperatively patients were followed up at 1month, 6moths and 1 year. Majority of the patients (92%) were found to have either excellent or good outcome. the Mayo Elbow Performance Score (MEPS) was found to have improved statistically significantly. Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) score was also found to have improved in all the patients and majority of the patients had either no or mild difficulty with a mean Quick Dash Score of 14. Conclusion: Treatment of benign epiphyseal bone tumors by curettage with bone grafting or combined bone grafting and cementing (sandwich technique) was found to have good to excellent functional outcome. There were no patients with significant functional disability at the end of 1 year postoperatively.

INTRODUCTION: Extensive loss of alveolar bone and teeth in the anterior mandible presents a complex problem for reconstruction. Alveolar osteotomy technique with the use of mixture of hydroxy apatite and beta-tricalcium phosphate together with injectable PRF is one of the reliable methods to restore vertical ridge deficiencies. OBJECTIVES: : Evaluate vertical ridge augmentation using sandwich osteotomy technique in anterior atrophic mandible and the use of hydroxy apatite, beta-tri-calcium phosphate mixed with injectable PRF as a grafting material. MATERIALS AND METHODS: This study was conducted clinically on 8 patients indicated for vertical ridge augmentation by sandwich technique osteotomy and fixation of the osteomatized segment by micro-plates and screws, and the placement of Ha- BTCP mixed with I-PRF as interpositional graft material. Patients were evaluated clinically and radiographically by using panoramic radiograph and cone beam computed tomography (CBCT). RESULTS: In this study no severe pain was recorded postoperatively. No signs of inflammation or swelling were observed in almost all of the patients along the follow up period. Vertical bone height gain of the residual ridge was satisfactory and prepared the ridge to receive final prosthesis successfully. CONCLUSIONS Sandwich osteotomy technique with Ha- BTCP mixed with I-prf is a reliable method to restore vertical ridge deficiencies in anterior mandible.

Intercalations are found in the Gospel of Mark. They are graphically described by the following scheme: A – B – A’. Mark’s convention consists of the break off narration (pericope A) through insertion of another one (B) and placing it inside. Such a technique is called intercalation, interpolation or a sandwich technique. The use of intercalation is somehow intended. The purpose of this article is to indicate a problem of criteria that will allow to select the texts of intercalations precisely. The analysis of the criteria and the features of intercalations corroborates the use of sandwich technique by Mark in the six commonly accepted by the biblical scholars conjoined narratives: 3:20-35; 5:21-43; 6:6b-31; 11:12-25; 14:1-11; 14:53-72 and also in case of the juxtaposed pericopes from the group of disputable ones: 8:1-21 and 15:40-16,8. DOI: https://doi.org/10.31743/ba.2018.8.3.03

Defects of the posterolateral abdominal wall of the abdomen, lumbar hernias are rare. They represent 2% to 3% of hernias of the abdominal wall. This rarity explains the large number of short series and the absence of a well-defined therapeutic modality in the publications. Grynfeltt’s hernia at the top and Jean Louis Petit’s at the bottom are the two entities. The old lumbar hernias are bulky with a rich history and easy diagnosis. Though young, they are discreet and reveal most often by their strangulation. We report the case of a Grynfeltt hernia revealed by colonic occlusion in a 77-year-old woman who had a superior right posteriolateral tumefaction for 15 years. The hernia cure was prosthetic made by the sandwich technique. No recurrence was observed after 25 months of follow-up. Through a review of the literature, we reveal the diagnostic and therapeutic difficulties.

The surgical indication and optimal approach for ischemic mitral regurgitation with ventricular septal defect remain uncertain. Very few studies have reported the occurrence of left ventricular aneurysms after repair of ischemic ventricular septal defects. We report a case of a left posterior ventricular aneurysm that developed after an urgent operation to repair an acute ischemic posterior ventricular septal defect using the double-patch sandwich technique via a right ventriculotomy.

Objective. We aimed to investigate the clinical efficacy of collagen membrane with umbilical cord-derived mesenchymal stem cells in the endoscopic repair of nasal septal perforation. Methods. We performed a prospective clinical trial between March 2017 and October 2019. Nasal septal perforations were repaired by the endoscopic sandwich technique with the collagen membrane and umbilical cord-derived mesenchymal stem cells. These patients were followed up postoperatively. Their outcomes were comprehensively evaluated by assessing the healing process of the perforations, the visual analog scale (VAS) for nasal discomfort, and the nasal mucociliary transit time (MTT) for the regenerated nasal mucosa. Results. Our study included a total of eight patients with nasal septal perforation (six males and two females, age 36.6 ± 12.8 years, diameter of perforation 1.0 ± 0.2 cm). Seven patients successfully underwent surgical repair. These patients had significantly improved VAS scores 1 month after the operations (1.1 ± 0.4) compared with the preoperative period (5.9 ± 0.7) (P < 0.05). Although the nasal MTT in the nasal septum and the inferior turbinate surface were within the normal limits before the operation and at 1 month after the operation, the postoperative transit time (11.1 ± 2.0 m) was significantly shorter than the preoperative transit time (12.1 ± 2.4 m) (P < 0.05). There were no recurrences of perforation, scab formations, or epistaxis after the operation. Conclusions. The application of the collagen membrane with umbilical cord-derived mesenchymal stem cells is a simple and feasible endoscopic procedure to repair perforated nasal septa and restore satisfactory functional mucosa.

Aims The use of synthetic meshes in potentially infected operative fields such as in the vicinity of large bowel, is controversial. This study describes our experience with the use of a synthetic composite mesh for prophylaxis and repair of parastomal hernias. Methods Data were collected retrospectively over a 7-year period from 2008 to 2015. An IPOM (DynaMesh™) was used either during the formation of the stoma to reinforce the abdominal wall around the stoma or during the surgical repair of existing parastomal hernias, using keyhole or sandwich technique. Majority of meshes were placed laparoscopically. Clinical data and outcomes any stoma wound complications were collected. Results Forty seven patients were included with a male to female ratio of 34:13. Median age was 66 years (38–91 years) with median follow-up of 17 months (3–73 months). Twenty seven patients had a prophylactic mesh placement (PMP) around colostomy after resection of colorectal cancer. None of these patients had any wound complications. Twenty patients had repair of parastomal hernias (RPH). One patient (1/20) in this group had a superficial wound infection around the stoma site and underwent an incision and drainage. One patient developed seroma and one had parastomal wound haematoma. Conclusions The use of a composite synthetic mesh using a laparoscopic IPOM technique for the prophylaxis and treatment of parastomal hernias, even in a clean contaminated surgical field, is safe and feasible.

Purpose Various surgical methods to prevent intraoperative and postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal approach (TSA) surgeries have been reported, but surgical techniques to address large dural defects have been less thoroughly investigated in the literature. The authors retrospectively evaluated the usefulness of the sandwich technique using fibrin-coated collagen fleece (TachoSil) to prevent intraoperative CSF leakage from large dural defects in TSA surgery. Methods In total, 101 cases of intraoperative CSF leaks were observed among 465 patients who underwent TSA surgery at a single university hospital between 2002 and 2014. Among them, cases with Grade 3 intraoperative CSF leakages and large diaphragmatic/dural defects were reconstructed via the sandwich technique using TachoSil or via the conventional technique using simple intrasellar packing with fat or synthetic materials, and these cases were enrolled in this study. Results A total of 28 cases with Grade 3 intraoperative CSF leakages were identified and analyzed. The sandwich technique using TachoSil was applied in 13 cases, and the conventional technique was applied in 15 cases. The postoperative CSF leakage was significantly decreased by the sandwich technique as compared to the conventional technique (retrospectively, 0 cases vs. 4 cases (30.8%); P = 0.044). Conclusion The sandwich technique using TachoSil can effectively prevent CSF leakage in cases with large dural defects during TSA surgery.

Purpose: To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. Materials and Methods: Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. Results: Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9–1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. Conclusion: The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.

Objectives: An in vitro study which was assessed by testing the appropriate microfiltration protocol using a conventional ionomer cement with sandwich technique in Black’s cavities class I. Methods: 60 human premolars, which underwent standardized cavities. These were randomly divided into 4 groups of 15 teeth each: G1 had IVC Ketac Molar Easymix and G3 had Ionofil Plus respectively to the edge of the cavity and then to wear them in 24 hours, leaving 1mm cavity base and subsequently using phosphoric acid on both enamel and dentin. In G2 and G4 both were simultaneously conditioned with polyacrylic on dentin and phosphoric acid on enamel, followed by washing, drying and 1mm placement of IVC Ionofil Plus and Ketac Molar Easymix respectively. All groups received two layers of adhesive OneCoat S Bond Coltene, light cured for 30 seconds, finally Brillant Coltene resin was applied in an incremental technique polymerizing each layer for 20 seconds. After final polishing of the dental restorations, the premolars became subjected to 10,800 cycles of thermocycling for future placement in methylene blue and measuring the microfiltration with the use of a stereo microscope. Results: There were no differences in the number of steps, but did indicate a minimal discrepancy as to the material used, whereas Ketac Molar Easymix showed a lower degree of filtration. The results were corroborated with SEM images. Conclusions: The analysis made it possible to determine no difference between the two ionomer materials placed using a closed sandwich technique in one or two steps

Objectives Acute type A aortic dissection frequently induces aortic root disease; however, the optimal surgical strategy for aortic root dissection remains a challenge. The objective of this study was to introduce a novel technique for reconstruction of type A dissection to improve patient prognosis. Methods We performed a retrospective review of 791 consecutive patients with acute type A aortic dissection between January 2003 and July 2015. Among these patients, 151 were selected (72% men, age 51.7 ± 9.8 years) to have the modified sandwich repair of aortic root dissection. Results The in-hospital mortality rate of the 151 patients was 6.6% (10/151). During a mean follow-up period of 52.7 ± 28.6 months, the survival rate was 100, 89.1 and 69.7% at 1, 5 and 10 years, respectively. Echocardiography and computed tomographic angiography were performed every year to monitor the pathological change in the aortic root. Freedom from severe aortic regurgitation at 5 years was 100%. No patients required reintervention due to dissection or pseudoaneurysm of the proximal aortic root. Conclusions Aortic valve resuspension and repair of the sinus of Valsalva with the modified sandwich technique using Teflon felt strips for acute type A dissection could be reliable and effective.