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Background Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains the most common surgical complication. We have developed a novel stump closure technique after DP using transpancreatic mattress suture with Vicryl mesh (TMV) and reported our initial findings. The purpose of this study is to evaluate the efficacy of TMV compared to the conventional handsewn stump closure technique (CHS). Methods This retrospective single-center study included 165 consecutive patients who underwent open DP from January 2010 to May 2018. Of these, 71 patients underwent DP using TMV after September 2014 and 94 patients underwent DP with CHS. The surgical outcomes were compared between the two groups. Results Clinically relevant POPF rate in the TMV group was significantly lower than that in the CHS group (5.6% vs. 17.2%, P = 0.027). Morbidity rate was higher in the CHS group than that in the TMV group (16.9% vs. 27.7%, P = 0.104). In the multivariate analysis, absence of additional organ resection (OR 3.57; 95% CI 1.18-10.43; P = 0.025) and TMV (OR 0.24; 95% CI 0.07-0.73; P = 0.010) were identified as independent preventing factors for clinically relevant POPF. Conclusion TMV can be an effective stump closure technique for preventing POPF after DP.

Achieving sufficient mechanical purchase of pedicle screws in osteoporotic or previously instrumented bone is technically and biologically challenging. Techniques using different kinds of pedicle screws or methods of cement augmentation have been used to address this challenge, but are associated with difficult revisions and complications. The purpose of this biomechanical trial was to investigate the use of biocompatible textile materials in combination with bone cement to augment pullout strength of pedicle screws while reducing the risk of cement extrusion. Pedicle screws (6/40mm) were either augmented with standard bone-cement (Palacos LV + G) in one group (BC, n = 13) or with bone-cement enforced by Vicryl mesh in another group (BCVM, n = 13) in osteoporosis-like saw bone blocks. Pullout testing was subsequently performed. In a second experimental phase, similar experiments were performed using human cadaveric lumbar vertebrae (n = 10). In osteoporosis-like saw bone blocks, a mean screw pullout force of 350N (± 125) was significantly higher with the Bone cement (BC) compared to bone-cement enforced by Vicryl mesh (BCVM) technique with 240N (± 64) (p = 0.030). In human cadaveric lumbar vertebrae the mean screw pullout force was 784 ± 366N with BC and not statistically different to BCVM with 757 ± 303N (p = 0.836). Importantly, cement extrusion was only observed in the BC group (40%) and never with the BCVM technique. In vitro textile reinforcement of bone cement for pedicle screw augmentation successfully reduced cement extrusion compared to conventionally delivered bone cement. The mechanical strength of textile delivered cement constructs was more reproducible than standard cementing. This article is protected by copyright. All rights reserved

En bloc transplantation of pediatric kidneys into adults is a suitable measure to help correct the shortage of available kidneys. This practice, however, is not widespread because of the high incidence of vascular complications. Our institution has previously described a vicryl mesh technique for en bloc kidneys, with an attempt to reduce the incidence of vascular complications. The purpose of this study was to evaluate the long-term results of recipients with en bloc kidneys stabilized with this technique. The charts of 644 adult renal transplants performed between July 1987 and July 1999 were reviewed. During this period, 14 adult patients have received 14 pairs of en bloc pediatric kidneys using the vicryl mesh technique. All patients received OKT3 as an induction immunosuppression with cyclosporine started 10-14 d after the transplant. The median donor age was 24 months (range 14-84 months), and the median recipient age was 49 yr (range 23-68 yr). The mean recipient weight was 79 kg (range 60-114 kg). The mean cold ischemia time was 14.2 hr. None of the patients developed vascular or urological complications. Delayed graft function and moderate acute rejection occurred in one patient each. At a mean follow-up of 51 months (range 7-96 months), all 14 patients maintained excellent renal function with a mean creatinine of 1.01 mg/dL. Renal measurements pre-operatively and at follow-up ultrasound examinations were available in 9 patients, and the mean length of the kidneys had grown approximately 5.0 cm. These data demonstrate that minimal vascular and immunological complication rates can be achieved with pediatric en bloc kidneys using the vicryl mesh envelope technique.

Summary— The sapphire crystal infrared photocoagulator and polyglactin (Vicryl) mesh, two new methods for closure of radial nephrotomies, were assessed in 16 dogs. Six radial nephrotomies were carried out in each dog; in 10 the nephrotomies were sealed by the infrared photocoagulator and in six they were left open, but the kidney was covered with a polyglactin mesh. Functional and morphological studies were performed using creatinine clearance, microfil casting, corrosion cast angiography and histology. There was no significant loss of function or loss of renal tissue. Both methods were shown to be safe and effective in the closure of radial nephrotomies.

Purpose: Initial outcome data from our institution have shown that sublobar resection in combination with I‐125 brachtherapy is associated with recurrence rates of 2.0%, compared to 18.6% with sublobar resection alone. The objective of this work is to present the technical and dosimetric aspects required to execute this procedure from the radiationoncology perspective, as well as to analyze the dose distributions of patients treated with this technique. Method and Materials: I‐125 seeds in vicryl suture were embedded into vicryl mesh and surgically inserted providing a 2.0 cm margin on each side of the resection staple line. A nomogram was developed to determine the suture spacing in the vicryl mesh, as a function of seed activity in order to deliver 120 Gy at a distance of 0.5 cm above and below the seed array. Postoperative dosimetry consists of CT‐based planning and dose volume analysis. Results:Dose distributions, DVH data, mean dose and NTCP values for lung were analyzed in a group of patients. The mean doses ranged from 3.72 Gy to 9.10 Gy. NTCP values were below 1%. DVH data shows that a small volume of ipsilateral lung was irradiated for all patients. A comparison of brachytherapy with external beam therapy was investigated for one patient. Brachtherapy was judged to be superior to external beam therapy. Results showed that most of the ipsilateral lung volume received a lower dose when treated with an implant to 120 Gy compared to external beam therapy treated to 60 Gy. Conclusions:Lungbrachytherapy with I‐125 at the time of sublobar resection is a precise and conformal option of dosedelivery for stage I NSCLC patients with compromised physiologic reserve. Patient related toxicity has not been linked to this procedure. This simple technique provides significant lung sparing when compared to standard external beam therapy.

Background To address the question of how much chest-wall (CW) resections and prosthetic reconstructions influence functional outcome. Methods We retrospectively reviewed 175 patients who underwent surgery for CW tumors. The clinical, histological, surgical, oncological, and functional factors were analyzed. Results We performed: 75 rib resections; 20 sternal resections; 15 combined resections; and 27 lung resections. In 39 cases (22.2%) CW was stabilized with non-rigid prosthesis (Vicryl-mesh: 8 patients; Goretex-mesh: 31 patients). Postoperative complications occurred in 22 cases (12.6%): a correlation with lung resection was evidenced by multivariate analysis (P = 0.025). Five-year survival for primary and secondary tumors was 50% and 36%, respectively: multivariate analysis (P = 0.048) showed a worse survival in men only. In the prosthesis subset, pulmonary function tested as percentage of forced expiratory volume in one second (%FEV1) (pre: 87.1 ± 18.9%; post: 82.3 ± 23.0%, P = ns), percentage of forced vital capacity (pre: 94.1 ± 19.3%; post: 82.0 ± 21.6%, P = ns), diffusing capacity of the lungs for carbon monoxide (pre: 15.7 ± 7.4; post: 12.1 ± 4.1, P = ns) and paO2 (pre: 82.6 ± 10.9 mmHg; post: 83.9 ± 7.3 mmHg, P = ns) was slightly modified from pre to postoperative. Interestingly, the decline of FEV1% was lower in the prosthesis-subset (4.1 ± 15.9%) compared with the subgroup who did not undergo prosthetic stabilization (17.5 ± 16.2%), but this difference was not statistically significant (P = ns). Conclusion Because of the low decrease of lung parameters, CW prosthetic reconstruction could be helpful for avoiding postoperative worsening of functional outcome, mostly in patients with pre-existing pulmonary diseases.

Objective Wound histology and mesh bioincorporation following intraperitoneal fixation using laser-assisted soldering was evaluated. Methods 2.8–3.2 kg NZW rabbits underwent laparotomy. Controls had 2×2 cm segments of Mersilene™ stapled to peritoneum. Group 2 segments were affixed with 55% collagen solder onlay by fiber-coupled diode laser (1.43 ± 10 µ, 2.5 W CW, 4 mm spot, 60°C set temperature). Group 4 had Mersilene™ inlaid into melted solder. Group 3 had solder-embedded Vicryl™ mesh affixed. Animals were euthanized at 0, 2, 4, 6 weeks. Fixed sections were assessed for integrity, inflammation, and fibrosis using H & E, Masson's Trichrome and Evans Van Gieson staining. Results Histology demonstrated cell types, local mesh reaction, and progressive evidence of solder reabsorption mimicking normal healing and bioincorporation. Mersilene™ groups demonstrated normal arrangement of collagen-rich layers around mesh. Conclusion Collagen-based tissue soldering permits normal wound healing and may mitigate use of staples. Further development of this strategy is warranted. © 2005 Wiley-Liss, Inc.

The purpose of the present study was to examine the effect on periodontal regeneration of preventing bacterial contamination of the membrane material following the guided tissue regeneration procedure (GTR). Periodontal dehiscence defects were surgically produced in 2 monkeys. In each monkey, 8 of these defects were submerged after resection of the crowns of the teeth and a teflon (Gore-Tex Periodontal Material®) or a polyglactin (Vicryl Mesh®) membrane was adjusted to cover the defect and the exposed root surface. 4 defects on non-crown resected teeth were treated with either a teflon or a polyglactin membrane positioned with the coronal border approximately 2 mm below the margin of the covering tissue flap. Following 6 months of healing, the animals were sacrificed. Histological evaluation of the specimens revealed that roots which were kept completely covered during the healing period demonstrated new connective tissue attachment and bone formation corresponding to 67–100% of the length of the initial defect depth, whereas the amount of new connective tissue attachment and bone on non-submerged roots ranged between 30–59% and 11–31%, respectively. It seems reasonable to anticipate that it is bacterial contamination of the membrane material which jeopardizes the formation of new connective tissue attachment but in particular bone formation following the GTR-procedure.