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Pharyngocutaneous fistula (PCF) is a complication of laryngectomies in 14 to 23% of patients. The rate of spontaneous resolution of small and low-output fistulas has been shown to be 65 to 94% in those who are radiation-naive, with a reduced rate of resolution in patients who were previously radiated as low as 33%. Two patients are presented who underwent total laryngopharyngectomy and anterolateral thigh free flap reconstruction at our institution eventually complicated with PCF. All the pertinent patient data were retrieved through chart review from the records of our institution. The cases presented had a prior history of radiation or chemoradiation complicating the spontaneous resolution of the PCF. Both patients had successful resolution of PCF with the flexible endoscopic techniques presented. This case series highlights the management of small PCFs using flexible endoscopic techniques including over-the-scope clips and Vicryl mesh plugs.

Summary Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position. Clinical question/level of evidence Therapeutic, IV.

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.

Background Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases. Methods Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum. Results All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively. Conclusions Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches. Study type Therapeutic. Level of evidence IV

Background Although thoracoscopic stapled bullectomy is a standard procedure for primary spontaneous pneumothorax (PSP), the postoperative recurrence rate is high. We investigated whether using a Vicryl (Ethicon, Somerville, NJ) mesh to cover the staple line after bullectomy reduces the postoperative recurrence rate. Methods Our single-blind, parallel-group, prospective, randomized controlled trial at 2 medical centers in Taiwan studied patients with PSP who were aged 15 to 50 years and required thoracoscopic bullectomy. On the day of operation, patients were randomly assigned (1:1) to receive Vicryl mesh (mesh group) or not (control group) after thoracoscopic bullectomy with linear stapling and mechanical apical pleural abrasion. Randomization was achieved using computer-generated random numbers in sealed envelopes. Our primary end point was the pneumothorax recurrence rate within 1 year after the operation ( clinicaltrials.gov number, NCT01848860 .) Results Between June 2013 and March 2016, 102 patients were assigned to the mesh group and 102 to the control group. Within 1 year after operation, recurrent pneumothorax was diagnosed in 3 patients (2.9%) in the mesh group compared with 16 (15.7%) in the control group (P = .005). The short-term postoperative results and hospitalization duration were comparable between the groups. Conclusions For thoracoscopic bullectomy with linear stapling and mechanical apical pleural abrasion, the use of a Vicryl mesh to cover the staple line is effective for reducing the postoperative recurrence of pneumothorax. Vicryl mesh coverage can be considered an optimal adjunct to the standard surgical procedure for PSP.

Background: oncoplastic surgical treatment is defined as mix of excision of a tumor, with proper margin consisting of lumpectomy or mastectomy and prompt reconstruction of the bust, this may require applying mesh to stabilize the structure beneath the skin. Objective: we discussed the efficiency of Vicryl mesh and it usage in surgery after lumpectomy. Method: we searched in detailed following electronic databases; (PubMed, Embase, Google scholar) for relevant studies published in English language with human subject only up to July,2018.Results: absorbable surgical mesh is the most current method in oncoplastic surgery. The simpleness of the time-preserving method that is comfortably appropriate has actually been reported to have substantial benefits for specialists in addition to a fairly affordable and acceptable aesthetic end results. Conclusion: elimination of just the area of cancer by lumpectomy intends to keep most of the bust tissue, is much less of a modification to your body compared to mastectomy and has a healing time of a couple of weeks. Immediate Vicryl mesh insertion is a simple approach. Additionally, surgeons ought to think about mesh use when constructing patients who are mosting likely to or have actually obtained radiotherapy to the bust; vicryl mesh is a reliable choice to acellular dermal matrix in non-irradiated bust reconstruction and is accessible at approximately one twentieth the expenses. Acellular dermal matrix or complete muscular tissue coverage could be preferable in irradiated reconstructions.

Aim: Non-small-cell lung cancer recurs locally 10–40% of the time after local therapy, presenting a therapeutic challenge given poor pulmonary reserve. Herein, we seek to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for retreatment of such patients. Methods: We identified and reviewed clinical outcomes in ten patients with recurrent non-small-cell lung cancer after past vicryl mesh brachytherapy. Results: Ten patients with a median age of 77 were treated to a median dose of 48 Gy in five fractions. Local control at 1 year was 88%. There was one distant failure at 29 months. There was no significant toxicity after SBRT. Conclusion: SBRT is safe and effective when used for re-irradiation after past ablative therapies.

An open sternal wound is a dreaded complication after open heart surgery for neonatal congenital cardiac anomalies. Vascularised muscle flap reconstruction of sternal wound defects, to prevent life-threatening mediastinal infections, is the standard of care in adults and children. However, there is paucity of published literature regarding the safety of this technique in neonates. We describe a successful operative technique for complex reconstruction of an open heart sternal defect on a neonatal male patient. On 6 months postoperative follow-up, we identified an issue with sternal instability. Patient underwent a subsequent operation for reinforcement of the sternal wound repair with Vicryl mesh. The authors report safety of using three separate vascularised muscle flaps in a single neonatal operation. Long-term follow-up of the sternal wound reconstruction is warranted to determine need for secondary procedures.

Highlights • Inflammatory bowel disease increases the risk of radiation enteritis. • Tissue expanders displace bowel from the radiation field. • Thromboembolism and fistulae may be risks associated with tissue expander placement. A Vicryl mesh hammock may prevent bowel from entering the radiation field.

Supplemental Digital Content is available in the text., Summary: Direct-to-implant reconstruction after mastectomy is routinely performed with excellent oncologic and aesthetic outcomes. Several different techniques for placement of the prosthesis including total and partial subpectoral coverage have been described. Prepectoral implant placement is increasingly reported as a safe method, while patient selection and techniques are areas of further work. Most prepectoral prosthesis placement techniques describe complete acellular dermal matrix (ADM) coverage of the implant, often requiring multiple or larger ADM sheets than a comparable subpectoral implant procedure, resulting in high cost per reconstructed breast. This article describes the use of a vicryl mesh pocket and ADM support in prepectoral breast reconstruction achieving predicable and safe results at a lower cost.

Recurrent aggressive falcine meningiomas are uncommon tumors that recur despite receiving extensive surgery and radiation therapy (RT). We have utilized brachytherapy as a salvage treatment in two such patients with a unique implantation technique. Both patients had recurrence of WHO Grade II falcine meningiomas despite multiple prior surgical and RT treatments. Radioactive I-125 seeds were made into strands and sutured into a mesh implant, with 1 cm spacing, in a size appropriate to cover the cavity and region of susceptible falcine dura. Following resection the vicryl mesh was implanted and fixed to the margins of the falx. Implantation in this interhemispheric space provides good dose conformality with targeting of at-risk tissue and minimal radiation exposure to normal neural tissues. The patients are recurrence free 31 and 10 months after brachytherapy treatment. Brachytherapy was an effective salvage treatment for the recurrent aggressive falcine meningiomas in our two patients.

Highlights • Perihepatic packing has significant inherent risks. • Vicryl liver mesh wrap does not possess the complications of packing. • BOLSA construction is simpler to construct than previously describe liver mesh wrap., Introduction Severe traumatic liver hemorrhage quickly leads to exsanguination. Perihepatic packing is frequently used in damage control surgery. This method can be unsuccessful and accompanied by complications. Vicryl mesh wraps have been described in the treatment of liver hemorrhage. In this report, we describe an enhanced technique of hepatic wrapping in a case of hepatic bleeding after liver biopsy in a coagulopathic patient. The technique is called the hepatic “BOLSA” (Bag on Liver Supporting Anti-Hemorrhage). Presentation of case A 59 year old male presented in the recovery room after liver biopsy of a mass, followed by angio-embolization of the hepatic mass 9 h earlier. The patient was acidotic, coagulopathic, and demonstrated intra-abdominal hypertension. Computed tomography demonstrated perihepatic fluid. The patient continued hemorrhaging despite attempts to correct coagulopathy by transfusion. Multiple operating room visits were required where a combination of packing and hemostatic agents could not stop hepatic venous parenchymal hemorrhage. Mesh wrap consisting of Vicryl and PDS suture were used to create the “BOLSA” to achieve hemostasis. Discussion Perihepatic packing compromises pulmonary excursion, elevates intra-abdominal pressure, is a risk factor for sepsis, and requires an additional trip to the operating room for removal. The use of Vicryl mesh wrap obviates these complications. Previously described mesh wraps require anchoring. The self-supporting structure of the BOLSA simplifies construction and application. Conclusion The BOLSA is an effective tool in treatment of severe liver hemorrhage in coagulopathic patients. It is the modern simplification of hepatic wrapping and the solution to the side effects of perihepatic packing.

Acellular dermal matrix has proven to be a useful adjunct in tissue expander or direct-to-implant breast reconstruction. Although versatile, acellular dermal matrix adds considerable cost. Vicryl (polyglactin) mesh has an established track record in many fields of surgery, and is considerably less costly than acellular dermal matrix. This study examines the use and long-term follow-up of Vicryl mesh in breast reconstruction.Vicryl mesh was used in 46 breast reconstructions (38 patients; 35 immediate and three delayed). The mesh was used along the inframammary fold to maintain position of the inferior pectoral edge, and/or along the lateral border to maintain expander position and prevent lateral migration. Eight breasts received adjuvant radiation therapy.Mean follow-up at the time of review was 43 months. In the nonirradiated group (38 breasts), there was one postoperative infection (2.6 percent), which required expander removal. In the irradiated group, there were three complications requiring expander removal (37.5 percent): two infections and one device exposure after irradiation. Significant malposition was not observed in any breast where Vicryl mesh was used, and no visible mesh remained at the time of implant placement. The incidence of symptomatic capsular contracture in nonirradiated breasts was 3.2 percent. At latest follow-up, nonirradiated breasts had an average Baker capsule grade of 1.1, compared with 1.5 in the irradiated group.Vicryl mesh is an effective alternative to acellular dermal matrix in nonirradiated breast reconstruction and is available at approximately one-twentieth the cost. Acellular dermal matrix or full muscle coverage may be preferable in irradiated reconstructions.Therapeutic, IV.

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

The main questions when approaching a patient who potentially requires a relaparotomy in the delayed postoperative period can be split into the following categories: preoperative decision-making, intra-operative management, and postoperative challenges. The most important question to answer preoperatively is whether this patient indeed requires another laparotomy or will the cure, operative, or non-operative be worse than the situation at hand. Advances in imaging techniques, particularly computed tomography, not only have greatly enhanced our ability to make more educated decisions regarding the need for reoperation but have also greatly assisted our ability to preoperatively plan. Reentry into the abdomen can be difficult. An extension of the existing open incision or even an alternate incision may be helpful in gaining entry into the peritoneal cavity. Limiting the re-exploration to the minimum that is needed to address the issues at hand without causing further harm is essential. Utilizing native tissue for closure is the most desired option if at all possible. If the fascia will not close without tension, a fascial release with or without buttressing with an underlay of vicryl mesh or a biologic can be used. Postoperatively, the re-operative patient is at a much higher risk for wound complications and fascial dehiscence than after the primary operation. The surgical site should be carefully inspected for any signs and symptoms of infection and/or dehiscence. In conclusion, relaparotomy in the delayed postoperative period can be accomplished safely. Taking a stepwise approach to the patient is essential as there are potential pitfalls at every step.

Aim The purpose of the present study was to evaluate clinical and radiological healing effects after treatment of class II furcation defects using bioresorbable periodontal mesh barriers. Materials and methods The patients for the following study were selected from Outpatient, Department of Periodontics, College of Dental Sciences, Davanagere, Karnataka. Inclusion criteria: 1. Patients with age group between 18 and 60 years. 2. Patients who were nonsmokers. 3. Patients who had not undergone any type of periodontal therapy 6 months prior to initial examination. 4. Patients diagnosed as advanced periodontitis having mandibular grade II furcation involvement (Glickman 1953) clinically and radiologically. Exclusion criteria: 1. Patients who required antibiotic prophylaxis. 2. Patients allergic to tetracycline and/ or chlorhexidine. 3. Pregnant and lactating mother. 4. Patient showing unacceptable oral hygiene during presurgical (phase 1) therapy. Results In this study clinical parameters were compared and attempt was made to compare the results radiographically too, with the limitations, the present study showed that the use of resorbable periodontal mesh barriers for GTR therapy at class II furcations resulted in reduction of furcation involvement. Conclusion Therefore it appears that a patient with class II furcations involvement benefits from barrier treatment, because results are superior to conventional treatment without barriers. Clinical significance The present study was taken up to evaluate the clinical effects of GTR therapy of class II furcations using bioresorbable periodontal mesh barriers. How to cite this article Balusubramanya KV, Ramya R, Govindaraj SJ. Clinical and Radiological Evaluation of Human Osseous Defects (Mandibular Grade II Furcation Involvement) Treated with Bioresorbable Memberane: Vicryl Mesh. J Contemp Dent Pract 2012;13(6):806-811.

Background: Both cosmetic and oncologic outcomes are becoming more important for breast cancer patients. Breast-conserving surgery (BCS) has an acceptable cosmetic result compared with mastectomy, but BCS is also associated with cosmetic failure. In this study, we evaluated the cosmetic outcome of reconstructive surgery with the absorbable implant vicryl mesh after BCS compared with the outcome of BCS alone. Methods: From May 2007 to December 2009, 101 patients were involved in this study at Hallym University Sacred Heart Hospital. We used absorbable implants made of folding vicryl mesh and wrapped them with Interceed. In 79 cases, BCS with vicryl mesh implantation was performed; in the other 56 cases, only BCS was performed. Patient satisfaction with cosmetic outcomes was evaluated. We also analyzed other factors that affected cosmetic outcomes, including patient ages, body mass indices, tumor locations, and removed breast tissue. Results: In the vicryl mesh implantation group, 65 of 79 patients (82.3%) were satisfied; in the BCS-only group, 24 of 56 patients (43%) were satisfied (P < 0.05). In the vicryl mesh implantation group, patient ages, body mass indices, and removed breast tissue did not affect cosmetic outcomes. When the tumor was located in the upper outer quadrant, the patients were more satisfied (P < 0.05). Conclusions: Reconstructive procedures with vicryl mesh are simple, safe, and less expensive than other plastic reconstruction techniques. This study suggests that the procedure was superior to BCS alone in cosmetic outcomes. We believe that the procedure could become a favorable technique in oncoplastic surgery. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-11.

BACKGROUND Abdominal vacuum therapy has simplified the treatment of a laparostoma. But is that all that it can achieve? The role of abdominal vacuum therapy concerning the development of small bowel fistulas is still under discussion. Treatment of the bowel surface seems to be crucial for the prevention of fistulas. As military surgeons, we need a simple, standardised regimen, leading to reproducible good results and low complication rates. The question is: are we able to eliminate small bowel fistula during open abdominal treatment? PATIENTS AND METHODS We analysed 28 consecutive patients with open abdominal treatment in the period of 2004 to 2009. From June 2006 on, we implemented an algorithm, using the KCI V.A.C.® Abdominal Dressing (Kinetic Concepts Inc., San Antonio, Texas, USA) and a vicryl mesh between the non-adherent layer and the foam to prevent fascial retraction. The patients treated -after the installation of the new algorithm were compared to a group treated from 2004 to May 2006 before its installation. Fistula rates, mortality, the fascial closure rate, the number of abdominal dressing changes and the duration of open -abdominal treatment were evaluated. RESULTS After implementation of our new algorithm, the fistula rate decreased from 45 % to 0 %. The mortality during open abdominal treatment decreased from 45 % to 6 %. In addition, the duration of open abdominal treatment was reduced as well as the number of dressing changes. The primary fascial closure rate was 87 %. CONCLUSION We implemented a regimen, which is suitable for our mission in Afghanistan, as well as for medical evacuation and for the treatment of patients in our hospitals in Germany. It ensures a standardised treatment of the open abdominal cavity with an ideal protecting treatment of the bowel surface. Our algorithm utilises the advantages of the laparostoma while minimising the complications. The development of a small bowel fistula was eliminated in the evaluated patient group and mortality was clearly reduced.

Role of locking plate in skeletal reconstruction after resection of bone tumours in Indian patients. Retrospective evaluation of skeletal reconstruction using locking plate in 20 cases of long bone tumours was done. Reconstruction was done in 12 patients following limb salvage surgery, internal fixation of pathological fracture in seven bone tumours and one angiomatous tumour. There were 12 females and 8 male patients. Average age at the time of surgery was 30.1 years (range 10–58). Minimum follow-up was 11 months (range 11–38). Average time for union in pathological fractures was 4 weeks and 120 days after limb salvage surgery. Vicryl mesh was used to contain the morcellized allograft and cancellous iliac crest in 17 cases. Eighteen reconstructions were intact at an average follow-up of 17 months. Two failed reconstructions included one plate breakage and one screw pull out. Use of locking plate does not ensure the bony union at the site of reconstruction but it expedite it and allow early mobilization of joints and weight bearing particularly in Indian patients with late presentations. Careful selection of patients and proper preoperative planning including length of resection are essential for optimal outcomes and to minimize complications. Reconstruction should be supported by cortico-cancellous autograft/allograft for stabilization and union at junction of host and autograft/allograft bone and should be given adequate protection. Vicryl mesh helps in containing the morcellized grafts along the long axis of reconstruction.

Zwischen April 1982 und August 1994 wurden bei 255 Patienten insgesamt 259 Nierentransplantationen durchgefuhrt. In 8 Fallen (3,1 %) wurde eine Nierentransplantatruptur beobachtet. Bei einem Patienten war die Transplantatnephrektomie erforderlich. Bei den ubrigen 7 Patienten erfolgte die chirurgische Versorgung mittels Collagenvlies, Fibrinkleber und Vicrylnetz. Im Falle einer histologischen Abstosung wurde eine Behandlung mit ATG und Kortison oder OKT angeschlossen. In allen Fallen konnte ein Organerhalt mit zufriedenstellender Transplantatfunktion erreicht werden. Der durchschnittliche Kreatininwert nach einer mittleren Nachbeobachtungszeit von 57,9 Monaten (9 bis 101 Monate) betragt bei 6 der 7 Patienten 1,66 mg/dl (1,0-2,9 mg/dl). Einer der 7 organerhaltend versorgten Patienten mit einer Transplantatnierenruptur ist nach 22 Monaten und mehreren Abstosungskrisen erneut dialysepflichtig. Bei 85,7% der organerhaltend operierten Patienten liegt der durchschnittliche Kreatininwert nach nahezu 5 Jahren nach der Transplantatnierenruptur nur unwesentlich uber dem Kreatininwert des Gesamtkollektivs der Nierentransplantierten (1,44 ± 0,55 mg/dl). Unsere Ergebnisse zeigen, das bei einer Transplantatnierenruptur in jedem Fall ein Organerhalt angestrebt werden mus. Long-Term Results: This report describes the evaluation of patients with renal allograft rupture treated by organ-preserving management. From April 1982 to August 1994, a total of 259 renal transplantations were performed on 255 patients of these. 8 cases (3.1 %) of renal allograft rupture occurred. In 1 patient transplant nephrectomy was necessary. The remaining 7 patients were treated surgically with collagen foam, fibrin glue, and vicryl mesh. In all 7 cases renal salvage and satisfactory graft function was achieved. Average creatinine value after a mean follow-up of 57.9 months (9-101 months) was 1.66 mg/100 ml (1.0-2.9 mg/100 ml). Almost 5 years after renal allograft rupture, the average creatinine value after transplant-preserving management is only slightly higher than the mean creatinine values of all donor kidney recipients (1.44 ± 0.55 mg/100 ml). Our results demonstrate that salvage of the transplanted organ after allograft rupture should be aimed at in all cases.

In this study, we assessed the feasibility of laser-assisted tissue welding as a means of fixing mesh prostheses to the peritoneum. We then tested the initial tensile strength of the bonds.Fresh porcine peritoneal coupons were lap-joint bonded with laser-activated solder. Anesthetized New Zealand white rabbits and Yorkshire pigs also underwent laparotomy. Vicryl mesh (2.0 x 1.0 cm) was attached to the peritoneum using a laser system (1.43 mu, 2.5 W, 60 degrees C), solder formulations and configurations, and a 1 cm2 bond area. Control segments were affixed with 4.8-mm staples. After the animals were killed, the segments were excised en bloc. Tensile strength assessment was conducted by measuring peak force breaking strength.The strength of the solder bonds were similar in all groups (range, 261.5 +/- 170.3-465.3 +/- 288.2 g/cm2) and were not statistically different from the controls (215.8 +/- 117.8 g/cm2).These values are similar to the 200-500 g/cm2 acute strengths reported for sutured or stapled peritoneal closure. Mesh fixation by solder is feasible, and further development of this technology is warranted.

Posterior component separation has become a common approach to complex abdominal wall reconstructions. This technique includes creation of an extraperitoneal retromuscular space for subsequent large synthetic mesh reinforcement. In certain cases, when complete restoration of “posterior” layer is precluded by significant tissue loss/damage, one proposed strategy is to replace the posterior fascia with an absorbable synthetic polyglactin (Vicryl) mesh. However, the safety of this strategy to prevent mesh-related visceral complication is unknown. Herein, we aimed to characterize mesh-viscera adhesion profiles and host tissue response of synthetic mesh either exposed directly to the viscera, or protected with Vicryl mesh. Using adult Yorkshire pigs, 5 × 5 cm pieces of mesh were secured to the intact peritoneum in each of the four quadrants (n = 6 pigs, 24 mesh samples). The study groups were Vicryl (V), Marlex (M), Softmesh (S), Marlex + Vicryl construct (MV), Softmesh + Vicryl construct (SV). The self-made composite meshes were then implanted with the Vicryl side facing the exposed viscera. The pigs were survived for 60 days. At necropsy, grossly, the extent and tenacity of visceral adhesions were evaluated using established scales. Histologically, all specimens for fibrous encapsulation on the visceral surface of the mesh were reviewed by an experienced pathologist blind to meshes used. At necropsy, all Vicryl meshes were completely resorbed. The mean adhesion and tenacity scores for M and MV were 1.8 and 1.1 (P > 0.05), 2.0 and 1.5 (P > 0.05), respectively; while the mean adhesion extent scores and tenacity scores for S and SV were 2.0 and 1.2 (P > 0.05), 2.0 and 1.7 (P > 0.05). No significant difference in adhesion extent and tenacity was observed between Synthetic and Vicryl composite mesh groups. Histologically, Marlex + Vicryl mesh and Softmesh + Vicryl mesh constructs had thicker fibrous capsules than the corresponding unprotected Marlex and Soft mesh implants. Furthermore, visceral adhesions in the composite groups were noted to be to the fibrous capsule and not synthetic mesh itself. Utilization of the absorbable polyglactin (Vicryl) mesh as a separating layer between a synthetic mesh and intestines, did not reduce adhesions across various mesh types and composites. Histologically, however, a thick fibrous capsule replaced the Vicryl mesh and may be an important layer to prevent intestinal erosion into retromuscular synthetic meshes.

The aim of this study was to compare the pubovaginal sling with a new Vicryl mesh rectus fascia (VMRF) sling in the surgical treatment of low urethral pressure genuine stress incontinence. Fifty-one consecutive women who had a VMRF (n = 27) or a pubovaginal sling (n = 24) procedure between March 1995 and December 1997 were evaluated. The patient-determined subjective success rate of the VMRF sling (85%) was significantly higher than that of the pubovaginal sling (58%) in women with low urethral pressure stress incontinence (P=0.03). The objective success rates following the VMRF and the pubovaginal sling were 52% and 50%, respectively. The prevalence of postoperative symptomatic voiding dysfunction and de novo detrusor instability was 7% after the VMRF sling and 25% following the pubovaginal sling (P = 0.08). The VMRF sling had a higher patient-determined success rate and a lower complication rate than the pubovaginal sling, and should be considered in the surgical management of women with low urethral pressure stress incontinence.

As we have gained experience with the extended superficial musculoaponeurotic system (SMAS) technique in face lifting, refinements in our procedure have led to increased consistency in results. The important factors that have led to our technical modifications include the following: (1) the significance of the retaining ligaments of the midface, which determine the degree of surgical dissection required for both skin and SMAS in rhytidectomy ; (2) the changes in facial shape that occur with aging, secondary to the descent of facial fat; (3) the possibility of modifying facial shape through the repositioning of facial fat in an extended SMAS face lift; (4) the improved longevity of result to be obtained by incorporating Vicryl mesh into SMAS fixation; (5) the artistic nuances of incision design that help to minimize scar perceptibility. Understanding these factors enables surgeons to use the extended SMAS technique successfully with more challenging cases, enhancing facial appearance while minimizing signs that the patient has undergone a surgical procedure.

Large abdominal wall defects may require a prosthesis for closure. The aim of our study was to identify the best material for abdominoplasty in pediatric patients. One hundred twenty-eight Wistar KY strain male rats (3 weeks old) were used. All animals underwent celiotomy via a midline skin incision. They were divided into seven groups as follows: the animals in groups 1 through 6 underwent full-thickness abdominal wall excision 3 cm in diameter. The animals in group 1 underwent primary closure. In groups 2 through 6 the defect was closed with prosthetic material. In Group 7, a sham operation was performed. Daily weights were measured. The animals were killed after 3 and 9 weeks. Adhesion scores were assigned for each group. Vicryl mesh resulted in the fewest adhesions and had no effect on weight gain in the developing rats.

One hundred forty-seven flaps in 135 consecutive patients undergoing microvascular transplantation were monitored using a miniature Doppler ultrasonic probe. Using a modification of a technique described previously by Swartz, the probes were secured to the outflow vein of the flap with Vicryl mesh. Twenty instances of thrombosis or spasm were detected in 16 patients, and all flaps were salvaged (100 percent). There were four false positive and no false negative results. This probe allows for safe, continuous monitoring of flap blood flow, which permits the rapid detection and hence rapid treatment of postoperative complications. Our experience suggests that a significant improvement in the salvage rate of microvascular transplants may be attainable with the use of this device.

Das Vicrylnetz-Wrapping stellt eine wenig verbreitete, jedoch akzeptierte Alternative zum konventionellen „Bauchtuch-Packing“ des schweren Lebertraumas dar. Bei gesicherten Vorteilen fehlt bisher die Beschreibung von verfahrensspezifischen Komplikationen. Hier wird der Fall einer polytraumatisierten Patientin mit schwerem Lebertrauma dargestellt, bei der sich nach Vicrylnetz-Wrapping beider Leberlappen zweitzeitig eine Leberischamie eingestellt hat, die durch ein progredientes posttraumatisches Odem einerseits und die Kompression der Leber durch die Vicrylnetze andererseits bedingt war. Eine engmaschige Kontrolle der Serumtransaminasen, insbesondere nach beidseitigem Vicrylnetz-Wrapping, ist daher zwingend, um diese Komplikation durch eine umgehende Relaparotomie zu beherrschen.

Wandering spleen is a rare clinical condition associated with a high incidence of splenic torsion and infarction. The preferred treatment for this condition is splenopexy to reposition the spleen in the left upper quadrant of the abdomen and to preserve splenic function. We present two cases of wandering spleen managed by laparoscopic splenopexy. Both young women presented with intermittent abdominal pain. A CT scan was diagnostic of wandering spleen in each case. Both patients were successfully treated with the laparoscopic splenopexy. The spleen was inserted in a Vicryl mesh bag and fixed in the left upper quadrant in both cases. Both patients had resolution of their preoperative symptoms. Laparoscopic splenopexy has many advantages over open splenopexy or splenectomy, including preserving splenic function, minimal postoperative pain, early discharge from the hospital, and rapid recovery.

Collagen-coated Vicryl mesh (C.C.V.M.) was used in 28 children who needed repair of thoracic and abdominal wall defects. Herein the authors report the clinical experience, surgical technique, and outcome in these cases.

Hydroxyapatite (HA) implants currently are most commonly wrapped in donor sclera before implantation to facilitate placement within the orbit and allow attachment of the extraocular muscles. Although the risk of acquiring a transmittable disease through donor sclera is extremely low, some individuals remain concerned about receiving nonautologous material. As an alternative to sclera, autologous temporalis fascia, or autologous fascia lata, we have been wrapping HA in "Vicryl mesh" before insertion into the orbit. The Vicryl mesh-wrapped implant goes into the socket readily, allows one to easily attach the extraocular muscles, and has no risk of transmittable disease. In addition, the Vicryl mesh is readily available at most hospitals and is dissolvable.

Over the past 5 years, Vicryl mesh (polyglactin-910) implants were used successfully to reconstruct the orbital floor in 28 patients with significant preoperative diplopia due to orbital floor fractures. The layered mesh is available in 26.5 x 24 cm sheets, each of which is folded onto itself into 24 layers and packaged; 24 layers are approximately 4 mm thick. Appropriately sized implants varying in thickness from 6 to 56 layers were used to cover and fill the orbital floor defect. Absorbable Vicryl mesh is well-tolerated by orbital tissues; since it is soft and pliable, it is unlikely to compress orbital structures such as the optic nerve, lacrimal sac, or extraocular muscles. A second surgical site necessary for autogenous implants is avoided. The Vicryl mesh implant is technically easy to insert and does not require fixation in the orbit. Because Vicryl mesh is absorbable, the risks associated with permanent alloplastic implants are reduced. Similarly, there is no potential spread of communicable disease with homologous tissue implants. Follow-up ranged from 1 month to 2 years (median, 13 months). None of the patients had late complications. The only complication was transient, low-grade eyelid inflammation in four patients.

Summary An experimental study was performed in rats to evaluate the potential usefulness of the vicryl-collagen prosthesis in limiting epidural scar formation after laminectomy. The results obtained suggest that the presence of the prosthesis in the epidural space did not significantly influence the density or thickness of epidural scar tissue. Nevertheless, the fact that this material was well tolerated, being replaced by fibrous tissue without inflammatory tissular response, suggests that its use in the epidural space may be preferable to that of other absorbable materials and supports earlier studies suggesting the usefulness of the vicryl mesh as a dural substitute.

Resection of anterior vaginal wall that occurs with some cases of anterior pelvic exenteration leaves the patient with a small and narrow vagina. This affects their sexual life leading to major psychologic problems, especially in young women. The aim of this study is to evaluate a new technique of vaginal reconstruction following anterior pelvic exenteration with clinical and cytohistologic follow-up. Between March 2002 and November 2004, ten sexually active female patients underwent vaginal reconstruction after radical cystectomy that required en bloc removal of the anterior vaginal wall, with a pedicle graft of greater omentum combined with a vicryl mesh. The mean age of the patients was 38 years. The mean operative time of the reconstructive procedure was 50 min. There were no complications regarding the reconstructive procedure. On follow-up, the neovagina accepted two fingers easily and showed a pink-colored smooth lining. Seven patients reported successful attempts of sexual intercourse. It was concluded that reconstruction of vagina after anterior pelvic exenteration in sexually active women can be done safely with the use of vicryl mesh combined with a pedicled omental graft. It is a simple, reliable, and not time-consuming technique. The long-term follow-up was very beneficial in detection of complete healing, postoperative infections, and hormonal activity of the graft and recurrence of malignancy.

Summary Introduction . Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration. Objectives We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb ®) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. Patients 85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. Results In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary. Conclusion We consider the vicryl mesh (Ethisorb ®) as an ideal dural substitute especially for the dural closure of the posterior fossa.

Introduction. Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration. Objectives. We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb®) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. Patients. 85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. Results. In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary. Conclusion. We consider the vicryl mesh (Ethisorb®) as an ideal dural substitute especially for the dural closure of the posterior fossa.

To assess the feasibility and outcomes of (125)I Vicryl mesh brachytherapy after sublobar resection in stage I non small cell lung cancer (NSCLC) patients with poor pulmonary function.Between January 1997 and July 2004, patients with poor cardiopulmonary reserve who had stage IA and IB (T1-2 N0 M0) NSCLC and a forced expiratory volume in 1s (FEV(1)) ofmicro=0.6L were considered for limited surgical resection either by an open or video-assisted thoracoscopic procedure and for a subsequent (125)I Vicryl mesh brachytherapy implant. Mediastinal and hilar lymph node staging was performed routinely in all patients. After clear margins were obtained grossly and on frozen section, a single-plane (125)I implant was designed to encompass a plane consisting of the staple line and a 2-cm margin of surrounding visceral pleura. The implant was introduced through the surgical incision and sutured to the visceral pleura. A prescribed dose of 100-120 y was delivered to a volume within 0.5 cm rom the plane of the implant. Follow-up orthogonal films or CTs were obtained for dosimetric analysis. Kaplan-Meier analyses were used to estimate the local control, locoregional control, and overall survival rates.Of the 110 patients, 65 had stage IA and 45 had stage IB NSCLC. The mean preoperative FEV(1) was 47% of the predicted volume. With a median follow-up of 11 months (range 1-68 months), there were four recurrences within the radiation volume. The estimated 5-year local (in-field) control, locoregional control, and overall survival rates were 90%, 61%, and 18%, respectively.Vicryl mesh brachytherapy after sublobar resection for high-risk stage I NSCLC patients is a feasible procedure, which results in an excellent local (in-field) control rate.

Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

The circumstances in which it is unsafe or impossible to perform primary fascial closure are becoming more frequent. Five cases are reported using a combination of Vicryl and Marlex mesh, such that the Vicryl mesh prevents enterocutaneous fistulae and the Marlex mesh prevents late ventral hernias.

Purpose: This study was designed to evaluate a new type of hydroxyapatite (HA) implant (produced in China) in a rabbit model. Methods: Three New Zealand white rabbits underwent enucleation of one eye followed by implantation of a 12-mm Chinese HA implant wrapped in Vicryl mesh (polyglactin 910). Magnetic resonance imaging was performed to assess host fibrovascularization of the implant 4, 8, and 12 weeks after implantation. One animal was sacrificed at each of these times for histopathologic examination. The Chinese implant was also examined chemically and by scanning electron microscopy. It was compared to the original BioEye and the third generation synthetic HA implant produced in France by FCl (FCl 3 ). Results: This new variety of HA implant from China is heavier than the FCl 3 implant but lighter than the original BioEye. The Chinese implant was easy to work with and not fragile. The pore size was more uniform than the FCl 3 implant and similar to the BioEye implant clinically and by scanning electron microscopy. The pores in this implant are unidirectional. Analysis for impurities revealed a calcium oxide (CaO) content of 4.4%. Histopathologically, central vascularization occurred by 4 weeks and was similar in extent to the vascularization seen with the FCl 3 implant and the BioEye. Conclusions: The Chinese implant is less expensive then the BioEye and the FCl 3 implants, and appears to be a viable alternative to the BioEye. Further refinements are in progress to eliminate the CaO contaminant.