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Importance: Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery. Objective: Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures—flaps and full-thickness skin grafts (FTSG). Design, Setting, and Participants: This retrospective case–control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair. Main Outcomes and Measures: The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression. Results: The study population consisted of 143 propensity score-matched pairs (n = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection (p = 0.004), poor scar cosmesis (p

OBJECTIVE We sought to investigate the clinical efficacy and safety of a novel endoscopic closure technique in repairing gastric wall defects after endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) originating from the muscularis propria layer. METHODS From December 2016 to December 2019, patients with gastric submucosal tumors were enrolled and clinicopathological data were collected. All SMTs were resected by EFTR and gastric wall defects were closed using a novel endoscopic closure technique. The feasibility, efficacy, and safety were evaluated. RESULTS A total of 21 patients with gastric SMTs were included in this study. Among the included SMTs, 15 tumors were located in the fundus of the stomach, and 6 were located in the upper body of the stomach. The average size of the lesions was 2.3 cm (range: 1.9-2.5 cm). All patients underwent EFTR and the gastric wall defect was closed by endoscopic closure. The average endoscopic closure time was 9 min (range: 7-15 min) and the average hospitalization stay length was five days (range: 4-6 days). One patient developed abdominal pain on the first day after the procedure and their body temperature increased; he received treatments such as anti-infection, antacid, and gastrointestinal decompression and was cured and discharged after 4 days. No instance of delayed bleeding, postoperative gastrointestinal fistula, or abdominal infection occurred. No case was transferred to surgery. The postoperative pathology profile included 18 stromal tumors and 3 leiomyomas. During the follow-up period (6-24 months), no case of residual or recurrence was recorded. CONCLUSION The described endoscopic loop ligation technique is feasible, effective, and safe for repairing gastric wall defects after EFTR for gastric submucosal tumors originating from the muscularis propria layer.

Tongue repair after radical surgical removal of malignant tumors with subsequent rehabilitation of patients and their return to normal life and work has been a challenging issue for decades.This review aims to give an up to date summary of existing literature on different methods of tongue repair in cancer patients depending on the type of defect. We describe advantages and disadvantages of local and regional free autologous grafts.

INTRODUCTION The kite flap is widely used in the repair of facial skin defects because of its high survival rate and simple operation. However, the flap mobility of traditional kite flap is limited and needs to be improved. We conducted this survey to evaluate clinical efficacy of modified kite flap in repairing facial skin defects after tumor resection. METHODS Clinical data of 25 patients with facial skin tumors were collected and analyzed. All patients received skin defect repair with modified kite flaps after Mohs surgery. The survival conditions of the flaps were observed 24 hours after the surgery. The patients were followed up at the first month and the third month after surgery and then every 3 months thereafter. The shape and texture of the flaps, as well as the matching degree with surrounding tissues, were evaluated. RESULTS All the flaps were survived without infection and healed by the first intervention. The shape and color of the flaps were all good without obvious scar. Satisfactory functional and cosmetic results were achieved in both donor sites and recipient sites. CONCLUSIONS The modified kite flap is effective for the repair of facial skin defects, which has a high survival rate and larger mobility.

BACKGROUND Composite grafts have previously been reported to achieve a good outcome for nasal defect repair, but composite grafts have greater metabolic needs than simple skin. Therefore, the traditionally recommended size of a composite graft for nasal reconstruction is less than 1.5 cm in diameter. However, the distal nose is generally well supplied with blood vessels, which might support the use of larger composite grafts in such a highly vascularized recipient site. The aim of the article is to investigate whether a large skin-fat-fascia composite graft (larger than 2.0 cm) is viable for the repair of partial-thickness nasal defects. METHODS From October 2017 to December 2019, 13 patients with partial-thickness nasal defects underwent nasal reconstruction using a large postauricular skin-fat-fascia composite graft. Cases were followed up for 3 to 14 months postoperatively. The aesthetic outcome was evaluated in comparison with preoperative digital images. RESULTS Skin-fat-fascia composite grafts survived without graft necrosis, dermal fibrosis, or skin contraction in all cases. Favorable aesthetic outcomes were obtained in all patients, and no further revision surgery was need. CONCLUSIONS A postauricular composite graft larger than 2.0 cm is a safe and effective reconstruction approach for partial-thickness nasal defects. This technique offers significant advantages in terms of no additional facial scar, no visible asymmetry on the face, no additional surgery for revision, and with mild scar in the donor site of the postauricular region.

OBJECTIVE To investigate the effect of WeChat follow-up management of infants who underwent ventricular septal defect (VSD) repair on parents' disease knowledge and quality of life. METHODS Participants were randomly assigned to an intervention group (n = 40) or a control group (n = 40). The intervention group was followed up with WeChat, while the control group was followed up using a traditional method. The disease knowledge, mental state, and quality of life of the two groups of parents were analyzed and compared. RESULTS During the 3-month follow-up period, the PedSQL (PedsQL family impact module) results showed that the overall score in the intervention group was significantly higher than that in the control group. The parents in the intervention group were better at managing "emotion control," "worry," and "family communication" than those in the control group. The results of the LKQCHD (Leuven congenital heart disease knowledge questionnaire) showed that the parents in the intervention group had a higher mastery of "basic knowledge and treatment of congenital heart disease," "related complications," and "postoperative rehabilitation" than those in the control group. CONCLUSION Knowledge education and psychological counseling for parents of children who underwent VSD repair through WeChat follow-up management can effectively improve parents' knowledge, relieve their anxiety and sadness, and improve their quality of life.

Injuries and tumours of the cervical spine represent therapeutic challenges to the treating surgeon due to the complex anatomical relationships and biomechanical features. The anterior cervical midline (ACM) and anterior cervical retropharyngeal (ACR) approaches are effective and safe surgical approaches for certain cervical spine lesions, such as cervical spine neoplasms, atlantoaxial subluxation, and certain odontoid fractures. Posterior pharyngeal wall defects (PPWDs) is one of the most frequently encountered surgical morbidities after anterior cervical spine surgery (ACSS). However, limited information has been published concerning effective approaches for PPWD reconstruction after ACSS. The manuscript aimed to describe a novel application of the island sternocleidomastoid myocutaneous flap (ISMF) in the management of PPWDs after ACSS, including surgery with the ACM approach and ACR approach. From April 2015 to November 2019, the clinical data of three patients with PPWDs repaired using the ISMF in Peking university third hospital were retrospectively analysed. The observational indexes are as follows: postoperative survival of the flap, wound healing 2 weeks after surgery, eating and pronunciation function 2 months after surgery. The above indexes of these three cases recovered well. Three patients did not have any persistent PPWD after repair with the ISMF and did not require any further surgical procedures related to the cervical spine.

To report second-look arthroscopic assessment after all-arthroscopic autologous chondrocyte implantation (ACI) for articular cartilage defects at the patella. A second-look arthroscopy after all-arthroscopic ACI using chondrospheres® (ACT3D) was performed in 30 patients with 30 full-thickness retropatellar cartilage defects. The mean time from ACI to second-look arthroscopy was 14.9 ± 16.3 (6–71) months. The quality of cartilage regeneration was evaluated by the International Cartilage-Repair Score (ICRS)—Cartilage Repair Assessment (CRA). Eleven lesions (36.7%) were classified as CRA grade I (normal) and 19 lesions (63.3%) as grade II (nearly normal). Concerning the degree of defect repair, 25 lesions (83.3%) were repaired up to the height of the surrounding articular retropatellar cartilage. Five lesions (16.7%) showed 75% repair of defect depth. The border zone was completely integrated into the surrounding articular cartilage shoulder in 28 lesions (93.3%) and demarcated within 1 mm in 2 lesions (6.7%). Macroscopically and by probing, 12 lesions (40%) had intact smooth surface, 17 lesions (56.7%) had fibrillated surface and 1 lesion (3.3%) had small, scattered fissures. A negative correlation was found between the overall repair assessment score and the defect size (r2 = − 0.430, p = 0.046) and between integration into border zone and defect size (r2 = − 0.340, p = 0.045). A positive correlation was found between macroscopic appearance and age (r2 = + 0.384, p = 0.036). All-arthroscopic ACI using chondrospheres® (ACT3D) for full-thickness retropatellar articular cartilage defects proved to be reproducible and reliable. The advantage of the procedure is that it is minimal invasive. Arthroscopic second-look demonstrated a high grade of normal or nearly normal cartilage regeneration. Although statistically significant differences were not observed, larger defect size and younger age may compromise the result of overall repair. III.

Aims The present study investigates the effectiveness of platelet-rich plasma (PRP) gel without adjunct to induce cartilage regeneration in large osteochondral defects in a rabbit model. Methods A bilateral osteochondral defect was created in the femoral trochlear groove of 14 New Zealand white rabbits. The right knees were filled with PRP gel and the contralateral knees remained untreated and served as control sides. Some animals were killed at week 3 and others at week 12 postoperatively. The joints were harvested and assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) MRI scoring system, and examined using the International Cartilage Repair Society (ICRS) macroscopic and ICRS histological scoring systems. Additionally, the collagen type II content was evaluated by the immunohistochemical staining. Results After 12 weeks post-surgery, the defects of the PRP group were repaired by hyaline cartilage-like tissue. However, incomplete cartilage regeneration was observed in the PRP group for three weeks. The control groups showed fibrocartilaginous or fibrous tissue, respectively, at each timepoint. Conclusion Our study proved that the use of PRP gel without any adjuncts could successfully produce a good healing response and resurface the osteochondral defect with a better quality of cartilage in a rabbit model. Cite this article: Bone Joint Res 2021;10(3):192–202.

We have developed and implemented a new approach to postoperative defect repair in patients with pilonidal fistula (PF) and pilonidal cyst (PC). We analyzed different variants of subcutaneous fat and skin suturing, as well as the avoidance of drains in the area of intervention. The new approach reduced the incidence of postoperative wound suppuration and wound dehiscence.

BACKGROUND Although many repair methods for postsurgical lip defects have been described, the literature lacks a comprehensive review of these methods. OBJECTIVE To perform a systematic review of lip defect repair methods after Mohs surgery or excisions. MATERIALS AND METHODS Terms related to perioral anatomy, Mohs surgery and excision, and reconstruction were used to search 8 databases. Articles were included if they reported postsurgical lip repair data for 4 or more patients, were in English, and were published from 2004 onward. Two reviewers screened all titles and abstracts, followed by the full texts of the remaining articles. Data were then extracted including author specialties, study design, demographic, tumor, and defect information, surgical procedures, outcomes, and complications. RESULTS Forty-two studies were eligible, including a randomized trial, 25 case series, and 16 cohort studies. Most were written by dermatologic or plastic surgeons, and most studies were small, with an average subject number of 61. Very few studies used structured outcome measures. Many repair methods were described, the most common of which were linear closures and various flaps. CONCLUSION Many repair methods for lip defects have been published, but overall, the quality of the available evidence is low.

To describe a new semiquantitative computed tomography (CT) scoring system for multi-feature analysis of cartilage defect repair by osteochondral allografts for the knee and to assess its intra-observer and inter-observer variability. A semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system was designed based on fresh osteochondral allograft transplantations for the knee. The system includes five CT features: density relative to host bone, integration at the host-graft junction, surface percentage with a discernible cleft at the host-graft junction, cystic changes, and intra-articular fragments. Inter-observer variability was calculated by three observers blinded to the patient’s medical history and treatment. Intra-observer variability was also determined. Inter-observer agreement was moderate to substantial for all CT score components and intra-observer agreement was moderate to almost perfect for all CT score components (κ > 0.5, p < 0.05). The ACTOCA score is a reliable tool to evaluate integration of osteochondral allograft transplantations. It provides an accurate evaluation of bone changes and may help to standardize CT scan reports following osteochondral allograft transplantation for the knee.

Background: The European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) was founded in 1999 and is open for worldwide participation. The current dataset includes a large amount of surgical data from both Europe and China. The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD. Methods: We examined all European (125 centers, 58,261 operations) and Chinese (13 centers, 23,920 operations) data in the ECHSA-CHSD from 2006-2018. Operative mortality, postoperative length of stay, median patient age and weight were calculated for the ten benchmark operations for China and Europe, respectively. Results: Benchmark procedure distribution frequencies differed between Europe and China. In China, ventricular septal defect repair comprised approximately 70% of procedures, while Norwood operations comprised less than one percent of all procedures. Neonatal cardiac procedures were rare in China overall. For procedures in STAT mortality category 1, Chinese centers had lower operative mortality rates, while procedures in categories 3 and 5 mortality is lower in European centers. Operative mortality over the time period decreased from 3.89% to 1.64% for the whole cohort, with a sharper decline in China. This drop coincides with an increase of submitted procedures over this 13-year-period. Conclusion: Chinese centers had higher programmatic volume of congenital heart surgeries, while European centers have a more complex case mix. Palliation for patients with functionally univentricular heart was performed less commonly in China. These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.

The radial forearm free flap (RFFF) is one of the commonly used flaps in the repair of head and neck soft tissue defects, especially small and medium-sized defects. The free skin grafts from abdomen are usually used to repair the RFFF donor site wound. This study aims to design a novel V-shaped RFFF, hoping that it might facilitate the direct closure of the forearm donor site wound. From August to December in 2019, 20 patients with oral cancers received radical surgeries, and V-shaped RFFFs were designed to repair the soft defects and the forearm donor site wound was directly closed. The patients were followed up for 6 months to assess the final outcome of repair. The results showed that the pre-designed V-shaped RFFF met the needs of soft tissue defect repair, with the size ranging from 24 cm to 30 cm. Fifteen patients with tongue cancers and four with buccal cancers had satisfactory repair results, and only one patient with buccal cancer had mild limitation of mouth opening. There were 3 patients with a small area of ischemia. The mean postoperative hospital stay was 13.85 ±â€Š1.09 days. In 5 patients, wrist tilt motility decreased compared with that before surgery. The postoperative influence score of wrist exercise on daily life was 2.75 ±â€Š0.44 points. In conclusion, the V-shaped RFFF can meet the needs of small and medium-sized defect repair. This novel design can directly close the forearm donor site wound, which avoids surgical trauma to secondary donor site, and significantly reduces related complications.

Large skull defects can result in chronic injury to intracranial tissues as well as psychological trauma for patients, and their repair presents a challenge to surgeons. Hydroxyapatite has been used in reconstructing skull defects for many years, but it is difficult to adjust the shape and size of the material intraoperatively, especially for large defects. With three-dimensional digital technology, a new type of customized composite implant made of epoxide acrylate maleic and hydroxyapatite has been applied in clinical practice. In this retrospective review, 15 patients with large skull defects (4 female and 11 male, at a mean age of 36.4 years, range from 24-65 years) were treated with the novel customized composite implant, reconstructing the large skull defects successfully. During the average 2.2 years follow-up period (range 0.5-4 years), complications including infection, cerebrospinal fluid leakage, intracranial hemorrhage, or implant exposurea were not occured, only 1 patient (6.7%) with a seroma managed non-operatively. The customized implants, which required no intraoperative adjustments and are about a third of the cost of titanium implants, are an excellent alternative for large skull defect repair.

Objective Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. Methods A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Results The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a “rescue” nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. Conclusion Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care. Level of Evidence NA, Endoscopic reconstruction of skull base defects has rapidly advanced since the introduction of the nasoseptal flap in 2006. Here, we review current techniques of vascular pedicled flap reconstruction of skull base defects, their indications and success rates, and novel techniques currently under investigation.

Encephalocele is most commonly a defect in the neural tube characterised by herniation of the brain and the membranes in form of protusions that cover it through openings in the skull. It is mostly congenital but can be acquired following trauma. It usually presents with cerebrospinal fluid leak, which may get overlooked because of their subtle or intermittent course. High level of suspicion is required for early diagnosis and treatment. We hereby present a rare scenario, the patient presented more than 12 years after trauma with complaint of unilateral nasal blockage and discharge. The diagnostic investigations and treatment options are discussed. Patient was treated by endonasal endoscopic resection of mass and multilayered repair of skull base defect and is without recurrence in last more than 1 year follow up. Keywords: Paediatric encephalocele, Acquired encephalocele, Transnasal endoscopic repair, Intranasal encephalocele, Surgery.

The facial artery pedicle nasolabial island flap (FAPNIF) is widely used for oral and maxillofacial reconstruction. However, its use in reconstruction after malignant tumour resection is limited by the possibility of ipsilateral cervical lymph node metastasis along the facial artery. Through fine dissection, it was found that the contralateral FAPNIF can be used to repair the defect after buccal carcinoma resection. The aim of this study was to evaluate the clinical outcomes of the contralateral FAPNIF for buccal defect repair. From 2013 to 2016, 30 patients underwent the repair of a buccal defect with a contralateral FAPNIF after tumour resection. Clinical outcomes and complications were recorded and quality of life was evaluated preoperatively and at 3, 6, and 12 months postoperative. The flaps survived in all 30 cases. Mean mouth opening was 2.50±0.14cm at 1 month, 3.22±0.25cm at 6 months, and 3.35±0.23cm at 12 months postoperative. With regard to patient quality of life, adverse effects included impaired aesthetics, pain, and difficulty eating; these usually subsided within 1year after surgery. The contralateral FAPNIF is easily harvested and is a safe and effective option for the repair of medium-sized buccal defects after the resection of carcinoma.

Focal cartilaginous and osteochondral lesions can have traumatic or chondropathic degenerative origin. The fibrocartilaginous repair tissue that forms naturally, eventually undergoes fibrillation and degeneration leading to further disruption of joint homeostasis. Both types of lesion will therefore eventually lead to activity‐related pain, swelling and decreased mobility and will frequently progress to osteoarthritis. Most attempts at realising cartilage regeneration have so far resulted in cartilage repair (and not regeneration). The aim of this article was to review experimental research on surgical cartilage restoration techniques performed so far in equine models. Currently available surgical options for treatment of osteochondral lesions in the horse are summarised. The experimental validity of equine experimental models is addressed and finally possible avenues for further research are discussed.

A sheet material is widely used to repair pleural defects due to its excellent pressure resistance. We examined the long-term effects of sheet materials using an animal pleural defect model. Beagles were used for this study. The 5-mm circular pleural defects were created at 2 sites on each of the anterior, medial, and posterior lobe and repaired using a 2 cm square sheet material. The frequency of adhesion of those sheets to the thoracic walls and histological changes was examined after 6 months. In this study, three types of sheet materials were examined: polyglycolic acid, nano-polyglycolic acid, and oxidized regenerated cellulose where each sheet was tested with or without coating with fibrin glue, for a total of 6 groups. Each group contained an equal number of defect sites and evaluation of 12 defect sites was conducted. Adhesion was observed in 16 of 72 sites (22%). Presence or absence of adhesion was not affected by the repair method or by the type of sheet material used. However, the use of fibrin glue significantly reduced the occurrence of adhesion (p = 0.023). At the defected sites, the posterior lobe showed significantly less adhesion (p = 0.019). Histologically, the sheet materials caused a thickening of the pleural wall 6–10 times thicker than the normal pleural wall. No statistically significant differences regarding the presence or absence of adhesion to the thoracic wall were found among the sheet materials. The use of fibrin glue significantly reduced the adhesion to the thoracic wall.

The authors present an excellent retrograde analysis of a rare condition of a phenomenal number of cases and their surgical outcomes. A majority of the studies in published literature are anecdotal case reports which are a rare and dreadful entity. A comprehensive countrywide view of the UK National Adult Cardiac Surgery Audit database is presented in this study. This study represents the changing trends in the risk factors, management strategies, and outcomes of ventricular septal rupture for over 23 years in a nutshell.

Objective To evaluate the feasibility and clinical effect of facial-submental artery island flap (FSAIF) in the repair of palatal defects, and to provide reference for the clinical application of submental artery island flap. Methods Nine patients with palatal defects, the range of nasal palatal perforation defects were 3 cm × 4cm to 3 cm × 6 cm (median 3 cm × 5.4 cm), were repaired by FSAIF, and the sizes of FSAIF were 4 cm × 9cm to 4 cm × 12 cm (median 4 cm × 10.4 cm,). Postoperative clinical efficacy was evaluated, including infection and necrosis of mucosal flap and postoperative palatal fistula perforation. Patients were followed up to evaluate their chewing, swallowing, speech function, and satisfaction of appearance. Results All patients were successfully repaired with FSAIF. Followed up 13∼35 months, there was no palatal fistula perforation in all patients. The speech, agitation, and swallowing function were not affected and the patients were satisfied with the appearance. Conclusion FSAIF is a safe and reliable method for palatal defect repair.

Background Surgical repair of extensor hallucis longus (EHL) tendon rupture with a concomitant capsular defect has not been reported in the literature. This case presents a novel approach to EHL tendon rupture repair along with repair of a first metatarsophalangeal joint capsule defect. Methods A case study is presented of a 61-year-old man with a traumatic EHL tendon rupture and capsular defect treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons with autograft flap reconstruction of the first metatarsophalangeal joint capsule. Discussion A 61-year-old man presented with an acute traumatic EHL tendon rupture and first metatarsophalangeal joint capsule compromise after a chainsaw injury. He subsequently lost dorsiflexion of his hallux, and magnetic resonance imaging confirmed a 2.2-cm gap in the EHL tendon. He was treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons to reestablish dorsiflexion to the hallux. The injury was noted to infiltrate the first metatarsophalangeal joint capsule and was treated with an autograft of the first metatarsophalangeal joint capsule for a capsular defect. At 1-year follow-up the patient has regained dorsiflexion of the hallux and is back to activities such as snow skiing without pain. Conclusions Ruptures of the EHL tendon with first metatarsophalangeal joint capsule defects have not been reported in the literature. Herein, a novel approach was used to reestablish physiologic function to the EHL tendon and provide sufficient coverage of the first metatarsophalangeal joint.

Objective To evaluate the reliability and long-term efficacy of the sternocleidomastoid (SCM) flap in reconstructing and repairing soft tissue defects after oral cancer surgeries. Study Design A total of 102 patients who underwent soft tissue defect reconstruction with the SCM flap after oral cancer surgery (from 2012 to 2019) were assessed. Relevant clinical indicators were analyzed. They were also grouped according to pathologic cervical lymph node staging. Postoperative recurrence and metastases were compared with radial forearm free flap (RFFF). Results The flap healing rate was 100% in SCM flap, compared with a success rate of 94% in RFFF. SCM flaps would not increase the risk of dysfunction or paresthesia in the neck dissection area. Prognostically, the rate of cervical lymph node metastasis was similar in patients with pathologic cervical lymph node staging N0 and N1 for both flap types, whereas the rate of cervical lymph node metastasis was significantly higher in patients with SCM flaps compared with RFFF in N2 cases. Conclusions The SCM flap is a reliable, cost-effective flap with minimal adverse effects. It is ideal for soft tissue reconstruction of oral cancers if the patients are selected judiciously. N2 cases are not an indication for SCM flaps.

A child with Down syndrome, who had undergone uneventful ventricular septal defect repair one year earlier with a normal heart rate during routine follow-up, presented with recurrent seizure-like episodes that did not respond to antiepileptics. She was subsequently found to have complete heart block with significant bradycardia requiring permanent pacemaker insertion. This late and unusual presentation of complete heart block after ventricular septal defect repair is discussed. Prudence must be applied in the evaluation of children who have undergone surgical correction of congenital heart defects and presented with recurrent seizure-like episodes.

The main drawbacks of the use of the circumflex scapular artery perforator (CSAP) flap for complex soft-tissue defect repair are the limitation of skin paddle size, which can be harvested to allow precise wound coverage and primary closure of the donor site. We developed a variant of the dual skin paddle CSAP flap to extend its applications and minimize donor-site morbidity when reconstructing complex soft-tissue defects in children.A detailed anatomical investigation of circumflex scapular artery (CSA) branches was conducted using a standardized injection of lead oxide in 25 fresh cadavers. Dual skin paddle CSAP flaps were harvested for the reconstruction of complex defects in the extremities in 16 children. Three types of dual skin paddle CSAP flap were used in this study: transverse chain-shaped, oblique chain-shaped, and trefoil-shaped flaps.Three CSA branching patterns with superior branch diameters were observed: 34% of CSAs were of the transverse branch dominant type, 54% were of the descending branch dominant type, and 12% were of the codominant type. Sixteen dual skin paddle CSAP flaps were elevated successfully; they were of the transverse chain-shaped type in 2 cases, the oblique chain-shaped type in 9 cases, and the trefoil-shaped type in 5 cases. All flaps survived postoperatively. Primary closure of the donor site was achieved in all cases.The CSA system is an appropriate source for harvesting dual skin paddle CASP flap. Use of this flap for the reconstruction of complex soft-tissue defects in the extremities in children is an alternative approach that reduces morbidity and improves the cosmetic outcome at the donor site.

Epileptogenic encephaloceles, most frequently located in the temporal lobe, are a known lesional cause of focal epilepsy. Data are limited regarding diagnosis, management, and outcomes of patients with epilepsy in the setting of an encephalocele, because the literature mostly comprises case reports, case series, and retrospective studies. We conducted a broad literature review for articles related to encephaloceles and epilepsy regardless of level of evidence. Hence, this review provides a summary of all available literature related to the topic. Thirty-six scientific reports that fulfilled our inclusion criteria were reviewed. Most reported patients presented with focal impaired awareness seizures and/or generalized tonic-clonic seizures. Although most of the encephaloceles were located in the temporal lobe, we found 5 cases of extratemporal encephaloceles causing epilepsy. More patients who underwent either lesionectomy or lobectomy were seizure free at time of follow-up. In the temporal lobe, there is no clear consensus on the appropriate management for epileptic encephaloceles and further studies are warranted to understand the associated factors and long-term outcomes associated with epilepsy secondary to encephaloceles. Reported data suggest that these patients could be manageable with surgical procedures including lesionectomy or lobectomy. In addition, because of data suggesting similar results between procedures, a more conservative surgery with lesionectomy and defect repair rather than a lobectomy may have lower surgical risks and similar seizure freedom.

Introduction As the limits of advanced skull base malignancies that can be managed through an endoscopic endonasal approach continue to be expanded, the resultant anterior skull base defects are of increasing size and complexity. In the absence of nasoseptal or turbinate flaps, the vascularized pericranial flap has been employed at our institution with excellent results. Objective The study aimed to review the outcomes of patients who underwent endonasal anterior craniofacial resection with anterior skull base reconstruction using a vascularized pericranial flap. Design Retrospective chart review of patients treated by the University of California – San Francisco minimally invasive skull base service from the years 2011 to 2017. Average duration of follow-up was 16.4 months. Setting This study was conducted at Academic tertiary referral center. Participants A total of nine patients with advanced anterior cranial base malignancies were identified who were treated with a minimally invasive, endoscopic anterior craniofacial resection from the years 2011 to 2017. Due to the nature of the resection in these patients, nasoseptal flaps and inferior/middle turbinate flaps were unavailable or insufficient for anterior skull base defect repair. Each patient underwent reconstruction of the anterior cranial base defect using an anteriorly based pericranial flap harvested by bicoronal incision, and tunneled anteriorly to the nasal cavity through a frontoethmoidal incision.

Study Objective: Several studies have been published on hysteroscopic treatment of cesarean scar defect using the 26 Fr resectoscope. This study compared the effects of the 26 Fr resectoscope with those of the 16 Fr mini-resectoscope in terms of efficacy, safety profile, and peri- and postoperative complications. Design: A prospective cohort study. Setting: Tertiary care university hospital (S. Orsola–Malpighi, Bologna, Italy). Patients: Three hundred and nine women having symptoms and with a cesarean scar defect diagnosis were divided into 2 groups according to a temporal criterion: from March 2012 to March 2015, 155 consecutive women (control group) underwent isthmoplasty with the 26 Fr resectoscope (Karl Storz, Tuttlingen, Germany), whereas from April 2015 to March 2018, 154 consecutive women (study group) underwent isthmoplasty with the 16 Fr mini-resectoscope (Gubbini system, Tontarra Medizintechnik, Tuttlingen, Germany). Interventions: One hundred and fifty-five women (control group) underwent isthmoplasty with the 26 Fr resectoscope, and 154 women (study group) underwent isthmoplasty with the 16 Fr mini-resectoscope. The so-called “channel-like” 360° endocervical resection technique was applied. Measurements and Main Results: The isthmoplasty time with the 2 resectoscopes, excluding cervical dilatation, was similar (p =. 25), whereas the overall surgical time was shorter in the case of the mini-resectoscope. The use of the 16 Fr mini-resectoscope was significantly associated with a reduced volume of distension medium used (p

Introduction:Hospital readmission is an important driver of costs among patients with CHD. We assessed predictors of 30-day rehospitalisation following cardiac surgery in CHD patients across the lifespan.Methods:This was a retrospective analysis of 981 patients with CHD who had cardiac surgery between January 2011 and December 2012. A multivariate logistic regression model was used to identify demographic, clinical, and surgical predictors of 30-day readmission. Receiver operating curves derived from multivariate logistic modelling were utilised to discriminate between patients who were readmitted and not-readmitted at 30 days. Model goodness of fit was assessed using the Hosmer–Lemeshow test statistic.Results:Readmission in the 30 days following congenital heart surgery is common (14.0%). Among 981 patients risk factors associated with increased odds of 30-day readmission after congenital heart surgery through multivariate analysis included a history of previous cardiac surgery (p < 0.001), longer post-operative length of stay (p < 0.001), as well as nutritional (p < 0.001), haematologic (p < 0.02), and endocrine (p = 0.04) co-morbidities. Patients who underwent septal defect repair had reduced odds of readmission (p < 0.001), as did children (p = 0.04) and adult (p = 0.005) patients relative to neonates.Conclusion:Risk factors for readmission include a history of cardiac surgery, longer length of stay, and co-morbid conditions. This information may serve to guide efforts to prevent readmission and inform resource allocation in the transition of care to the outpatient setting. This study also demonstrated the feasibility of linking a national subspecialty registry to a clinical and administrative data repository to follow longitudinal outcomes of interest.

Background The traditional technique of gastrointestinal reconstruction of the esophagus after esophagectomy presents plenty of complications. Hence, tissue engineering has been introduced as an effective artificial alternative with potentially fewer complications. Three types of esophageal scaffolds have been used in experimental studies so far. The aim of our meta-analysis is to present the postoperative outcomes after esophageal replacement with artificial scaffolds and the investigation of possible factors that affect these outcomes. Methods The present proportional meta-analysis was designed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and A MeaSurement Tool to Assess systematic Reviews guidelines. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases from inception until February 2020. Results Overall, 32 studies were included that recruited 587 animals. The pooled morbidity after esophageal scaffold implantation was 53.4% (95% CI = 36.6–70.0%). The pooled survival interval was 111.1 days (95% CI = 65.5–156.8 days). Graft stenosis (46%), postoperative dysphagia (15%), and anastomotic leak (12%) were the most common complications after esophageal scaffold implantation. Animals that underwent an implantation of an artificial scaffold in the thoracic part of their esophagus presented higher survival rates than animals that underwent scaffold implantation in the cervical or abdominal part of their esophagus (P Conclusion Tissue engineering seems to offer an effective alternative for the repair of esophageal defects in animal models. Nevertheless, issues like graft stenosis and lack of motility of the esophageal scaffolds need to be addressed in future experimental studies before scaffolds can be tested in human trials.

The growth and advancement of minimally invasive cardiac surgery in recent years has allowed robotic and totally endoscopic procedures to become safe and effective options for the treatment of patients with various diseases of the heart. However, despite these advances, outcome data for robotic correction of congenital cardiac anomalies are scarce. This is particularly true for robotic ventricular septal defect (VSD) repair with initial experiences only recently having been published by a single group. Here, we present the case of a 29-year-old female who underwent robotic totally endoscopic VSD repair due to persistent symptoms with resolution of preoperative shunting and severe tricuspid regurgitation following surgery. This unique case adds to the limited data currently available in the literature on robotic VSD repair to show that it is a safe procedure when performed by a dedicated surgical team experienced in minimally invasive robotic cardiac surgery. We feel that, in this setting, the benefits of a robotic surgical approach can be afforded to more patients with excellent results.

Background Repair of the soft tissue defect in myelomeningoceles remains challenging. The literature currently lacks a systematic approach, reporting high rates of complications. We present outcomes from the largest series to date and describe a simplified approach that minimizes morbidity and streamlines decision making. Methods Patients 1 year or younger who underwent myelomeningocele repair between 2008 and 2018 were reviewed. Flap types were categorized by tissue composition. Complications were dichotomized into early and late ( 30 days postoperative, respectively). Logistic regression was used to measure the impact of flap tissue composition and skin closure technique on odds of postoperative complications. Results Ninety-seven patients met inclusion criteria. Reoperation was required in only 3 (3.0%) patients-1 for wound dehiscence and 2 for surgical site infections. Zero cases of tethered cord or cerebrospinal fluid leak occurred. The most common minor complications were early wound complications (n = 18, 18.6%) and early infection (n = 5, 5.2%). Fascia-only flaps and muscle + other tissue flaps were not associated with higher odds of complications compared with muscle-only flaps (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.53-8.50, P = 0.29; OR = 2.87, 95% CI 0.66-12.51, P = 0.16, respectively). Rhomboid flaps for skin closure were associated with higher odds of complications (OR, 4.47; 95% CI, 1.00-19.97; P = 0.05). Conclusions Our approach to myelomeningocele repair demonstrated no cases of secondary tethered cord or cerebrospinal fluid leak, and reoperative rates were extremely low. Because complications were unrelated to flap type, we recommend a simplified approach using any tissue type for dural coverage and 2-layer primary closure of the skin.

Introduction: Transurethral endoscopic surgery is limited by its incompatibility in defect repair that requires suturing. Open surgery carries significant higher morbidities, whereas pneumoperitone...

It is reported that almost one in five women will need some form of pelvic organ prolapse surgery in their lifetime, with anterior wall repair accounting for nearly half of these. Cystoceles occur secondary to defect(s) in one or more of the vaginal wall support mechanisms, including its lateral paravaginal attachments. Paravaginal defects are very common in women presenting with cystocele, thus highlighting the importance of paravaginal defect repair for optimal cystocele correction in the majority of cases. Although there are several paravaginal defect repair procedures, some entail complex techniques, whereas others rely on the use of transvaginal mesh, which is currently not permitted in many countries. In this video article we present a novel trans-obturator native tissue paravaginal defect repair for the management of cystocele. This procedure has the advantages of avoiding complex transabdominal paravaginal defect repair, the controversial use of transvaginal mesh, or a single-point fixation to an arcus tendineus fasciae pelvis that might be difficult to identify. We believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives.

Background Outcomes after the arterial switch operation (ASO) for dextro-transposition of the great arteries have improved significantly since its inception in the 1980s. This study reviews contemporaneous outcomes and predictors for late reinterventions after ASO. Methods We retrospectively reviewed patients who underwent ASO for dextro-transposition of the great arteries from 1997 to 2017. Technical performance score (TPS) class (class 1, trivial or no residua; class 2, minor residua; class 3, major residua or reintervention) was assigned at discharge based on echocardiographic evaluation of components of the ASO. Multivariable Cox regression identified patient- and procedure-specific factors associated with postdischarge reinterventions. Results Among 598 patients, 410 (69%) underwent ASO and 188 (31%) underwent ASO with ventricular septal defect repair. Median age at surgery was 5 days (interquartile range, 3 to 7); median follow-up time was 8.2 years; 408 (68%) were male; 50 (8.3%) were premature; and 10 (1.7%) had noncardiac anomalies or syndromes. Survival to hospital discharge was 98% (n = 591). Among 349 patients with follow-up, freedom from unplanned reintervent2ion at 5 years was 99% for TPS class 1, compared with 84% for class 2 and 30% for class 3. On multivariable Cox regression, classes 2 and 3 had significantly higher hazard for reintervention (class 2 hazard ratio 10.6; 95% confidence interval, 2.5 to 44.2; P = .001; class 3 hazard ratio 58.2, 95% confidence interval, 13.1 to 259; P Conclusions At our center, ASO was associated with relatively low mortality. Class 2 and class 3 TPS were the most important independent predictors of reinterventions after discharge. Therefore, TPS can serve as a tool for identifying high-risk patients who warrant closer follow-up.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p

The study objective is to describe currently available and optimal methods of central skull base reconstruction.Material and methods. This article describes a 10-year experience of endoscopic surgery in reconstructing the defects after the removal of chiasmosellar tumors.Results. We developed a strategy for assessing the risks for postoperative liquorrhea and choosing an optimal surgical technique. This strategy allows maintaining the incidence of postoperative liquorrhea of 4 %.Conclusion. Autografts are the most widely used material for reconstructing skull base defects after the removal of chiasmosellar tumors. The multilayer reconstruction is more preferable due to the high risk of postoperative liquorrhea.

The importance of a functioning Achilles tendon for normal gait underlies the need for adequate reconstruction in the event of problems with repair or initial surgical manipulation. Large segmental Achilles tendon defects present a difficult problem to treating surgeons, and catastrophic failure of the reconstruction can be very intimidating. Multiple procedures including fascial turndowns and allograft reconstruction have been utilized with varying degrees of success. Causes of failure are multifactorial and include poor intraoperative tensioning, postoperative adhesions, infection, and noncompliance with postoperative recovery protocols. After appropriate preoperative workup, the surgeon should be prepared to do an extensive resection of tendon and be prepared for a large defect repair. The benefits of a long turndown flap versus an allograft rebuilding have not been resolved: both procedures offer good results. The turndown flaps work well but require extensive dissection and have risk for significant scar formation. Dual semitendinosus allograft reconstruction offers preservation of the proximal muscle tendon unit and strength.

Titanium mesh was widely used for cranium defect repair but associated with high complication rates. In this study, the authors describe a method using latissimus dorsi-myocutaneous flap in the repair of titanium mesh exposure and scalp defect after cranioplasty, and the plate retaining is also achieved. Fifteen patients from April 2012 to May 2016 underwent this procedure, the age ranged from 32 to 62 years and 47 years old on average, and all the patient had plate exposure combined with surgical site infection and variation of scalp defect. All the patients had fully flap survive, and follow up ranged from 6 months to 24 months, 1 patient had titanium mesh re-expose and received additional operation to remove the plate. The free latissimus dorsi musculocutaneous flap could supply large size of bulky tissue coverage with good blood supply and strong anti-infection ability. This method was an option for retaining the titanium mesh and repairing the exposure for the mild infection with small size scalp defect patient.

This is a case presentation of successful defect repair after radical surgical excision of a moderately large basal cell carcinoma by a simple procedure taking advantage of a patient's individual face features.

INTRODUCTION AND HYPOTHESIS: Paravaginal defect (PVD) has been suggested as one of the main contributors to the development of prolapse in the anterior vaginal wall (AVW). We aimed to evaluate the descent of pelvic organs, presence of vaginal H configuration, and pubococcygeus (PC) muscle defect by pelvic magnetic resonance imaging (MRI), together with subjective symptoms of prolapse, before and 6 months after PVD repair. We also aimed to evaluate risk factors of recurrence.METHODS: Fifty women with PVD diagnosed by gynecological examination and scheduled for vaginal PVD repair were planned for enrollment. Preoperatively and 6 months postoperatively, subjective symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) together with MRI of the pelvis to evaluate defects in the PC muscle, vaginal shape, and pelvic organ descent.RESULTS: Forty-six women completed the study. Twenty had PVD repair alone, whereas 26 also had concomitant surgery performed. Prolapse grade, subjective symptoms, sexual problems, and quality of life (QoL) were significantly improved at follow-up. Missing vaginal H configuration was observed in 21 women before operation and was correlated with PC muscle defect. Recurrence rate was 39%, and significantly more women with recurrence had PC muscle defects and missing H configuration.CONCLUSION: Vaginal PVD repair alone or combined with concomitant surgery significantly reduces objective prolapse and subjective symptoms. We could not demonstrate MRI findings of missing H configuration to be a sign of PVD but, rather, a sign of defect in the PC muscle. Risk of recurrence is significantly higher in women with major PC muscle defects and missing H configuration.

Cerebrospinal fluid rhinorrhea of the sphenoid sinus is a serious clinical condition. Endoscopic management has become the gold standard treatment. Use of multilayer closure to occlude the anatomical defect was suggested by some reports. The current study aims to evaluate endoscopic repair of sphenoid sinus CSF leak using multilayer closure. The present study included 17 patients. Their CSF leak was caused by accidental trauma in 9 patients (52.9 %), iatrogenic trauma in 1 patient (5.9 %) and in 7 patients (41.1 %), the leak occurred spontaneously. After localization of the leak, multilayer closure was used for anatomical defect repair. All patients achieved successful operative repair form the first attempt. The reported complications included meningitis in only 1 patient (5.9 %).Endoscopic repair of the sphenoid sinus CSF leaks using multilayer closure is a safe and effective approach. The Hadad–Bassagasteguy flap is the corner stone for sealing skull base defects in sphenoid sinus.

Study Objective To demonstratefull-thickness excision of the affected muscularis along the submucosal plane. Design Stepwise demonstration of LRSD technique with narrated video footage. Setting LRSD takes advantage of the submucosal layer of the bowel wall and uses it as an easier line of excision for rectal endometriosis compared with the very difficult traditional line of excision of irregular disease-muscularis interface. The expansion of the submucosal layer by the injection separates the affected muscularis away from the mucosa, making it safer to excise the lesion with less chance of entering the bowel lumen. Excision of disease is more complete with LRSD because the full-thickness excision of the muscularis layer includes the healthy deep muscularis, which will form the disease-free deep excision margin. Intervention This video will highlight anatomic and technical aspects of LRSD including the following key steps: 1. Mobilization of diseased bowel segment 2. Submucosal injection 3. Circumferential incision of the muscularis 4. Submucosal dissection along the submucosal plane 5. Bowel wall integrity test 6. Muscularis defect repair Conclusion Rectal shaving by LRSD appears to be easier, safer, and more complete in excision of bowel endometriosis than the classical rectal shaving technique. This modification requires further evaluation to confirm its potential in the surgical management of rectosigmoid deep infiltrative endometriosis.

Objective: Neural tube defects occur in approximately one in 1000 live births in the US. Myelomeningocele (MMC) is the most common and severe form of spina bifida aperta. In this study, we present a surgical modification of the bilateral fasciocutaneous rotation and advancement flap technique in MMC patients.Material and Methods: Twenty-four patients (12 male, 12 female) with MMC who were operated on between August 2011 and June 2013 were retrospectively evaluated. Presence of hydrocephalus, the neurological status, and the level and size of the MMC were recorded. We used bilateral perforator-based fasciocutaneous rotation and advancement flaps for defects larger than 3 cm in width, or in the presence of prominent kyphosis together with any defect size.Results: The follow-up period ranged from eight days to two years. One patient died on the eighth day after surgery because of sepsis secondary to aspiration pneumonia. One patient had cerebrospinal fluid accumulation under the repair zone. In another patient, cerebrospinal fluid leakage through the repaired incision was observed on the ninth day after surgery. Three patients had minimal wound dehiscence at the distal end of the suture line.Conclusion: In this study, 24 patients were treated with the described perforator-based technique by preserving at least one perforator vessel on each side. Reconstruction of MMC defects with paraspinal fasciocutaneous rotation and advancement flaps is still one of the best choices for closing moderate-to-large defects without using skin graft, and the safety of the flaps increases by preserving the perforators., Amaç: Nöral tüp defektleri Amerika Birleşik Devletleri'nde yılda 1000 canlı doğumda bir ortaya çıkmaktadır. Myelomeningosel, Spina Bifida Aperta deformitesinin en yaygın ve en ağır formudur. Bu çalışmada, myelomeningosel hastalarında bilateral fasyokutanöz rotasyon ve ilerletme flebi tekniğinin cerrahi modifikasyonunu sunuyoruz.Gereç ve Yöntemler: Ağustos 2011 ile Haziran 2013 arasında opere edilen 24 myelomeningosel hastası (12 erkek, 12 kız) retrospektif olarak analiz edildi. Hidrosefali varlığı, nörolojik durum ve myelomeningoselin düzeyi ve boyutu kaydedildi. Defekt boyutunun 3 cm'den daha geniş olduğu ya da kifoz deformitesinin eşlik ettiği durumlarda, perforatör bazlı bilateral fasyokutan rotasyon flebi kullandık.Bulgular: Takip süresi sekiz gün ile iki yıl arasında gerçekleşti. Bir hasta postoperatif sekizinci günde aspirasyon pnömonisine sekonder sepsis nedeniyle kaybedildi. Bir hastada onarım bölgesi altında beyin omurilik sıvısı birikimi saptandı. Bir hastada ise postoperatif dokuzuncu günde onarım hattından beyin omurilik sıvısı sızıntısı gözlendi. Üç hastada onarım hattı distalinde minimal dehissans gözlendi.Sonuç: Bu çalışmada 24 hastada defekt rekonstrüksiyonu, her bir tarafta en az bir perforatörün korunduğu perforatör bazlı teknik ile gerçekleştirildi. Paraspinal fasyokutan rotasyon ve ilerletme flepleri, geniş myelomeningosel defektlerin onarımında greft kullanımına gerek bırakmayan en uygun rekonstrüksiyon seçeneğidir ve perforatör korunması ile flep güvenliği artar.

Dural defects are a common problem, and inadequate dural closure can lead to complications. Several types of dural substitute materials have recently been discarded or modified owing to poor biocompatibility or mechanical properties and adverse reactions. The small intestinal submucosa (SIS) is a promising material used in a variety of applications. Based on the limitations of previous studies, we conducted an animal study to evaluate the efficacy and safety of the SIS in preclinical trials. Twenty-four male beagle dogs were subjected to surgical resection to produce dural defects. SIS or autologous dural mater was patched on the dural defect. Gross and histological evaluations were carried out to evaluate the efficacy and safety of the therapy. Our findings demonstrated that the SIS, which stimulated connective and epithelial tissue responses for dural regeneration and functional recovery without immunological rejection, could provide prolonged defect repair and prevent complications. The mechanical properties of the SIS could be adjusted by application of multiple layers, and the biocompatibility of the material was appropriate. Thus, our data suggested that this material may represent an alternative option for clinical treatment of dural defects.