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Open in new tab Download slide OBJECTIVES The aim of this study was to compare postoperative outcomes between biologic and synthetic reconstructions after chest wall resection in a matched cohort. METHODS All patients who underwent reconstruction after full-thickness chest wall resection from 2000 to 2022 were reviewed and stratified by prosthesis type (biologic or synthetic). Biologic prostheses were of biologic origin or were fully absorbable and incorporable. Integer matching was performed to reduce confounding. The study end point was surgical site complications requiring reoperation. Multivariable analysis was performed to identify associated risk factors. RESULTS In total, 438 patients underwent prosthetic chest wall reconstruction (unmatched: biologic, n = 49; synthetic, n = 389; matched: biologic, n = 46; synthetic, n = 46). After matching, the median (interquartile range) defect size was 83 cm2 (50–142) for the biologic group and 90 cm2 (48–146) for the synthetic group (P = 0.97). Myocutaneous flaps were used in 33% of biologic reconstructions (n = 15) and 33% of synthetic reconstructions (n = 15) in the matched cohort (P = 0.99). The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic reconstructions in the unmatched (3 [6%] vs 29 [7%]; P = 0.99) and matched (2 [4%] vs 4 [9%]; P = 0.68) cohorts. On the multivariable analysis, operative time [adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI), 1.00–1.01; P = 0.006] and operative blood loss (aOR = 1.00, 95% CI, 1.00–1.00]; P = 0.012) were associated with higher rates of surgical site complications requiring reoperation; microvascular free flaps (aOR = 0.03, 95% CI, 0.00–0.42; P = 0.024) were associated with lower rates. CONCLUSIONS The incidence of surgical site complications requiring reoperation was not significantly different between biologic and synthetic prostheses in chest wall reconstructions. [ABSTRACT FROM AUTHOR]

Aim. To analyze the long-term outcomes of a novel method of femoropopliteal bypass (FPB) surgery.Material and methods. This retrospective, open-label, comparative study for the period from October 1, 2016 to December 25, 2019 at the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital №1 (Krasnodar Krai) included 473 patient who underwent FBP. Depending on the type of graft, 5 groups were formed: group 1 (n=266) — reversed vein (great saphenous vein (GSV)); group 2 (n=59) — autologous vein graft (GSV) prepared in situ; group 3 (n=66) — autologous vein graft (GSV) prepared ex situ; group 4 (n=9) — synthetic graft (Jotec, Germany); group 5 (n=73) — upper limb veins. In all cases, Multislice computed tomography angiography revealed an extended (25 cm or more) Trans-Atlantic Inter-Society Consensus (TASC II) class D occlusion of the superficial femoral artery. The longterm follow-up period was 16,6±10,3 months. The technical result of novel FPB technique was achieved using proposed type of an autologous vein graft preparation, in which, after GSV isolation, ex situ valvulotomy was performed, followed by the non-reversed subfascial orthotopic graft passage along the neurovascular bundle by tunneling (Sheath Tunneler Set; Peripheral Vascular, USA) soft tissues. The GSV ex situ was prepared as follows: the GSV was isolated from the saphenofemoral fistula in the distal direction to the required length and removed from the wound. Further, valvulotomy was performed through the proximal end of GSV. Then the valvulotome was removed and a metal cannula was inserted. Through it, a saline solution at indoor temperature with unfractionated heparin was injected into the GSV lumen, simulating blood flow, and the quality of the performed valvulotomy was assessed.Results. In the inhospital postoperative period, all complications developed in groups 1, 2, 3 and 5. However, no significant intergroup statistical differences were found. In the long-term follow-up, there were no significant intergroup differences in the prevalence of deaths (group 1: 4,6%; group 2: 1,7%; group 3: 4,6%; group 4: 0%; group 5: 2,8%; p=0,78), myocardial infarction (group 1: 1,9%; group 2: 0%; group 3: 1,5%; group 4: 0%; group 5: 0%; p=0,62), ischemic stroke (group 1: 0,8%; group 2: 1,7%; group 3: 1,5%; group 4: 0%; group 5: 0%; p=0,8) and shunt thrombosis (group 1: 14,5%; group 2: 19,3%; group 3: 18,5%; group 4: 44,4%; group 5: 19,7%; p=0,16). However, the highest number of limb amputations (group 1: 4,2%; group 2: 5,3%; group 3: 9,2%; group 4: 22,2%; group 5: 1,4%; p=0,03) and the highest rate of composite endpoint (sum of all complications) (group 1: 26,0%; group 2: 28,1%; group 3: 35,4%; group 4: 66,7%; group 5: 23 ,9%; p=0,05) were observed in patients with synthetic prosthesis.Conclusion. FPB with the autologous vein graft ex situ is characterized by a comparable inhospital and long-term outcomes with BPS using the reversed autologous vein and autologous vein in situ. Thus, this surgical technique may become one of the preferable operations for patients with extended occlusion of the superficial femoral artery.

An analysis of results of experimental research was made in 60 patients with critical ischemia of lower extremities due to bilaterally atherosclerotic lesions of aorto-iliac segment, which had a high operationally anaesthetic risk. Synthetic polytetrafluoethylene prosthesis or biological shunt from internal pectoral bull arteries were used as a shunt. Revasculization was performed through the system of arteria profunda femoris considering multilevel lesions of lower limb arteries. An application of biological prosthesis allowed decreasing the rate of early postoperative complications on 13,3% , late thromboses - on 30%, extending the medium term of shunt functioning in 1,8%, improving physical component of health on 12,8% and mental - on 9,1% during the immediate postoperative period. The experiments on rabbits were carried out. It was shown, that biological prosthesis had the greatest biological compatibility.

In art, what appears to be a condition for change is almost always strategically expedient. This is especially the case when one positions art and change within a prosthetic space. Charles Garoian lays claim to this strategy by posing prosthesis as the fourth dimension that follows a third synthetic stage that dialectically binds a thesis to its antithesis. Re-reading Garoian’s claims against the Soviet and Neo-Liberal renditions of Hegel’s theory of the dialectic, this article argues that such claims could reduce art’s space to a prosthetic synthesis that risks pedagogical and aesthetic ossification. Given the performative élan by which Garoian invests education, this appears paradoxical, especially in terms of the personal dimension by which he invests his art as a métier of living and surviving a history that is firmly marked by the devastation of genocide. Strangely, this paradox is what gives us the ability and power by which we could seek a counter-Bildung. As this article’s author puts it, in art, such a counter-Bildung takes the form of unlearning by which one would exit the predicament of instrumental reason. For unlearning to become possible, prosthetic syntheses must be reversed by making of arts education a case for synthetic prostheses. Only then could Garoian’s performative method begin to assert an inverse positioning that would effectively counter the instrumentalization of the dialectic, and with it, that of history and art. [ABSTRACT FROM PUBLISHER]

We report a review of 215 reconstructions for aorto-iliac arterial occlusive lesions, involving 156 patients. At 13 years, the cumulative patency rate of 158 aorto-femoral or aorto-iliac dacron synthetic bypass prostheses was 71.6 per cent as compared to 52.7 per cent at 5 years for 22 blunt endarterectomies and 47.4 per cent at 6 years for 35 axillo-femoral bypass prostheses. Of the 158 synthetic bypass prostheses, the cumulative patency rate at 13 years was 85.1 per cent in cases with no occlusive involvement of the peripheral arteries, significantly higher (p<0.03) than the 39.3 per cent patency rate at 7 years in cases in which associated femoro-politeal occlusive lesions were not treated. At 12 years, the patency rate was 53.2 per cent in cases in which associated femoro-popliteal occlusive lesions were treated during the same reconstructive intervention, i.e. markedly higher (p<0.08) than in patients in whom the degree of outflow in the distal vessels was poor. Our findings indicated that, in order to achieve a satisfactory long-term patency rate, it is important to treat associated occulusive lesions in the femoro-popliteal arteries. [ABSTRACT FROM AUTHOR]