Objective To discuss the surgical treatment and experience of mesh infection after prosthetic patch repair of inguinal hernia. Methods The clinical data of 67 cases of mesh infection after prosthetic patch repair who were treated in Chao-Yang Hospital from Jan. 2011 to Jun. 2012 were retrospectively analyzed. Results All patients were treated with surgical operation successfully， including removing the infected mesh and surrounding tissues， primary suture， and a placement of wound drainage， without replacement of a new patch substitute. The hospital stay of the patients was 10-25days with an average of 16days. Of the 67 patients， 51 patients got primary healed and the other 16 patients healed delayed after local dressing change due to the superficial infection following stitch removal. Sixty-six patients were followed-up for 6-24 months （average of 20 months） after operation without recurrence and complication， including seroma， wound infection， intestinal fistula， and postoperative pain. Conclusions The treatment of mesh infection after inguinal hernia repair is very complicated， but the primary suture repair and a placement of wound drainage after removing infected mesh with complete debridement is a effective therapy for it.
ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
Abstract: Objective To investigate the prognosis of residual shunt after surgical repair in infants. Methods We selected 407consecutive infant patients (255 males and 152 females) with venticular septal defects(VSD) between January 2008 and June 2008 in Shanghai Children’s Medical Center, Shanghai Jiaotong University. Of the patients, 273 were less than 1 yearold, 88 were 12 yearsold, and 46 were 23 years old. All of whom underwent surgical repair of the ventricular septal defect with autologous pericardial defect treated by glutaraldehyde. Results Of the 407 patients, 29 had residual ventricular septal defects, there was no significant difference among age groups in the rate of residual shunts （χ2=0.054，P=0.973）.Twentynine patients were followedup,and in the followup period of 1.5 months to 2 years postsurgery, 26 patients had spontaneous closure, while the other 3 patients did not heal. None of the patients needed reoperation. There was no significant difference amongage groups or type of ventricular septal defect in the rate of residual shunts (χ2=1.035，P=0.596). Conclusions Postsurgical residual ventricular septal defects smaller than 0.4 cm will close spontaneously in most infants.
ObjectiveTo evaluate the feasibility of using acellular bovine pericardium as a viable tissue engineering vascular patch.MethodsFresh bovine pericardium was treated by enzyme detergent cell extraction, then they were used as vascular patches, ovine jugular vein segments were harvested, separated into endothelial and myofibroblast cells, expanded in cell culture, sequentially seeded onto acellular bovine pericardium patches (3cm×3cm). After 7 days of in vitro culture, the autologous cell/patches as experimental group ( n =5) were used to replace partial pulmonary artery wall. Animals were sacrificed at 4, 6, 8, 12 and 24 weeks. The acellular bovine pericardium patches without autologous cells were used as control group ( n =3). Animals were sacrificed at intervals of 4, 12 and 24 weeks. Explanted patches were evaluated by macroscopic and histologic examinations, assayed for calcium, elastin and collagen content.ResultsAll animals were survived without complications of thrombosis and aneurysm before sacrificed; there was no significant difference in calcium content in two groups; elastin ratio assay showed progressive increase over 4 to 24 weeks, similar to normal pulmonary artery wall, suggesting an ongoing tissue remodeling.ConclusionThe acellular bovine pericardium patch with or without autologous cell seeded to a certain extent can be changed into viable vascular wall tissue after being used to replace partial ovine pulmonary artery wall.
Objective To investigate the effectiveness of endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch for chronic abdominal wall sinus by comparing with the traditional surgical method. Methods Retrospective analysis was made on the clinical data of 53 cases of chronic abdominal wall sinus between January 2006 and May 2012. Of 53 patients, 18 underwent endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch (trial group), and 35 underwent traditional surgical treatment (control group). No significant difference was found in gender, age, etiology, disease duration, and location between 2 groups (P gt; 0.05). Results The blood loss during sinus clearance, postoperative hospitalization days, and sinus union time of the trial group were significantly better than those of the control group (P lt; 0.05), but no significant difference was found in the operative time for sinus clearance (t=0.28, P=0.78). No postoperative sinus bleeding or infection occurred in the trial group, but bleeding and infection in 5 and 3 cases of the control group respectively, showing significant differences between 2 groups (P lt; 0.05). The follow-up time was 4-18 months (mean, 12.4 months) in the trial group, and was 6-48 months (mean, 38.5 months) in the control group. No sinus recurrence was observed during follow-up. Conclusion Endoscopic low-temperature plasma radiofrequency ablation with acellular dermal matrix patch has the following advantages in treating chronic abdominal wall sinus: clear view, thorough cleaning of granulation necrosis tissues, less bleeding, faster sinus union, and shorter hospitalization days; however, further observations on the long-term effectiveness and the safety are required .
Objective To study the reconstruction method and effectiveness of titanium plate and Teflon patch for the chest wall after resection of sternal tumors. Methods Between October 2006 and November 2009, 4 patients with sternal tumors were treated and the thoracic cages were reconstructed. There were 2 males and 2 females, aged 30-55 years. The patientswere admitted because of chest lump or pain. The sizes of palpable lump ranged from 4 cm × 3 cm to 10 cm × 8 cm. CT examination showed bone destruction. After sternal tumor resection, defect size ranged from 10 cm × 8 cm to 18 cm × 14 cm, and titanium plate and Teflon patch were used to repair and reconstruct the chest wall defect. Results The operations of the tumor resection and reconstruction of chest wall defect were successfully performed in 4 cases. Incisions healed by first intention with no abnormal breath, subcutaneous emphysema, pneumothorax, and infection. One case failed to be followed up after 6 months; 1 case died of intracranial hemorrhage; and 2 cases were followed up 1 and 4 years respectively without tumor recurrence. The chest wall had good remodel ing. No loosening and exposure of titanium plate, difficulty in breathing, chest distress, and chest pain were observed during followup. Conclusion Surgical resection of sternal tumors will cause large chest wall defect which can be repaired by titanium plate and Teflon patch because it had the advantages of easy operation, satisfactory remodel ing, and less compl ication.