Arthroscopic transosseous foveal footprint repair of the triangular fibrocartilage complex

Foveal disruption of the triangular fibrocartilage complex contributes to the instability of distal radioulnar joint. We have developed an arthroscopic transosseous foveal footprint repair technique, which maximizes the contact between the disrupted triangular fibrocartilage complex and its foveal footprint for better healing by using four sutures in a divergent configuration through a 1.6-mm bone tunnel. Twelve patients with triangular fibrocartilage complex foveal injuries who had undergone this repair technique were reviewed with a mean follow-up of 53 months. All patients achieved significant improvement in the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score. All patients had stable distal radioulnar joints with comparable ranges of motion and grip strengths between the operated and contralateral wrists. There was no significant difference in functional score in those who were treated more than 6 months after injury. Level of evidence: IV

Foil tape—a simple, versatile tool for turtle shell repair

The repair of shell fractures in turtles is often delayed due to the time, labor and resources involved in many current shell repair methods, resulting in increased stress, handling and recovery time for the patient. This article introduces a new repair technique using aluminium foil tape combined with cyanoacrylate glue, which allows quick, simple and long-lasting closure of fresh shell injuries. Strips of malleable but inelastic foil tape are cut to size and positioned across the fracture at critical junctures, then glued in place on either side of the wound and burnished down to conform to surface irregularities and insure consistent adhesion. This technique is non-invasive, requires no curing time and can be customized for a wide range of turtle sizes and injuries, either as a stand-alone method or a preliminary stabilization tool. In the author’s experience, it has proven to be consistently effective at reducing fractures and staying in place until removal, when it is easily peeled off with no residual damage. The speed, ease and endurance of the foil tape method may encourage more widespread repair of fresh shell fractures and, in so doing, optimize recovery time and results for chelonian patients.

O52 LAP-T MINI LAPAROSCOPIC TECHNIQUE FOR THE REPAIR OF RECURRENT UMBILICAL HERNIA ON PRIMARILY UNTREATED DIASTASIS

Aim “This retrospective analysis on 1000 cases of Diatasis Recti (DR) complicated by single/multiple, primary/recurrent hernias, all treated with the Laparoscopic Abdominoplasty Technique (LAP-T), aims at evaluating the possible correlation of higher recurrence rate and complications when DR is left untreated” Material and Methods “This review on 1000 patients, <65yrs, BMI<30, 3>IRD>12, based on CT Scan/MRI study, showed 235 (23,5%) of them to be recurrent umbilical/midline hernias engaged on untreated RMD, independently from the surgical technique used for primary repair. Re-operation with LAP-T technique, consisted in removal of recurrent hernia and dislocated mesh when present, closure by self-locking running sutures of the hernia defect and the DR. Repair is consolidated placing an intra-peritoneal mesh” Results “In all patients, recurrence was repaired, DR reconstructed and abdominal wall anatomy and physiological functionality successfully restored. No intra operative bleeding, seroma formation, chronic pain, nor mesh infection have been recorded. 98% follow up at 12 months, 91% at 24, no recurrences observed” Conclusions “Higher incidence of recurrent umbilical/midline hernias observed in this analysis, compared to average recurrence rate reported in literature, suggest that regardless primary repair technique, the repair of the sole hernia engaged on a DR is likely to lead to a recurrent hernia, further midline hernia defects formation and worsening of the DR. A significant correlation between the recurrency after primary umbilical/midline repair when a concomitant RMD is left untreated is likely to lead to a more invasive and complicated re-intervention, higher complication rate and discomfort for the patient”

P032 SURGICAL SITE INFECTIONS FOLLOWING EMERGENCY HERNIA REPAIR: A SUB-STUDY FROM THE MASH PROJECT

Aim Acutely symptomatic hernia (ASH) of the abdominal wall and groin are common presentations. Decisions related to repair technique can be driven by contamination and surgical site infection (SSI) risk. The aim of this study is to report rates of SSI following ASH repair, and assess the performance of the Bluebelle wound health questionnaire in this population. Material and Methods This study reports on the operated sub-group of the MASH study. This was a 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Hernia site, repair type, wound complications, and Bluebelle questionnaire at 30 & 90 days were captured. Performance of this score was assessed using ROC curves, and regression modelling. Results 223 patients were operated on, and 21 (9.4%) developed SSI within 90 days. Infections were most common in umbilical hernia (16.2%). No infections were seen in ‘simple’ symptomatic hernia. There was no association with either repair type. Bluebelle scores for 109 patients had an area under the curve of 0.807, showing good performance in this population. Regression modelling showed that SSI was most strongly associated with increased Bluebelle score (OR 8.54 (4.27 to 12.80, p < 0.001)). Use of a sutured repair was associated with a lower score (OR -3.79 (-7.19 to -0.39, p = 0.029)). Conclusions SSI is common after surgical treatment of ASH. Strategies to reduce this are needed. The Bluebelle score appears valid for this population; mesh repair might affect scores independent of SSI.