P052 EARLY OPERATIVE OUTCOMES OF ENHANCED-VIEW TOTALLY EXTRA PERITONEAL REPAIR(ETEP) FOR VENTRAL HERNIAS

Aim Early operative outcomes of enhanced-view totally extraperitoneal repair (eTEP) for ventral hernias Material and Methods We have retrospectively analysed the date of 41 patients who underwent an eTEP procedure on between November 2018 and April 2021 by a single surgeon and monitored until May 2021. Results During the study period, 29 endoscopic transversus abdominis muscle release and 12 endoscopic Rives-Stoppa techniques were performed to repair incisional (30), umbilical (6), epigastric (3), and spigelian, and parastomal hernias occurred in 1 patient each. The mean age was 68.0 years, mean BMI was 26.4 kg/m2. The hernial orifice centers were as follows: M2 in 7, M3 in 23, M4 in 5, L2 in 4, L4 in 1, and M2 and L2 (2 orifices) in 1 patient. Nine cases of large incisional hernia (width ≥10cm) were included. An average mesh area of 624cm2 was used for an average defect area of 57cm2. Mean operative time, blood loss, and length of hospital stay were 278 min, 5 ml, 6 days, respectively. Only one case was converted to an open operation due to presence of severe adhesions. Postoperative complication consisted of hematoma (n = 1) and a small bowel obstruction due to a tear of the posterior sheath (n = 1). There was no hernia recurrence at mean follow-up of 448 days. No patient reported significant pain at the surgical site at the first postoperative follow up. Conclusions Judging from our short-term results, eTEP approach for ventral hernias can be an attractive option for selected cases.

In-situ estimation of defect volume from parameters of acoustic emission signals

By using two methods of nondestructive testing, i.e., acoustic emission (AE) measurements and X-ray computed microtomography (CT), an experimental study of defect accumulation during a uniaxial compression of a natural heterogeneous material was carried out. A joint analysis of the AE and CT data revealed a correspondence between energy characteristics of the acoustic emission accompanying defect formation and volume of defects. It is shown that the dependence of the total energy of AE signals on the defect volume is linear, which is consistent with the phenomenological dependences for earthquake focuses obtained earlier. The linear dependence was used to estimate the average defect size. It is shown that, regardless of the assumed defect shape, its average linear size does not exceed 100 μm.

Évaluation de la qualité des noix de cajou (Anacardium occidentale L.) produites dans le département de Korhogo en Côte d’Ivoire

La qualité des noix brutes de cajou est un facteur déterminant dans la fixation de leurs prix d’achat et de vente. L’objectif de cette étude est d’évaluer la qualité des noix de cajou afin de contribuer à l’amélioration des traitements post-récoltes desdites noix et la revalorisation des revenus des planteurs. Sur 208 échantillons du département de Korhogo, les paramètres de qualité ont été déterminés selon la norme ivoirienne PNI 4595. La valeur minimale des taux d’humidité moyens est 5,6±1,4% tandis que la valeur maximale est 5,8±1,8% avec une moyenne globale de 5,7±1,8%. Les grainages moyens sont 182±13 noix/kg, 179±13 noix/kg, 180±15 noix/kg, 179±12 noix/kg et 181±12 noix/kg respectivement pour les zones 1 ; 2 ; 3 ; 4 et 5 avec une valeur moyenne de 180±13 noix/kg. Concernant les taux de défauts moyens, ils varient entre 11,96±4,59% et 13,90±5,65% avec pour moyenne générale 13,10±5,08%. Les valeurs de l’out-turn oscillent entre un minimum de 44,87±3,65 lbs et un maximum de 45,90±2,62 lbs avec une moyenne globale de 45,42±2,78 lbs. Les proportions de noix de bonne qualité sont 54%, 66%, 64%, 64% et 69% respectivement pour les zones 1 ; 2 ; 3 ; 4 et 5 avec une proportion globale de 64%. La qualité des noix de cajou produites dans le département de Korhogo, est moyennement bonne. English title: Assessment of the quality of cashew nuts (Anacardium occidental L.) produced in the division of korhogo in Côte d’Ivoire The quality of raw cashews is a determining factor in setting their buying and selling prices. The aim of this study was to assess the quality of cashew nuts in order to contribute to the improvement of post-harvest treatments of said nuts and the revaluation of the income of the growers. On 208 samples, from the division of Korhogo, the quality parameters were determined according to the Ivorian standard PNI 4595. The minimum value of the average moisture contents is 5.6±1.4% while the maximum value is 5.8±1.8% with 5.7±1.8% as the overall average of the division of Korhogo. The average grainings are 182±13 nuts/kg, 179±13 nuts/kg, 180±15 nuts/kg, 179±12 nuts/kg and 181±12 nuts/kg respectively for zones 1; 2; 3; 4 and 5 with an average value of 180±13 nuts/kg. Concerning the average defect rates, they vary between 11.96±4.59% and 13.90±5.65% with the general average being 13.10±5.08%. The out-turn values fluctuate between a minimum (44.87±3.65 lbs) and a maximum (45.90±2.62 lbs). The average of this parameter in the division of Korhogo is 45.42±2.78 lbs. The proportions of good quality nuts are 54%, 66%, 64%, 64% and 69% respectively for areas 1; 2; 3; 4 and 5 with an overall proportion of 64%. The quality of the cashew nuts produced in the Korhogo division is moderately good.

Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap.Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps.Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects.Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

Background Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Methods A retrospective review was conducted of all patients who underwent vulvar–perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. Results Thirty-three patients underwent 55 soft tissue reconstructions for vulvar–perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. Conclusion In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.

The Retroauricular Incision as an Effective and Safe Alternative Incision for Decompressive Hemicraniectomy

BACKGROUND The reverse question mark (RQM) incision has been traditionally utilized to perform decompressive hemicraniectomies (DHC) to relieve refractory intracranial hypertension. Alternative incisions have been proposed in the literature but have not been compared directly. OBJECTIVE To present the retroauricular (RA) incision as an alternative incision that we hypothesize will increase calvarium exposure to maximize the removal of the hemicranium and will decrease wound-related complications compared to the RQM incision. METHODS This study is a retrospective review of all DHCs performed at our institution over a span of 34 mo, stratified based on the type of scalp incision. The surface areas of the cranial defects were calculated, normalizing to their respective skull diameters. For those patients surviving beyond 1 wk, complications were examined from both cohorts. RESULTS A total of 63 patients in the RQM group and 43 patients in the RA group were included. The average surface area for the RA and RQM incisions was 117.0 and 107.8 cm2 (P = .0009), respectively. The ratio of average defect size to skull size for RA incision was 0.81 compared to 0.77 for the RQM group (P = .0163). Of those who survived beyond 1 wk, the absolute risk for surgical site complications was 14.0% and 8.3% for RQM and RA group (P = .5201), respectively. CONCLUSION The RA incision provides a safe and effective alternative incision to the traditional RQM incision used for DHC. This incision affords a potentially larger craniectomy while mitigating postoperative wound complications.

Pudendal flap—a good option for creating neo-scrotum after Fournier’s gangrene: a case series

Scrotal skin loss following Fournier’s gangrene is very distressing to the patients. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We included a total of 14 patients with the diagnosis of Fournier’s gangrene over a period of 1 year in our department. We used a modified pudendal thigh flap to reconstruct neo-scrotum in patients with scrotal defects resulting from excision and debridement of Fournier’s gangrene. The average age group of the patients in our study was 41.8 years. The average body mass index in our study was 22.36 kg/m2. The average defect size in our study was 7.05 × 13.07 cm2. There was a single case of flap necrosis. Modified pudendal thigh flap produces a neo-scrotum that looks natural in appearance, provides good quality skin cover and cushion to the testes as well as protective sensation.

COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

Quality improvement in readymade garments industry by traffic light system

Consumers, manufacturers, and retailers worldwide are becoming conscious about high quality products at minimum cost. But plenty of apparels are becoming waste which increases the cost of production. As resources are decreasing but increasing costs of the products. Effective apparel waste management is needed to ensure the profit. Reducing such waste can be profitable options for the manufacturers as well as the buyers. Considering this matter, a project work is done in a ready-made garment manufacturing industry to improve the quality of the products through using a traffic light system. A traffic light system was implemented to minimize the defect rates of production. The study shows that the average defect rates were dropped from 4.13 to 1.25 pieces of a line for daily eight hours of production. By implementing this system, the defect rates are minimized and the monthly production is also increased and it clearly depicts that the monthly capacity before implementing the traffic light system was equivalent but the defective production was more whereas, after implementation, the defective production was negligible.

Use of an abdominal reapproximation anchor system in the closure of large, open myelomeningoceles

Open neural tube defects are complex congenital abnormalities of the nervous system in which nervous tissue is exposed on the patient’s back at the time of delivery. These malformations require surgical correction, and although replacement of the neural placode internally is fairly standard, providing skin closure can be very challenging especially in large defects. An abdominal reapproximation anchor (ABRA) device may be of value in attaining skin closure in these large, open myelomeningocele defects in which primary closure cannot be accomplished surgically. In a study period during which 65 patients underwent surgical closure of open myelomeningocele defects, 5 of them underwent ABRA-assisted closure.The average surgical intervention for myelomeningocele repair occurred on day 2.2 of life (range 2–3 days). The average defect size was 37 cm2 (range 16–56 cm2), and the average time to formal closure was 30.8 days (range 8–63 days). One of the patients had natural closure with just ABRA approximation. The remaining 4 patients underwent formal delayed primary closure when the skin edges became approximated. Use of the ABRA system in the closure of a large, open myelomeningocele may be valuable in select patients but requires further follow-up and comparison to identify truly significant differences with traditional techniques.