P028 COMBINING SEVEN ITEMS OF THE TOOLBOX TO TREAT A LARGE INCISIONAL HERNIA WITH HETEROTOPIC OSSIFICATION: A CASE REPORT

Aim We present our approach of treating a W3 (EHS-Classification) incisional hernia with heterotopic ossification in the abdominal wall. Material and Methods a 62-years-old female patient presented with a hernia in her inverted-T incision (midline and transverse) after undergoing multiple laparotomies. The CT-scan showed calcified structures within the abdominal wall. We planned the extensive reconstruction after preoperative Botox injections. Results The 20x25 cm hernial sack contained parts of the stomach and colon. The dissection of the midline and transverse scars was challenging with the needed removal of scattered pieces of heterotopic bone tissues. After dissecting the retro-muscular space, the fascial edges were 25 cm apart. With bilateral transversus abdominis release (TAR), It was reduced to 20 cm. The posterior fascia was approximated, leaving a central 12 cm defect, and a smaller lateral defect, which we covered using open-IPOM and underlay techniques respectively. A 30x40 cm mesh in sublay position was placed and fascial traction was applied on the anterior fascia. With the resulting defect of 16 cm, a tension-free closure was still not possible, and we bridged the gap with a mesh in inlay position. Conclusions Despite combining pre-operative Botox injection and fascial traction with TAR, complete closure of the fascia was not possible. IPOM, sublay, underlay and inlay bridging were needed. Specialized hernia surgeons should be familiar with a wide range of different techniques to deal with such cases.

Application of Buccal Fat Pad as Adjunct Flap for Lateral Defect Closure in Palatoplasty

Summary: Cleft lip and palate are the most widely recognized craniofacial congenital malformation. The buccal fat pad (BFP) can be utilized to close lateral fistulas at the time of palatoplasty due to its rich blood supply and simple accessibility. The aim is to report on the use of BFP as a pedicled flap in cleft palate surgery and to discuss promising results for this reconstructive concept. The case subject was a five-year-old male born with cleft lip and palate; the cleft lip was operated on 4 months old. The patient was operated on using Bardach's two flap palatoplasty techniques, and for the closure of the lateral lining defect, the BFP was used as a pedicled flap. After the surgery, no abnormality was found, including infection, graft loss, palatal fistulas, or cheek depression. All wounds were fully epithelialized. In palatoplasty, BFP is a safe and reliable method with a fast healing benefit.

Influence of outer geometry on primary stability for uncemented acetabular shells in developmental dysplasia of the hip

Excellent primary stability of uncemented acetabular shells is essential to obtain successful clinical outcomes. However, in the case of developmental dysplasia of the hip (DDH), aseptic loosening may be induced by instability due to a decrease of the contact area between the acetabular shell and host bone. The aim of this study was to assess the primary stability of two commercially-available acetabular shells, hemispherical and hemielliptical, in normal and DDH models. Synthetic bone was reamed using appropriate surgical reamers for each reaming condition (normal acetabular model). The normal acetabular model was also cut diagonally at 40° to create a dysplasia model. Stability of the acetabular components was evaluated by the lever-out test. In the normal acetabular model conditions, the maximum primary stabilities of hemispherical and hemielliptical shells were observed in the 1-mm under- and 1-mm over-reamed conditions, respectively, and the resulting stabilities were comparable. The lateral defect in the dysplasia model had an adverse effect on the primary stabilities of the two designs. The lever-out moment of the hemielliptical acetabular shell was 1.4 times greater than that of the hemispherical acetabular shell in the dysplasia model. The hemispherical shell is useful for the normal acetabular condition, and the hemielliptical shell for the severe dysplasia condition, in the context of primary stability.

Microvascular submental island flap prelaminated with oral mucosa in recon­struction of the lateral defect of nose

Introduction. Reconstruction of perinasal area is still a challenge for the surgeon who is involved in excisional tumor surgery. The authors report their experience in reconstruction of hemi-nose defects with the free microvascular submental island flap prelaminated with oral mucosa. Material and methods. A 73-year-old male patient with recurrent extensive basal cell carcinoma of the right hemi-nose (nasal ala and lateral nasal part) and portion of the upper lip underwent to excisional surgery and creation of lateral nasal defect 3x2cm in size. Six months after the first surgery the reconstruction of postoperative defect was done by means of free microvascular submental flap prelaminated with oral mucosa. Results. After necrosis of flap 3mm x 4mm in size around the tip zone of the nose on the 7th postoperative days, the rest of microvascular submental flap prelaminated with oral mucosa survived completely with good cosmetic and nasal respiratory results. Conclusion. This flap can be used successfully in reconstruction of the hemi-nose area. Color and texture of the flap match with adjacent tissue and adequate diameter of submental vessels and reasonably long vascular pedicle enables successful microvascular anastomosis.

Endoscopic Repair of Supraorbital CSF Leaks

Objective The supraorbital ethmoid and lateral frontal sinus are difficult to approach endoscopically. Their location, superior and lateral to the orbit, can make access technically challenging. In this study, we examined clinical and anatomical characteristics of patients with supraorbital CSF leaks and encepholeceles and identified specific considerations unique to their management. Methods Retrospective review of patients who underwent repair of supraorbital CSF leaks at our institution from 2003–2007. Results Eight patients were surgically treated. Seven were spontaneous leaks with an associated encepholecele and one was post-craniotomy. The majority of patients were women (5/8), middle-aged (mean: 54.9 years), and had a mean BMI of 42.3 kg/m2. Intracranial pressures were elevated in 6/8 patients and an empty sella was present in each of the 7 patients with a spontaneous leak. Anatomically, 6/8 patients had defects medial to a sagittal plane drawn through the medial orbital wall (mean distance: 4.15 mm) and 2/8 patients had defects lateral to the sagittal plane (mean distance: 8.14 mm). 7/8 were successfully repaired endoscopically and one patient with a lateral defect required conversion to a supra-orbital trephination. All defects were repaired successfully with a mean follow-up of 27.8 months. Conclusions Patients with supraorbital CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Endoscopic repair produces acceptable results with low morbidity. Extension of a skull base defect lateral to a sagittal plane through the medial orbital wall is a technical obstacle to endoscopic repair and may require an adjunctive external approach.

Impact of Chemical and Epitaxial Treatment on Surface Defects on Silicon Wafers

Defects on polished as well as hot SC1 treated silicon wafers were investigated with an Atomic Force Microscope (AFM) and Surface Scanning Inspection Systems (SSIS). Measurement with two SSIS of different type allows to identify most of the surface defects as non particulate scatterers. AFM of these defects reveals tiny pits or groups of pits. An almost linear relation is found between the geometrical lateral defect dimension and their average size in units of LSE (Latex Sphere Equivalent; an effective measure for the scattering cross section) as reported by one of the SSIS for the defects on wafers treated with hot SC1. Growth rates of about 40 nmLSE/h are observed for the defects during subsequent treatments of wafers with hot SC1. The LSE-size distribution of as-grown defects with a peak at about 105 and 110 nmLSE is obtained for two types of wafer by modeling the defect evolution during hot SC1 treatment. The number of surface flaws ≥ 0.12 μmLSE on a substrate is reduced by two orders of magnitude for epitaxial layers as thin as 1.5 μm.

Herniated thoracic disc at T1–2 level associated with Horner's syndrome

✓ A case of symptomatic herniation at the first thoracic disc level is reported. The patient presented with hand weakness, Horner's syndrome, and pain radiating along the medial aspect of the upper extremity. Myelography demonstrated a smooth lateral defect at T1–2. Three sequestrated epidural disc fragments were removed with postoperative relief of pain. A slightly miotic pupil remains.