Porcine dermal hammock for repair of anterior and posterior vaginal wall prolapse: 5-year outcome
ABSTRACT To estimate the long-term efficacy of acellular cross-linked porcine dermal implants for the substitution of prolapsed anterior and posterior endopelvic fascia. In addition, surgical techniques to improve outcome were examined.
Prospective longitudinal study (Canadian Task Force classification II-2).
Private urogynecology clinic.
Patients were reviewed who had Pelvic Organ Prolapse Quantification stage 2 or greater anterior and/or posterior pelvic floor defects repaired with porcine dermis from March 2000 through August 2002 with at least 5 years of follow-up.
Repairs consisted of endopelvic fascia implants side wall to side wall from the ischial spine to the vaginal introitus. Different techniques of dissection, wound closure, and tissue pliability were measured.
A total of 91 consecutive patients had endopelvic porcine dermal implants for pelvic organ prolapse. In all, 72 patients with a total of 82 defects had an objective cure rate of 81.6% and 86.4% at 5 years for anterior and posterior repairs, respectively. Concomitant anterior and posterior repairs had a 6 times higher objective failure rate. The method of dissection and mucosal wound closure significantly affected wound healing. Solid porcine implants had decreased tissue pliability. A significant improvement in quality-of-life questionnaires and high patient satisfaction occurred, shown by a visual analog scale.
Complete replacement of the endopelvic fascia with porcine dermis had a better outcome than reported in many studies using classic plication or plication augmentation repairs. Porcine was well tolerated with high patient satisfaction and improved quality of life. Solid dermal implants resulted in thick scar plates, yet had a low occurrence of de novo dyspareunia and did not appear to adversely affect sexual activity.
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ABSTRACT: Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires careful assessment of the patient and the extent of rotator cuff degeneration to determine the appropriate treatment. For a rotator cuff tear that is repairable, the goal is to produce a tension-free, anatomical repair that restores the footprint using soft tissue releases and various suturing techniques, including double-row, transosseous-equivalent suture bridges or the rip-stop stitch. For irreparable cuff tears, the surgeon may elect to proceed with 1 of 2 approaches: (1) palliative surgical treatment-that is, rotator cuff debridement, synovectomy, biceps tenotomy, tuberoplasty and/or nonanatomical repair with partial repair; or (2) salvage treatment with various tendon transfers. Even though the biomechanical constructs for rotator cuff repairs have been improved, the integrity of the repair still depends on biologic healing at the tendon-to-bone junction. There has been much interest in the development of a scaffold to bridge massive rotator cuff tears and adjuvant biologic modalities including growth factors and tenocyte-seeded scaffolds to augment tendon-to-bone healing. The treatment of rotator cuff disease has improved considerably, but massive rotator cuff tears continue to pose a challenging problem for orthopaedic surgeons.The American Journal of Sports Medicine 09/2009; 38(3):619-29. DOI:10.1177/0363546509343199 · 4.70 Impact Factor
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ABSTRACT: The last 10-12 years have seen an avalanche of changes in both the management of incontinence and genital prolapse. So many new procedures continue to appear that often the clinician is confused as to which approach to adopt. Complications are now being reported, creating a need to reappraise the situation.F1000 Medicine Reports 11/2009; 1. DOI:10.3410/M1-87
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ABSTRACT: Dyspareunia is a sexual dysfunction defined as genital pain experienced before, during, or after sexual intercourse. Pain during intercourse is a difficult clinical problem and one of the commonest complaints in gynecological practice. The causes of dyspareunia may be classified as organic, emotional, and psychological. Pelvic organ prolapse (POP) has been considered a cause of dyspareunia and sexual dysfunction may be affected positively or negatively by surgical treatment of prolapse. In this paper, the authors review the de novo dyspareunia after POP surgery. They conclude that the incidence of de novo dyspareunia was higher in series with vaginal repair with synthetic mesh than in abdominal sacropexy. KeywordsPelvic organ prolapse-De novo dyspareunia-SurgeryGynecological Surgery 09/2010; 7(3):217-225. DOI:10.1007/s10397-010-0553-8