Explore the vast range of titles available.

Improvements in acute burn care have enabled patients to survive massive burns that would have once been fatal. Now up to 70% of patients develop hypertrophic scars after burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. Approaches to optimise healing potential of burn wounds use targeted wound care and surgery to minimise the development of hypertrophic scarring. Such approaches often fail, and modulation of the established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventive and therapeutic strategies.

Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices produce the best outcomes. This review analyses these outcomes, namely the differences in aesthetic outcomes, cost, and the rates of the most commonly reported complications. The results indicate that breast reconstruction with a synthetic matrix produces comparable aesthetic outcomes to a biological matrix, with lower costs and complication rates. The individual results for complication rates show that biological matrixes are associated with lower infection rates and slightly lower capsular contracture, but higher haematoma rates, and slightly higher rates of skin necrosis and explantation—although many had post-op radiotherapy. The majority of the studies evaluated used biological matrices, and there are no randomised controlled trials directly comparing the two types of meshes; definite conclusions cannot be drawn from the available evidence. The authors suggest that a randomised controlled trial comparing these outcomes in synthetic and biological matrix use is needed.

In the past decade hernia surgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists.

The use of inguinal hernia repair techniques in the community setting is poorly understood. A retrospective review of all inguinal hernia repairs performed on adult residents of Olmsted County, MN, from 1989 to 2008 was performed through the Rochester Epidemiology Project. A total of 4,433 inguinal hernia repairs among 3,489 individuals were reviewed. Non–mesh-based repairs predominated in the late 1980s (94% in 1989), declined throughout the 1990s (40% in 1996), and are rarely used nowadays (4% in 2008). Open mesh-based repairs comprised 21% in 1990, peaked in 2001 with 72%, and declined to 55% in 2008. The adoption of laparoscopic repairs began in 1992 (6%) and has increased steadily to 41% in 2008 (P < .001). Although non–mesh-based repairs, once the predominant method, have been supplanted by open mesh-based techniques, nowadays the use of laparoscopic inguinal hernia repair techniques has increased substantially to nearly equal that of open mesh-based techniques.

Introduction Sacrocolpopexy is the gold standard treatment for vault prolapse. Current reported standards regarding surgical approach and technique vary. Our aim was to evaluate the surgical techniques used and identify any consistency. Methods Electronic surveys were sent to 148 candidates enrolled in a sacrocolpopexy workshop at the 2012 American Urogynecologic Society (AUGS) annual meeting and as a link in the International Urogynecology Association (IUGA) e-magazine. The survey assessed demographics, specific surgical steps including dissection techniques, number and type of sutures, graft materials, and the approach to intraoperative complications. Results Within the AUGS group, 61 candidates responded (41 %). From the IUGA membership, 128 responded for a total of 189. Overall, 59 % identified their primary practice as urogynaecology, 43 % having completed a fellowship. Only 33 % reported performing sacrocolpopexy as the primary surgery for vault prolapse. Technical aspects: 99.4 % used polypropylene mesh, with 57 % attaching it to the vagina using non-absorbable monofilament sutures. An average of 3–4 sutures were used on the anterior and posterior walls respectively. Suture location: 22.5 % reported not placing apical sutures and 55.7 % place their anterior wall sutures midway down the vagina. Posteriorly, 47 (30 %) placed sutures through the uterosacral ligaments, 19 (12.4 %) through the levator ani and 15 % extend the mesh to the perineal body. The mesh was attached to the sacrum using permanent sutures by 75 %. Dissection of the sacrum was deemed the most technically difficult aspect. Conclusion Surgical technique varies widely despite the level of expertise and training. This study highlights the need for an evaluation of the effect of surgical technique on outcomes.

Background Despite the prevalence of ventral hernias, there is little agreement as to the most appropriate technique or prosthetic to repair these defects. Our objective was to determine biologic mesh practice patterns of reconstructive surgeons with regard to indications, most appropriate technique, choice of prosthetic, and experience with complications. Methods A survey was mailed to 2,000 practicing surgeons. Main outcome measures included surgeon experience with biologic mesh and associated complications. Results Two hundred and forty (12 %) surgeons responded to the survey. Ten were excluded, as surgeons completing the survey indicated they did not perform ventral hernia repairs or left multiple questions unanswered. Of the 230 included, 93.5 % ( n  = 215) of responders had experience using biologic mesh. Frequency of biologic graft use in the last year was as follows: low-volume users (<5 times in the last year) 50.7 %; medium-volume users (5–20 times in the last year) 37.3 %; high-volume users (>20 times in the last year) 11.9 %. Indications for biologic mesh use based on wound classifications (clean, clean contaminated, contaminated or dirty) were quite varied and lacked consensus among surgeons ( p value < 0.05). The most commonly reported influences for use included personal experience (45 %), literature (28.3 %), and availability (17.2 %). Conclusions Despite a lack of level 1 evidence, biologic meshes are being used under various wound classifications. Importantly, use in clean and dirty-infected settings may reflect an inappropriate overuse of these expensive materials. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials under the various surgical wound classifications.

Introduction and hypothesis Members of the International Urogynecological Association (IUGA) come from different geographic locations and practice settings. A member survey regarding practice patterns provides valuable information for practitioners and researchers alike, and allows the IUGA to discover areas to focus on education and information dissemination. Methods A questionnaire was developed by the IUGA Research and Development committee and distributed electronically to IUGA surgeons. Answers were analyzed in reference to demographics, geographic distribution, and academic affiliation. Results Five hundred sixty-four members answered the questionnaire, representing a 28 % response rate, and closely reflecting the geographic distribution of IUGA membership. Preferred surgical treatment for uncomplicated SUI was the mid-urethral trans-obturator sling (49.7 %). Vaginal mesh was mainly used for repair of recurrent POP (20.4 %). Pessary use was offered “always” or “frequently” by 61.5 %, with no difference in academic affiliation, but significant differences based on region of practice. Compared to practitioners in non-academic centers, those with academic affiliation utilized Urodynamic studies (UDS) and Magnetic Resonance Imaging (MRI) more frequently in the evaluation of POP. Regions of practice significantly influenced the majority of practice patterns, with the highest impact found in the use of robotic assistance. Conclusions Many practice patterns in the evaluation and treatment of POP and SUI depend on academic affiliation and geographic location. Practice patterns are not always based on most recent evidence-based data.

Background: Incisional hernia (IH) remains one of the most frequent postoperative complications after abdominal surgery. As a consequence, primary mesh augmentation (PMA), a technique to strengthen the abdominal wall, has been gaining popularity. This meta-analysis was conducted to evaluate the prophylactic effect of PMA on the incidence of IH compared to primary suture (PS). Methods: A meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing PMA and PS for closing the abdominal wall after surgery were included. Results: Out of 576 papers, 5 RCTs were selected comprising 346 patients. IH occurred significantly less in the PMA group (RR 0.25, 95% CI 0.12-0.52, I 2 0%; p < 0.001). No difference could be observed with regard to wound infection (RR 0.86, 95% CI 0.39-1.91, I 2 0%; p = 0.71) or seroma (RR 1.22, 95% CI 0.64-2.33, I 2 0%; p = 0.55). A trend was observed for chronic pain in favor of the PS group (RR 5.95, 95% CI 0.74-48.03, I 2 0%; p = 0.09). Conclusion: The use of PMA for abdominal wall closure is associated with significantly lower incidence of IH compared to PS.