Aim The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groupsprimary perineal closure and reconstruction with a biological mesh. Method One hundred and forty-seven consecutive patients who underwent ELAPE for primary rectal cancer between January 2007 and December 2018 in two tertiary referral centres were retrospectively identified from prospective databases. Perineal closure was carried out via primary closure or with a biological mesh (porcine dermal collagen mesh). Outcome measures were perineal hernia and perineal wound morbidity (infection, dehiscence, persistent sinus and chronic pain). Results A total of 139 patients were included in the study. A prophylactic mesh was used in 80 (57.5%) and primary closure was practised in 59 (42.4%) patients. The median follow-up was 30 (interquartile range 46.88) months. Thirty patients (21.6%) developed perineal hernia. No significant differences were found between prophylactic mesh and primary closure (16.3% vs 23.3%, P = 0.07). The median period between surgery and hernia diagnosis was 8 months in the primary closure group and 24 months in the mesh group (P < 0.01). Perineal wound morbidity was significantly higher in the prophylactic mesh group (55% vs 33.9%, P < 0.01). Conclusion In our study, the use of a biological mesh did not reduce the rate of perineal hernia, although it did delay its appearance. Perineal closure using a biological mesh may increase perineal morbidity, both acute and chronic. Keywords Biological mesh, extralevator abdominoperineal excision, perineal wound morbidity, rectal cancer, primary perineal wound closure What does this paper add to literature? Although diverse methods have been described for repairing the pelvic floor defect after extralevator abdominoperineal excision there is still no consensus as to which closure technique should be applied. This paper shows similar results between primary closure and biological mesh in perineal closure in one of the largest series in Europe.
Introduction: Electrical burns range from 4 to 7 % of the total burn accidents and many of them affect primarily children biting on a live wire. Great confusion exists in the literature about the proper management of electrical burns to the mouth in the acute and late phases. Case report: 14 year results are shown in a severe electrical burn sustained in a 1 year 2 months old girl, involving 90% of the lips and commissures,tongue, alveolar ridges and teeth (primary central incisors and permanent dental germs). Two weeks after she was out danger, an active splint expansion device was built and used for 8 months to prevent secondary microstomia. Later, a new active splint device was used for a year after lip plastic surgery. At age 13, orthopedics and orthodontics were accomplished with a lip tattoo completed at age 15. Conclusion: No matter how good the final esthetic and occlusal results are, prevention is always the best option.
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