Late complications of Silastic duraplasty: low-virulence infections. Case report

The authors describe three patients with expanding hemorrhagic mass lesions who presented 13 to 18 years after undergoing Silastic duraplasty. In all patients, results of bacteriological cultures of the masses obtained intraoperatively were positive, revealing low-virulence bacteria. Two of the patients were treated with antibiotic drugs and made a good recovery. The third did not receive antibiotic medications initially and later developed an epidural empyema that necessitated reoperation, but subsequently made a complete recovery. Vascularized neomembranes are generally agreed to be causes of the expanding masses, but the possibility that patients could be harboring chronic infections must be considered. Thus, on removal of duraplasty materials a complete bacteriological culture should be obtained, and if it is positive the proper antibiotic therapy should be administered. Furthermore, the creation of a registry of patients who have received implants is advocated to facilitate tracking of implanted material in case of complications.     

Silastic foam in injured patients

Four dressing techniques are described; these techniques enable patients with granulating wounds complicating skeletal injuries to be treated as outpatients. The patients perform their own dressings, thus reducing demands on nursing services and freeing hospital beds. In a study of 63 patients there was no problem in managing the wounds from weekly outpatient clinics; good wound healing was achieved.     

Bovine pericardium for duraplasty: clinical results in 32 patients

Bovine pericardium has been widely used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report on the use of solvent-preserved, gamma-sterilized Tutoplast bovine pericardium for dural grafts in 32 patients undergoing cranial and spinal operations with the objective of clinically assessing this material and technique by a retrospective analysis. All available records were reviewed and information regarding the indication for grafting, complications, and outcome were collected and analyzed for all patients. Indications for grafting included tethered cord myelolysis, closure of lumbosacral myeloceles, Chiari decompression, posterior fossa craniotomy, supratentorial craniotomy, and trauma. Outcomes were excellent in 31 patients; the one poor outcome was unrelated to surgical closure. The dural graft was not intended for outcome in any patient. Bovine pericardium was found to be a flexible and easily suturable, safe and cost-effective material for duraplasty. These results confirm the excellent suitability of Tutoplast bovine pericardium for dural substitution. Received: 12 September 2000 / Accepted: 31 October 2000     

Decompressive craniectomy with lattice duraplasty

Summary A method of opening dura for decompressive craniectomies is described. Numerous cuts intersecting in a lattice pattern allow the dura to expand in a gradual and controlled manner minimising the chances of cortical laceration or venous kinking on the craniectomy edge.     

Long-term evaluation of Silastic trapezial arthroplasty in patients with osteoarthritis.

This study of 151 Silastic trapezial arthroplasties evaluates the long-term radiographic and clinical results in patients with osteoarthritis. A radiographic grading system was developed to objectively evaluate and quantify changes seen at the implant-bone contact areas, within the metacarpal medullary canal and distal pole of the scaphoid. Trapezial arthroplasties studied on average of 51 months after implantation revealed that in 56% (85 of 151) of scaphoids cysts had developed, and 74% (111 of 151) of the metacarpals had intramedullary radiolucency and/or cysts. Histopathologic evaluation of the areas of radiographic changes demonstrated silicone synovitis. Statistical analysis revealed that the radiographic changes in the scaphoid and medullary canal of the metacarpal were not directly related to time. Patient satisfaction, found to be 84% (127 of 151) of the study population, did not correlate with the grade of scaphoid or metacarpal radiographic change. This systematic radiographic grading system has been found useful in the long-term durability evaluation of Silastic trapezial arthroplasties.     

Silastic arthroplasty in rheumatoid MCP-joints

Resection arthroplasty using Swanson silicone prosthesis was performed in 74 MCP-joints in 22 patients, all with rheumatoid arthritis. Follow-up at 2 (1-7) years showed complete pain relief in 15 patients and considerable improvement in hand function; the average range of motion was unchanged but extension was improved and ulnar deviation and volar displacement were reduced. Complications included fracture of four implants, two superficial infections, one hematoma and one skin necrosis.     

Silastic arthroplasty in rheumatoid MCP-joints

Resection arthroplasty using Swanson silicone prosthesis was performed in 74 MCP-joints in 22 patients, all with rheumatoid arthritis. Follow-up at 2 (1-7) years showed complete pain relief in 15 patients and considerable improvement in hand function; the average range of motion was unchanged but extension was improved and ulnar deviation and volar displacement were reduced. Complications included fracture of four implants, two superficial infections, one hematoma and one skin necrosis.     

Silastic condylar arthroplasty

Interpositional Silastic condylar arthroplasty of the first carpometacarpal joint was used in 40 patients with disabling arthritis. Limiting bone resection at the base of the thumb improves prosthetic stability. Pain was lessened and function improved in most cases. Technical modifications and their rationale are discussed.     

Silastic sheeting in retroperitoneal fibrosis

The successful use of Silastic sheeting for the prevention of recurrent ureteral fibrosis following ureteral lysis in 3 patients with retroperitoneal fibrosis is reported.     

Endonasal endoscopic duraplasty: our experience.

Objective: Endoscopic repair of cerebrospinal fluid (CSF) leaks is a recognized technique. We consider our experience and evaluate the outcomes in patients who underwent endoscopic repair of CSF leaks. Methods: A retrospective case note review of 135 patients who underwent anterior cranial repairs of CSF leaks between August 1995 and December 2004 at a tertiary referral center. We describe the technical details and outcomes of care by purely endoscopic procedures. Results: Thirteen patients had combined transcranial and endonasal repairs and 122 patients had their repairs using an endoscopic approach only. There were 64 males and 71 females with ages that ranged from 1 to 75 years (mean age 42 years, median age 44 years). The success rate for first attempt only was 93.4%. Eight of the 122 patients (6.6%) needed a second surgical repair. In one patient a bicoronal approach was necessary while in the other cases a revision endoscopic procedure was appropriate. The period of follow-up ranged from 2 months to 9 years (mean 5 years, median 39 months). Conclusions: Our experience confirmed that endoscopic surgery is an effective and safe method of treatment for most CSF leaks. A variety of different endoscopic techniques allowed CSF leaks to be repaired in almost every site of the anterior skull base with very few exceptions.     

Silastic moulds for use in vaginoplasty

Summary A simple method is described for the manufacture of slightly flexible and adjustable vaginal obturators for use following vaginoplasty.     

Decubitus ulcer prevention in the nasal ala using Silastic foam in nasotracheal intubated patients

One of the most frequent causes of early reintubation through the other nostril or a tracheostomy is necrosis due to pressure in the region of the nares. Based on experience in 85 long-term intubated patients, prophylaxis with Silastik foam appears to be most efficient. It is inexpensive and easy to handle and can therefore be highly recommended.     

Silastic RingVertical Gastroplasty by Minilaparotomy

Background: The incision length has significant influence on the postoperative course after silastic ring vertical gastroplasty (SRVG). Methods: A technique is described in which SRVG can be performed through a minilaparotomy incision. Results: 110 patients were operated with this technique during 1996. No remarkable intraoperative or postoperative complications were encountered. Postoperative weight loss has been satisfactory. Conclusions: Performance of SRVG through a minilaparotomy is feasible. The technique is recommended for surgeons familiar with the operation through the formal incision.