A Confirmed Case of Zoonotic Aortitis and Successful Repair with an Allograft

Introduction

Streptococcus equi subspecies zooepidemicus is a β-haemolytic group C streptococcus that is a highly contagious infection in horses and other equines. Streptococcus equi infection of the native human aorta is a rare form of aortitis that has a high mortality owing to rupture. Surgical intervention with debridement and broad spectrum intravenous antibiotics are essential to improve the patient's status.

Report

In this case study, a 71 year old man with horse contact presented with left groin pain related to S. equi aortitis and mycotic aneurysm. He was successfully treated by excision of the infected abdominal aorta and iliac vessels with a biological graft reconstruction, debridement of the retroperitoneum, and application of antibiotic beads.

Discussion

Biological grafts have never been reportedly used in group C streptococcus infection of the native aorta, and the patient recovered without sequelae. The promising outcome of this case may provide a framework for future similar cases.

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A 71 year old farmer presented with S. equi aortitis and mycotic aneurysm.

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Streptococcus equi infections are rare and are reported after contact with infected horses.

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A human cadaveric aortic bypass graft was used for vascular reconstruction.

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Biological grafts have never been used in S. equi aortitis repair.

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The promising outcomes of this case may provide a framework for future cases.

Randomized, Prospective, Blinded-Enrollment, Head-To-Head Venous Leg Ulcer Healing Trial Comparing Living, Bioengineered Skin Graft Substitute (Apligraf) with Living, Cryopreserved, Human Skin Allograft (TheraSkin)

Chronic venous leg ulcers are responsible for significant morbidity and health care costs worldwide. This pilot study evaluated the effectiveness 2 biologically active grafts, TheraSkin and Apligraf, in conjunction with compression therapy. The study, not industry-sponsored, was designed and conducted as a prospective, head-to-head, single-site, randomized clinical trial to assess differences in healing rates, adverse outcomes, and treatment costs. The healing rates were different but not statistically significant, there were no adverse outcomes, and TheraSkin averaged $2495.33 and Apligraf averaged $4316.67 per subject. This suggests that TheraSkin may provide equivalent or superior outcomes to Apligraf while reducing costs.

First human use of hybrid synthetic/biologic mesh in ventral hernia repair: a multicenter trial. Surg Endosc. 2018;32:1123-1130. [PMID: 28726148 DOI: 10.1007/s00464-017-5715-6]

BACKGROUND

Mesh options for reinforcement of ventral/incisional hernia (VIH) repair include synthetic or biologic materials. While each material has known advantages and disadvantages, little is understood about outcomes when these materials are used in combination. This multicenter study reports on the first human use of a novel synthetic/biologic hybrid mesh (Zenapro^® Hybrid Hernia Repair Device) for VIH repair.

METHODS

This prospective, multicenter post-market clinical trial enrolled consecutive adults who underwent elective VIH repair with hybrid mesh placed in the intraperitoneal or retromuscular/preperitoneal position. Patients were classified as Ventral Hernia Working Group (VHWG) grades 1-3 and had clean or clean-contaminated wounds. Outcomes of ventral and incisional hernia were compared using appropriate parametric tests.

RESULTS

In all, 63 patients underwent VIH repair with hybrid mesh. Most were females (54.0%), had a mean age of 54.8 ± 10.9 years and mean body mass index of 34.5 ± 7.8 kg/m², and classified as VHWG grade 2 (87.3%). Most defects were midline (92.1%) with a mean area of 106 ± 155 cm². Cases were commonly classified as clean (92.1%) and were performed laparoscopically (60.3%). Primary fascial closure was achieved in 82.5% with 28.2% requiring component separation. Mesh location was frequently intraperitoneal (69.8%). Overall, 39% of patients available for follow-up at 12 months suffered surgical site events, which were generally more frequent after incisional hernia repair. Of these, seroma (23.7%) was most common, but few (8.5%) required procedural intervention. Other surgical site events that required procedural intervention included hematoma (1.7%), wound dehiscence (1.7%), and surgical site infection (3.4%). Recurrence rate was 6.8% (95% CI 2.2-16.6%) at 12-months postoperatively.

CONCLUSION

Zenapro^® Hybrid Hernia Repair Device is safe and effective in VHWG grade 1-2 patients with clean wounds out to 12 months. Short-term outcomes and recurrence rate are acceptable. This hybrid mesh represents a novel option for reinforcement during VIH repair.