title: Failure pressures of three rhinologic dural repairs in a porcine ex vivo model.
abstract: BACKGROUND
  The objective of this work was to determine the failure pressures of 3 commonly performed repair techniques of 5-mm dural defects in a controlled setting.
  
  
  METHODS
  This was a pig dura ex vivo study. A testing apparatus was fabricated to study failure pressures of 3 different repairs in a porcine model. Five-millimeter (5-mm) dural defects were created and plugged with autologous mucosa/Tisseel (MT) (Baxter International Inc.), fat graft (FG), and bath plug (BP) techniques. Saline solution was infused at 30 mL/hour to apply unidirectional pressure to the repair until failure occurred. Five dural repairs were performed for each arm of the trial, for a total of 15 trials.
  
  
  RESULTS
  The mean failure pressure of the MT repair was 4.3 ± 1.9 cmH2 O, of the FG repair was 10.9 ± 4.2 cmH2 O, and of the BP repair was 20.7 ± 2.2 cmH2 O. Differences among mean failure pressures were statistically significant.
  
  
  CONCLUSIONS
  The BP repair showed significantly higher tolerances for pressure than the other 2 repairs. The BP repair was the only technique that withstood adult physiologic supine cerebrospinal fluid (CSF) pressure.
authors.affiliation: Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, TX, USA.|Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.|Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Lin
authors.affiliation: Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, TX, USA.
authors.forename: Erik Kent
authors.initials: EK
authors.lastname: Weitzel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Chen
authors.affiliation: Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, TX, USA.
authors.forename: Kevin Christopher
authors.initials: KC
authors.lastname: McMains
authors.affiliation: Uniformed Services, University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, San Antonio, TX, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Majors
authors.affiliation: Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Leonid
authors.initials: L
authors.lastname: Bunegin
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena / Q000502:physiology; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D004388:Dura Mater / Q000378:metabolism / Q000601:surgery*; D007049:Iatrogenic Disease; D059747:Nasal Surgical Procedures / Q000009:adverse effects; D010256:Paranasal Sinuses / Q000293:injuries; D011312:Pressure / Q000009:adverse effects; D013552:Swine
keywords: CSF leak repair; dura; failure strength; pig; rhinology; skull-base