Pratt School of Engineering, Duke University, Durham, North Carolina.
Department of Surgery, Makerere University, Kampala, Uganda.
J Surg Res. 2020 Nov;255:565-574. doi: 10.1016/j.jss.2020.05.037. Epub 2020 Jul 6.
Gastroschisis silos are often unavailable in sub-Saharan Africa (SSA), contributing to high mortality. We describe a collaboration between engineers and surgeons in the United States and Uganda to develop a silo from locally available materials.
Design criteria included the following: < $5 cost, 5 ± 0.25 cm opening diameter, deformability of the opening construct, ≥ 500 mL volume, ≥ 30 N tensile strength, no statistical difference in the leakage rate between the low-cost silo and preformed silo, ease of manufacturing, and reusability. Pugh scoring matrices were used to assess designs. Materials considered included the following: urine collection bags, intravenous bags, or zipper storage bags for the silo and female condom rings or O-rings for the silo opening construct. Silos were assembled with clothing irons and sewn with thread. Colleagues in Uganda, Malawi, Tanzania, and Kenya investigated material cost and availability.
Urine collection bags and female condom rings were chosen as the most accessible materials. Silos were estimated to cost < $1 in SSA. Silos yielded a diameter of 5.01 ± 0.11 cm and a volume of 675 ± 7 mL. The iron + sewn seal, sewn seal, and ironed seal on the silos yielded tensile strengths of 31.1 ± 5.3 N, 30.1 ± 2.9 N, and 14.7 ± 2.4 N, respectively, compared with the seal of the current standard-of-care silo of 41.8 ± 6.1 N. The low-cost silos had comparable leakage rates along the opening and along the seal with the spring-loaded preformed silo. The silos were easily constructed by biomedical engineering students within 15 min. All silos were able to be sterilized by submersion.
A low-cost gastroschisis silo was constructed from materials locally available in SSA. Further in vivo and clinical studies are needed to determine if mortality can be improved with this design.
在撒哈拉以南非洲（SSA），由于胃膨出袋通常无法获得，导致死亡率很高。我们描述了美国和乌干达的工程师和外科医生之间的合作，他们用当地可用的材料开发了一种胃膨出袋。
设计标准包括以下内容：< 5 美元的成本、5 ± 0.25 厘米的开口直径、开口结构的可变形性、≥ 500 毫升的体积、≥ 30 牛的拉伸强度、低成本胃膨出袋和预成型胃膨出袋之间的泄漏率无统计学差异、易于制造和可重复使用。使用 Pugh 评分矩阵评估设计。考虑的材料包括以下内容：用于胃膨出袋的尿液收集袋、静脉输液袋或拉链储物袋，以及用于胃膨出袋开口结构的女用避孕套环或 O 型环。胃膨出袋用熨斗组装，用线缝合。乌干达、马拉维、坦桑尼亚和肯尼亚的同事调查了材料成本和可用性。
尿液收集袋和女用避孕套环被选为最容易获得的材料。胃膨出袋在 SSA 的估计成本< 1 美元。胃膨出袋的直径为 5.01 ± 0.11 厘米，体积为 675 ± 7 毫升。胃膨出袋的熨斗+缝合密封、缝合密封和熨烫密封的拉伸强度分别为 31.1 ± 5.3 牛、30.1 ± 2.9 牛和 14.7 ± 2.4 牛，而当前标准护理胃膨出袋的密封强度为 41.8 ± 6.1 牛。低成本胃膨出袋在开口处和密封处的泄漏率与带弹簧的预成型胃膨出袋相当。生物医学工程专业的学生在 15 分钟内就能轻松地制作出胃膨出袋。所有胃膨出袋都可以通过浸泡进行消毒。
用 SSA 当地可用的材料制造了一种低成本的胃膨出袋。需要进一步进行体内和临床研究，以确定这种设计是否可以降低死亡率。
