ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.

Spiral ("green bone") breakage has been suggested as an indicator of human activity by some workers. Our examination of broken ungulate long bones from six paleontological localities in western Nebraska, however, shows that such fractures commonly occurred in the Miocene and Pliocene, long before the advent of man in North America. Pseudotools also occur frequently in these sites. We postulate that spiral breakage, including the production of pseudotools, may be due to trampling by animals.

Our study demonstrates that neither spiral breakage nor gross morphology, alone or in combination, is diagnostic of human activity. Problematical examples must be accepted or rejected wholly upon the basis of patterned wear on the supposed tools.

Athens’ attack is based upon the fact that I did not cite an unpublished manuscript in my possession. In fact, the paper has little bearing upon the temporal argument. The radiocarbon dates which it contains should not be applied to the material in question. However, the paper does contain information which supports my hypothesis of contacts between the Coast and the Highlands. Such contacts help to account for the ceramic similarities between the two regions. New dates from the La Chimba site are internally inconsistent so that they cannot be used to support either point of view. However, the stratigraphic position of Espejo Phase ceramics beneath resist painted pottery is consistent with a Formative Period dating for the Espejo Phase.

Valdivia-related ceramics found near Lake San Pablo (Imbabura) demonstrate that this area was in contact with coastal Ecuador prior to 2000 B.C. The interaction between the coast and highlands is attributed to the existence of trade routes which probably originated in preceramic times. It is suggested that coca was among the scarce resources which attracted trade to the northern highlands.

The rapid decomposition of organic remains under tropical forest conditions forces the archaeologist to rely entirely upon soil characteristics, indestructible artifacts, and refuse deposition patterns for his cultural interpretations. Such evidence is used to identify a unifunctional turtle harvesting encampment on the lower Aguatia River in eastern Peru.