scholarly journals Lateral Abdominal Wall Reconstruction

2018 ◽  
Vol 32 (03) ◽  
pp. 141-146 ◽  
Author(s):  
Sahil Kapur ◽  
Charles Butler
Keyword(s):  
Abdominal Wall ◽  
Iliac Crest ◽  
Surgical Repair ◽  
Abdominal Wall Reconstruction ◽  
Abdominal Wall Defects ◽  
Costal Margin ◽  
Challenging Problem ◽  
Muscle Denervation ◽  
Careful Planning ◽  
Lateral Abdominal Wall

AbstractLateral abdominal wall defects, while rare, present a more challenging problem than commonly encountered ventral defects due to the complexity of the anatomy, physiologic forces, and impact of muscle denervation. The lateral abdominal wall encompasses a large surface area ranging from the costal margin superiorly to the iliac crest inferiorly and from the linea semilunaris anteriorly to the paraspinous musculature posteriorly. The ratio of muscle to fascia/aponeurosis is much higher, which makes repair through muscle tissue versus fascia less secure. Furthermore, these defects are subject to asymmetric forces caused by the independent contraction of anterior and posterior muscle units, which lead to unbalanced strain and hernia progression. These features necessitate the use of wide underlay mesh load bearing repairs supported by the static pillars of the abdominal wall. Management can be further complicated when defects extend beyond the defined boundaries, requiring surgical repair to be adapted based on the border structures involved. Primary fascial coaptation may not be as easily accomplished, and therefore careful planning is important to ensure stable coverage of exposed mesh.

scholarly journals P015 ABDOMINAL WALL PREPARATION PRECEDING COMPLEX ABDOMINAL WALL RECONSTRUCTION (CAWR) - SINGLE CENTER INITIAL EXPERIENCES UTILIZING BOTULINUM TOXIN A (BTA) ACCOMPANIED IN SELECTED PATIENTS BY PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM (PPP)

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Henrik Husu ◽  
Sanna Valle ◽  
Tom Scheinin ◽  
Jaana Vironen
Keyword(s):  
Abdominal Wall ◽  
Botulinum Toxin A ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Fascial Closure ◽  
Abdominal Wall Defects ◽  
Closure Rate ◽  
Loss Of Domain ◽  
Lateral Abdominal Wall ◽  
Preoperative Progressive Pneumoperitoneum

Abstract Aim Complex ventral hernia (CVH) treatment due to large abdominal wall defects or loss of domain is challenging. BTA-injection in lateral abdominal wall causing flaccid paralysis and elongation, so called chemical component separation (CCS), might facilitate closure of large fascial defects. Combining preoperative progressive pneumoperitoneum might help restore abdominal content in severe loss of domain situations. We studied the results after CAWR following abdominal wall preparation with BTA and possible PPP. Primary aim was to report fascial defect closure rate without need for surgical component separation. Material and Methods All electively operated patients to date that were treated preoperatively with BTA, including all patients treated with PPP. Results Hospital index patient received preoperative BTA in January 2018. Since then, altogether 42 patients underwent CCS prior to CAWR. Average patient suffered from obesity (mean BMI 31), 30% had diabetes, and a third were active smokers. Mean hernia defect area exceeded 200 cm2. All operations were mesh repairs. Surgical approach was mostly (88%) open retromuscular. Abdominal wall reconstruction via fascial closure was achieved in 93% of cases with only 21% needing surgical component separation. Preoperative morbidity was common in patients undergoing PPP. Around 40% of all patients had postoperative complications, half of which were surgical complications. One patient died of a yet unknown cause on the third postoperative day. There were no recurrences within median 15 months follow-up. Conclusions Restoring abdominal wall continuity without frequent need for surgical component separation seems likely in CVH following CCS.

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

2021 ◽  
pp. 155335062110414
Author(s):  
Dietmar Eucker ◽  
Nadine Rüedi ◽  
Clinton Luedtke ◽  
Oliver Stern ◽  
Henning Niebuhr ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Anatomical Reconstruction ◽  
Time Saving ◽  
Lateral Abdominal Wall ◽  
Hernia Size ◽  
Midline Closure

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

scholarly journals Thoracoabdominal herniation – but not as you know it

2014 ◽  
Vol 96 (5) ◽  
pp. e1-e2 ◽  
Author(s):  
J Wigley ◽  
F Noble ◽  
A King
Keyword(s):  
Abdominal Wall ◽  
Blunt Trauma ◽  
Rare Case ◽  
Surgical Repair ◽  
Diaphragmatic Rupture ◽  
Lateral Abdominal Wall

Thoracoabdominal hernias are uncommon following blunt trauma. If diaphragmatic rupture does occur, the abdominal viscera can herniate into the thorax through the diaphragm. We report a rare case of thoracoabdominal herniation in which the bowel herniated through the lateral abdominal wall, migrating cranially and entering the thorax through an intercostal defect. This case highlights the need for early and definitive surgical repair.

scholarly journals P011 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: A CASE-CONTROL SERIES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Claudio Birolini ◽  
Eduardo Tanaka ◽  
Jocielle Miranda ◽  
Abel Murakami ◽  
Edivaldo Utiyama
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Synthetic Mesh ◽  
Tissue Response ◽  
Abdominal Wall Defects ◽  
Chronic Infections ◽  
Control Series ◽  
Elective Setting ◽  
Abdominal Operations ◽  
Low Incidence

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

scholarly journals P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Ana Gabersek ◽  
Franz Mayer ◽  
Stefan Mitterwallner ◽  
Reinhard Kaufmann ◽  
Reinhard Bittner ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Ct Scans ◽  
Width Ratio ◽  
Surgical Trauma ◽  
Lateral Abdominal Wall ◽  
Myofascial Release ◽  
Diaphragmatic Hernias

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

Abdominal Wall Reconstruction

2018 ◽  
Author(s):  
Gregory A. Dumanian
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Abdominal Wall Defects ◽  
Gap Formation ◽  
Rectus Diastasis ◽  
Dramatic Form ◽  
Tensile Forces ◽  
Surgical Failure ◽  
Pull Through ◽  
Abdominal Shape

The closure of the abdominal wall defects is a fascinating field within surgery. The combined strength of sutures and scar after simple approximation of tissues in many cases does not suffice to contain the abdominal viscera and an incisional hernia results. Surgical failure can be seen immediately in the dramatic form of a dehiscence or can emerge slowly over time with a change in the abdominal shape and contour. This chapter delves into the theory and practicum of how a surgeon can approximate two halves of an abdominal wall together to resist the inherent tensile forces that exist and create a durable closure. This review contains 19 figures and 35 references Key Words: bioprosthetic, bridging, component release, force distribution, foreign body reaction, gap formation, hernia, laparotomy, mesh, perforator preservation, rectus diastasis, suture pull-through, TAR release

Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

2020 ◽  
pp. 155335062091419
Author(s):  
Jorge Daes ◽  
Joshua S. Winder ◽  
Eric M. Pauli
Keyword(s):  
Abdominal Wall ◽  
Lateral Displacement ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Lateral Abdominal Wall ◽  
Computed Tomography Images ◽  
Fresh Cadaver ◽  
Semilunar Line ◽  
Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

scholarly journals Innervated Free Flap Abdominal Wall Reconstruction: A Systematic Review

2017 ◽  
Vol 02 (02) ◽  
pp. e118-e123
Author(s):  
Paul Therattil ◽  
Stephen Viviano ◽  
Edward Lee ◽  
Jonathan Keith
Keyword(s):  
Abdominal Wall ◽  
Free Flap ◽  
Vastus Lateralis ◽  
Abdominal Wall Reconstruction ◽  
Free Flaps ◽  
Fascia Lata ◽  
Sensory Innervation ◽  
Abdominal Wall Defects ◽  
Tensor Fascia Lata ◽  
Anterolateral Thigh

Background Reconstruction of large abdominal wall defects provides unique challenges to the plastic surgeon. Reconstruction with innervated free flaps has been described and allows for true functional replacement of “like with like.” The authors sought to determine the frequency and outcomes of such reconstructions. Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for research articles related to innervated free flaps in abdominal wall reconstruction. Results Nine case series (16 patients) were included who underwent free flap reconstruction of the abdominal wall with motor and/or sensory innervation. Reconstruction was performed with latissimus dorsi (n = 5), tensor fascia lata (n = 4), rectus femoris (n = 2), combined tensor fascia lata-anterolateral thigh (n = 2), combined vastus lateralis-tensor fascia lata-anterolateral thigh flaps (n = 2), and vastus lateralis-anterolateral thigh (n = 1). All but one reconstruction had motor neurotization performed (n = 15), while only 12.5% (n = 2) had sensory neurotization performed. At least 66.6% of patients (n = 10) who had motor neurotization regained motor function as evidenced by documented clinical examination findings while 93.3% (n = 14) had “satisfactory” motor function on author's subjective description of the function. Both flaps that had sensory innervation were successful with Semmes–Weinstein testing of 3.61. Conclusion A majority of neurotized free flap reconstructions for abdominal wall defects have been performed for motor innervation, which is almost invariably successful. Sensory neurotization has been carried out for a small number of these reconstructions, and also has been successful. Improvements in techniques and outcomes in innervated free flap abdominal wall reconstruction are important to advancing efforts in abdominal wall transplantation.

scholarly journals 1024 The Use of the Pedicled Anterolateral Thigh (ALT) Flap for the Reconstruction of Abdominal Wall Defects in High-Risk Patients: A Case Series and Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Newall ◽  
C Jones ◽  
W Ho ◽  
A Curnier
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Case Series ◽  
Anterolateral Thigh Flap ◽  
Abdominal Wall Defects ◽  
High Risk Patients ◽  
Anterolateral Thigh ◽  
Risk Patients

Abstract Introduction The pedicled anterolateral thigh (ALT) flap is considered as a suitable option in complex abdominal wall reconstruction. Its use as a reconstructive option is infrequent in the literature, and to date, there has been no systematic review evaluating its long-term outcomes. We report our experience with the pedicled anterolateral thigh flap for abdominal wall reconstruction in high-risk patients. Method A prospective database was created for patients with abdominal wall defects treated with pedicled ALT with extended fascia lata flaps between 2014 and 2017. Patient demographics, aetiology, size, location of defect and post-operative results were reviewed. Abdominal defects were classified into the following zones: 1A, upper midline; 1B, lower midline; 2, upper quadrant; 3, lower quadrant. A systematic review of the literature was conducted using PUBMED and EMBASE. Results 4 patients (mean age 59.5 years, range 50-65 years) underwent reconstruction with pedicled ALT flaps. 3 flaps developed partial necrosis secondary to infection; 1 flap required surgical debridement, and 2 were managed conservatively. There was one flap failure, due to avulsion of the pedicle during inset. At mean follow up of 2.75 years (range 1 to 4 years) 3 patients have clinical bulging or herniation. Conclusions Review of the literature demonstrated 52 patients from 17 case series or reports. The overall infection and partial flap loss rates were both 6%. There were no reported flap failures. Our study demonstrates that the pedicled anterolateral thigh flap is an effective flap option for the repair of large defects of the abdominal wall in high-risk patients.

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