scholarly journals O04 DETERMINING THE EFFECT OF MESH WIDTH AND FIXATION PATTERNS ON THE STRENGTH OF PROPHYLACTICALLY REINFORCED LAPAROTOMY INCISIONS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Adrienne Christopher ◽  
Jonathon Sanchez ◽  
John Fischer
Keyword(s):  
Abdominal Wall ◽  
Best Practice ◽  
Additional Data ◽  
Biomechanical Testing ◽  
Wall Stress ◽  
Prophylactic Mesh ◽  
Mesh Width ◽  
Failure Loads ◽  
Pull Through ◽  
Fixation Points

Abstract Aim Research indicates that prophylactic mesh may help prevent incisional hernia after laparotomy, but best practice patterns in these situations are still evolving. Here, we compare the failure loads (FLs) and biomechanical stiffness (BMS) of 35 porcine abdominal wall laparotomy incisions reinforced with meshes of various widths and fixation distances using biomechanical testing. Material and Methods In each specimen, a ten centimeter (cm) incision was made and closed using continuous 1-0 Maxon suture. Specimens were randomized to mesh width (none, 2.5cm, 3cm, 4cm, 6cm, 8cm) and tack separation (1.5cm, 2cm apart), and the meshes secured in an onlay fashion. Cyclic loads oscillating from 15 Newtons (N) to 140N were applied to stimulate abdominal wall stress, and the specimens subsequently loaded to failure. FLs (N) and BMS (N/mm) were comparatively analyzed. Results All specimens failed via suture pull-through. FLs and BMS were lowest in specimens with suture-only (421.43 N; 11.69 N/mm). FLs and BMS were significantly higher in 4cm mesh specimens (567.51N) than those with suture, 2.5cm, and 3.0cm mesh (all p < 0.05). FLs in specimens with a greater number of tacks were consistently higher in meshes of similar sizes, although these did not reach significance. Conclusions Four cm mesh re-enforcement is superior to suture-only and smaller meshes at preserving strength in laparotomy closure in the early stages of healing, but larger meshes (6cm, 8cm) do not provide additional benefit. Meshes with more fixation points may be advantageous, but additional data is needed to make definitive conclusions.

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

Abdominal wall closure with prophylactic mesh in colorectal operations

2020 ◽  
Vol 90 (4) ◽  
pp. 564-568
Author(s):  
Jean Wong ◽  
Julia Jones ◽  
Saikrishna Ananthapadmanabhan ◽  
Alan P. Meagher
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Closure ◽  
Prophylactic Mesh

A Murine Model for Viable Right-Ventricular Myocardial Mechanical Behavior

2012 ◽  
Author(s):  
Daniela Valdez-Jasso ◽  
Marc A. Simon ◽  
Michael S. Sacks
Keyword(s):  
Right Ventricular ◽  
Murine Model ◽  
Ventricular Remodeling ◽  
Biomechanical Testing ◽  
Wall Stress ◽  
Tissue Level ◽  
Biomechanical Behavior ◽  
Myocardial Stress ◽  
Stress And Deformation ◽  
Rv Function

Although right-ventricular (RV) function is an important determinant of cardio-pulmonary performance in health and disease, RV myocardium biomechanical function has received little attention. In particular, no multiaxial data of the full-thickness RV have been reported for the passive or active myocardial states, for either normal or pathological conditions. Since an understanding of tissue-level biomechanical behavior is integral to connecting cellular behavior to organ-level performance, investigations into the RV myocardial stress-strain relationship are central in providing this link. For example, ventricular wall stress is considered to be a major driver of ventricular remodeling, and thus a better understanding of how wall stress and deformation are linked would provide unique insights into the mechanisms of RV function and ultimately failure in disease. Such knowledge would have direct applicability to improving methods to detect RV dysfunction, predicting response to disease-specific therapies and improving the timing of therapy if or when needed. Here, we present a murine model of viable RVFW to obtain stable and robust mechanical data suitable for structural modeling. Our study determines the of window for viability of the RVFW samples, verifies uniformity of the structure, and carries biomechanical testing to determine stability and consistency of the data.

scholarly journals Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer

2012 ◽  
Vol 94 (8) ◽  
pp. 569-573 ◽  
Author(s):  
NT Ventham ◽  
RR Brady ◽  
RG Stewart ◽  
BM Ward ◽  
C Graham ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Abdominal Wall ◽  
Parastomal Hernia ◽  
Abdominal Wall Defect ◽  
Prophylactic Mesh ◽  
Permanent Colostomy ◽  
Wall Defect ◽  
Mesh Placement ◽  
Clinical Endpoints ◽  
Index Operation

INTRODUCTION Parastomal herniation occurs in 30–50% of colostomy formations. The aim of this study was to radiologically evaluate the mechanical defects at stoma sites in patients who had previously undergone a permanent colostomy with or without mesh at the index operation for colorectal cancer. METHODS A study was performed of all colorectal cancer patients (n=41) having an end colostomy between 2002 and 2010, with or without Prolene® mesh plication, with blinded evaluation of the annual follow-up staging computed tomography (CT) for stomal characteristics. The presence of parastomal hernias, volume, dimensions, grade of the parastomal hernia and abdominal wall defect size were measured by two independent radiologists, and compared with demographic and operative variables. RESULTS In those patients with radiological evidence of a parastomal hernia, Prolene® mesh plication significantly reduced the incidence of bowel containing parastomal hernias at one year following the procedure (p<0.05) and also reduced the diameter of the abdominal wall defect (p=0.006). CONCLUSIONS Prophylactic mesh placement at the time of the index procedure reduces the diameter of abdominal wall aperture and the incidence of parastomal hernias containing bowel. Future studies should use both objective radiological as well as clinical endpoints when assessing parastomal hernia development with and without prophylactic mesh.

Midline Abdominal Wall Closure: A New Prophylactic Mesh Concept

2006 ◽  
Vol 203 (4) ◽  
pp. 490-497 ◽  
Author(s):  
Juan M. Bellón ◽  
Pedro López-Hervás ◽  
Marta Rodríguez ◽  
Natalio García-Honduvilla ◽  
Gemma Pascual ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Closure ◽  
Prophylactic Mesh

Influence of Interlocking Horizontal Mattress Epitendinous Suture Placement on Tendinous Biomechanical Properties in a Canine Common Calcaneal Laceration Model

2020 ◽  
Vol 33 (03) ◽  
pp. 205-211 ◽  
Author(s):  
Christina J. Cocca ◽  
Daniel J. Duffy ◽  
Mariana E. Kersh ◽  
George E. Moore
Keyword(s):  
Tendon Repair ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Mode Of Failure ◽  
In Vivo Testing ◽  
Failure Loads ◽  
Pull Through ◽  
Biomechanical Strength ◽  
Suture Placement

Abstract Objective This article evaluates the effect of an interlocking horizontal mattress epitendinous suture (IHMES) in addition to a three-loop pulley (3LP) core suture for canine tendon repair. Study Design Twenty-eight cadaveric common calcaneal tendons were randomized, sharply transected and repaired with either a 3LP or 3LP + IHMES. Tensile loads required to create a 1- and 3-mm gap, yield, peak and failure loads, and mode of failure were analysed. Significance was set at p < 0.05. Results Mean ± standard deviation yield and failure force for 3LP + IHMES was 178.0 ± 45.3 N and 242.1 ± 47.8 N, respectively, which was significantly greater compared with 3LP alone, 97.9 ± 36.2 N and 119.3 ± 35.6 N (p < 0.0001). Occurrence of 3-mm gap formation was significantly less in the 3LP + IHMES group (p < 0.013). Mode of failure was significantly different between the groups (p < 0.001) with 3LP + IMHES patterns failing by suture breakage (13/14) compared with suture pull-through in the 3LP (11/14). Conclusion Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (1.8 × ), peak (2.0 × ) and failure (2.0 × ) force of repairs. Use of an epitendinous suture should be considered to significantly increase biomechanical strength of repairs; however, further in vivo testing is necessary to evaluate its effect on tendinous blood supply.

scholarly journals Analysis of the tensile strength on the healing of the abdominal wall of rats treated with infliximab

2008 ◽  
Vol 23 (5) ◽  
pp. 441-446 ◽  
Author(s):  
João Vieira Lopes ◽  
Luís Alberto Mendonça de Freitas ◽  
Ravi Dias Marques ◽  
Anamélia Lorenzetti Bocca ◽  
João Batista de Sousa ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Abdominal Wall ◽  
Rupture Strength ◽  
Vena Cava ◽  
Suture Line ◽  
Male Rats ◽  
Surgical Wounds ◽  
Subcutaneous Dose ◽  
Tnf Α ◽  
Fixation Points

PURPOSE: To evaluate the effects of infliximab, a murine/human chimeric monoclonal antibody, on the tensile strength of abdominal wall surgical wounds. METHODS: Sixty Wistar healthy male rats with initial body weight between 215 and 390 g and 60 and 90 days of age were randomly assigned into two groups, E (Experimental) and C (Control) with 30 animals each. Group E animals received a single subcutaneous dose of 5mg/Kg of infliximab, and Group C animals received equivalent subcutaneous volume of a solution of 0.9% NaCl. After 48h, animals from both groups were submitted to a 4 cm median incision in the abdominal wall, including all layers that had been reconstituted with continuous suture of the aponeurotic muscle and skin, with 5.0 nylon thread. Then, Group E animals were separated by simple allotment into three subgroups named E3, E7 and E14 with ten animals each, and those from group C into C3, C7, C14 and were submitted, respectively, the reoperation and euthanasia at the third, seventh and fourteenth postoperative day. The anterior abdominal wall, which was resected during reoperation, was cut with No 15 scalpel lamina perpendicularly to the surgical wound. Each specimen, in the form of a 6 cm x 2 cm strip, was fixed by the extremity so that the suture line was equidistant from the fixation points of the dynamometer, in order to undergo the tensile strength test. The dynamometer, which was gauged for each series of measures, was calibrated to apply velocity to the 25 mm/min rupture test; the rupture value was expressed in N (Newton). Prior to euthanasia, the abdominal vena cava was identified and punctured in order to collect blood for TNF-α dosage. RESULTS: The mean tensile strength found for animals from subgroups E3, E7, E14, C3, C7, C14 were, respectively, 16.03, 18.69, 27.01, 28.40, 27.22, 29.15 and 24.30 N. In the results of the multiple comparisons tests, significant differences (p<0.05) was found between subgroups E3 and E7 compared with C3, C7 and C14. CONCLUSION: The infliximab interfered in the healing of the abdominal wall wound decreasing the rupture strength in the inflammatory and proliferative phases.

Totally Transanal LESS Pull-Through Colectomy: A Novel Approach for Avoiding Abdominal Wall Incision in Children with Long-Segment Intestinal Aganglionosis

2013 ◽  
Vol 23 (3) ◽  
pp. 276-280 ◽  
Author(s):  
Mohammad Reza Vahdad ◽  
Ali Foroutan ◽  
Sultan Mohsen Najafi ◽  
Grigore Cernaianu ◽  
Ralf-Bodo Tröbs ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Novel Approach ◽  
Pull Through ◽  
Intestinal Aganglionosis
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