scholarly journals The Role of STSG and Delayed Midline Approximation In Abdominal Wall Reconstruction

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Denny Irwansyah ◽  
Gentur Sudjatmiko
Keyword(s):  
Abdominal Wall ◽  
Tumor Resection ◽  
Abdominal Wall Reconstruction ◽  
Previous History ◽  
Perforated Appendicitis ◽  
Wound Dehiscence ◽  
Skin Grafting ◽  
Abdominal Wall Defects ◽  
Reconstructive Option ◽  
History Of

Acquired abdominal wall defects can result from previous surgery, trauma, infection and tumor resection. Complex abdominal wall defects challenge both general and plastic reconstructive surgeons. Skin grafting of abdominal viscera was originally described by Horton in 1953, demonstrated in dogs that STSG placed on the parietal peritoneum of abdominal viscera and buried in the peritoneal cavity would take well and survive. In 1994, Baker and Millard Jr reported serial cases of abdominal midline wound dehiscence which was treated with two stage abdominal wall reconstruction.Data was taken from medical and surgical records of patients consulted to the plastic surgery division with and acquired abdominal defect. We are reporting, Male, 42 yo, previous history of Perforated appendicitis with general peritonitis. We performed 2 stage reconstruction of abdominal wall for this patient.Treatment for an abdominal defect is selected on the basis of several factors, including the medical status of the patient, wound bed preparedness, depth, size and location of the defect. The goals of  abdominal reconstruction are restoration of function and integrity of the musculo-fascial abdominal wall, prevention of visceral eventeration and provision of dynamic muscle support.Skin grafting and delayed midline approximation are one of the reconstructive option available and deserve to be considered in the high risk, septic patient without compromising the patient final reconstructive result.

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 Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

2020 ◽  
Vol 7 (10) ◽  
pp. 3348
Author(s):  
Sheetal Ishwarappagol ◽  
Rohit Krishnappa
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Tobacco Consumption ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Postural Stabilization ◽  
History Of ◽  
And Function ◽  
Ventral Hernias

Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes. 

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

Revising Recommendations and Outcome Measurements after Complex Open Abdominal Wall Reconstruction

2015 ◽  
Vol 81 (10) ◽  
pp. 955-960 ◽  
Author(s):  
Shawn Diamond ◽  
H. Gill Cryer
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Clinical History ◽  
Long Term Results ◽  
Functional Domain ◽  
Grading Systems ◽  
History Of ◽  
Grade Ii ◽  
Restricted Use

Grading systems developed by the Ventral Hernia Working Group (VHWG) for complex open abdominal wall reconstruction rely on limited outcomes: surgical site occurrence (SSO) and hernia recurrence. This does not account for the longitudinal restoration of a functional abdominal wall and the ability to correct complications. We performed a single-site, retrospective review of consecutive complex open abdominal wall reconstruction interventions with 24-month minimum follow-up to establish reoperation rates and compare long-term results to the VHWG. About 125 midline hernia repairs (>200 cm2) were studied. All had loss of functional domain and 47-month average follow-up. Demographics included: mean age 57 years, 47 per cent male, 63 per cent obese, and 34 per cent with contamination. Rates of SSO per VHWG grade were 9 per cent grade I, 45 per cent grade II, and 55 per cent grade III. Forty-three of 59 patients who developed complications were eventually successful after reoperation leading to an 87 per cent restoration rate. Select factors independently associated with reoperation included biological mesh and clinical history of infection. Although rates of SSO were higher than the VHWG published, we experienced high salvage rates except in patients who underwent biologic repair. We recommend restricted use of biologic mesh in contaminated and clean fields as well as modifications to the VHWG grading and recommendations.

An Innovative Way to Separate Gastrointestinal and Abdominal Wall Reconstruction after Complex Abdominal Trauma

2017 ◽  
Vol 83 (9) ◽  
pp. 1001-1006 ◽  
Author(s):  
David H. Livingston ◽  
David V. Feliciano
Keyword(s):  
Abdominal Wall ◽  
Damage Control ◽  
Abdominal Wall Reconstruction ◽  
Skin Grafting ◽  
Small Bowel Resection ◽  
Fascial Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Staged Approach ◽  
Level I

Despite advances in trauma care, a subset of patients surviving damage control cannot achieve fascial closure and require split-thickness skin grafting (STSG) of their open abdomen. Controversy exists as to whether reconstruction of the gastrointestine (GI) should be staged or performed at the time of abdominal wall reconstruction (AWR). Many surgeons do not believe that operations through the STSG can be completed safely or without loss of graft. This series reviews the outcomes of operations for GI reconstruction performed through the elevated healed STSG. Concurrent series on all patients undergoing abdominal operation through the STSG. The technique involves elevating the STSG, lysing adhesions only as needed, avoid detaching underlying omentum or viscera to avoid devascularization, and then reattaching the elevated STSG to the abdominal wall with simple sutures. From 1995 to 2017, 27 patients underwent 40 distinct procedures during 36 separate abdominal reoperations (89% GI) through the elevated STSG approach at three Level I trauma centers at a mean interval of 11 months from application of the STSG. One STSG was lost (patient closed with skin flaps), one patient had 30 per cent loss of the STSG (regrafted), and one patient had 10 per cent loss of the STSG (allowed to granulate). One patient required a small bowel resection for intraoperative enterotomy during a difficult operative dissection. There were no GI complications, intraabdominal infections, or deaths, and all patients were deemed fit to undergo AWR after three months. Major intraabdominal reoperations can be readily and safely accomplished through the elevated STSG approach with a <4 per cent need for regrafting. This staged approach significantly simplifies and increases the safety of a second stage AWR.

scholarly journals Resection and Abdominal Wall Reconstruction of a Desmoid Tumor with Endometrioma Features

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Jaqueline Majors ◽  
Nathaniel F. Stoikes ◽  
Reza Nejati ◽  
Jeremiah L. Deneve
Keyword(s):  
Abdominal Wall ◽  
Soft Tissue Tumor ◽  
Abdominal Mass ◽  
Abdominal Cavity ◽  
Abdominal Wall Reconstruction ◽  
Pathologic Finding ◽  
Desmoid Tumors ◽  
History Of ◽  
Well Differentiated ◽  
Palpable Abdominal Mass

Desmoid tumors are rare, musculoaponeurotic mesenchymal origin tumors arising from the proliferation of well-differentiated fibroblasts. Desmoid tumors may arise from any location with the abdominal cavity, abdominal wall and extremity locations being most frequent. We present the case of a 35-year-old female with a history of endometriosis who presented palpable abdominal mass and cyclic abdominal pain. Resection was performed for a presumed desmoid soft tissue tumor. Final pathology demonstrated desmoid histology admixed with abdominal wall endometriosis (endometrioma). This unique pathologic finding has only been rarely reported and is discussed with a brief review of the literature.

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.

scholarly journals Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

2020 ◽  
Author(s):  
Lijin Zou ◽  
Youlai Zhang ◽  
Ying He ◽  
Hui Yu ◽  
Jun Chen ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Abdominal Wall ◽  
Damage Control ◽  
Abdominal Wall Reconstruction ◽  
Rabbit Model ◽  
Damage Control Surgery ◽  
Electrolyte Balance ◽  
Abdominal Wall Defects ◽  
Temporary Abdominal Closure

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

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