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

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 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.

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.

Management of Complex Abdominal Wall Defects Using Acellular Porcine Dermal Collagen

2010 ◽  
Vol 76 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Luis Felipe Chavarriaga ◽  
Edward Lin ◽  
Albert Losken ◽  
Michael W. Cook ◽  
Louis O. Jeansonne ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Wound Complications ◽  
Abdominal Wall Defects ◽  
Mesh Placement ◽  
Postoperative Wound ◽  
Porcine Dermal Collagen ◽  
Dermal Collagen

Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend™; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

scholarly journals A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

2016 ◽  
Vol 8 ◽  
pp. 204173141668653 ◽  
Author(s):  
Jeffrey CY Chan ◽  
Krishna Burugapalli ◽  
Yi-Shiang Huang ◽  
John L Kelly ◽  
Abhay Pandit
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Rabbit Model ◽  
In Vivo Model ◽  
Abdominal Wall Defects ◽  
Tissue Samples ◽  
Collagen Formation ◽  
Hernia Formation ◽  
Surgical Meshes

An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

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 early experience with the use of prosthetic mesh as fascia replacement in structural abdominal wall reconstruction

2007 ◽  
Vol 40 (02) ◽  
pp. 164-169
Author(s):  
I A Adigun ◽  
J K Olabanji ◽  
A O Oladele ◽  
O O Lawal ◽  
G H Alabi
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Bowel Resection ◽  
Anterior Abdominal Wall ◽  
Enterocutaneous Fistula ◽  
Abdominal Wall Reconstruction ◽  
Early Experience ◽  
Prosthetic Mesh ◽  
Abdominal Wall Defects ◽  
Black Patients

ABSTRACT Background: Abdominal wall defects occur from various causes and require reconstruction. autogenous tissue is often insufficient and incisional hernia often results. prosthetic mesh is a proven substitute to autogenous tissue but reports on its use is uncommon in our practice environment.Aim: the aim is to report our early experience with the use of prosthetic mesh in black patients in our practice environment.Materials and methods: the summaries of three patients with anterior abdominal wall defects which were managed with the use of a prosthetic mesh are presented as well as their intraoperative and postoperative photographs. one patient had intraperitoneal placement of the mesh and developed no complications.Results: one patient who had bowel resection developed a postoperative enterocutaneous fistula away from the site of the mesh and was managed conservatively. other patients had no complications.Conclusions: the use of prosthetic mesh is recommended.

scholarly journals A smart scaffold composed of three-dimensional printing and electrospinning techniques and its application in rat abdominal wall defects

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhi Yang ◽  
Zhicheng Song ◽  
Xin Nie ◽  
Kaijin Guo ◽  
Yan Gu
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Dermal Fibroblast ◽  
Abdominal Wall Reconstruction ◽  
Three Dimensional ◽  
Abdominal Wall Defects ◽  
In Vitro Test ◽  
Dependent Manner ◽  
3D Scaffold ◽  
Composite Scaffolds

Abstract Background Biological composite scaffolds are increasingly being used in abdominal wall reconstruction but still have certain shortcomings. The present study describes here a novel three-dimensional (3D) scaffold fabricated by combining 3D printing (3DP) and electrospinning (ESP). Methods Biological composite scaffolds are composed of integrated 3DP interconnected macrofiber and random ESP microfiber networks. The 3DP scaffold retains intact 3D architecture and mechanical properties, while the ESP network serves as a cell entrapment system at the extracellular matrix (ECM) scale. Biological composite scaffolds are implanted in a defective rat abdominal wall to detect if it could induce early vascularization and reconstruction of the tissue defect. Results SEM analysis reveals a pore diameter of 424.47 ± 58.49 μm and a porosity of 70.46 ± 2.48% for biological composite scaffolds. In the in vitro test of cell proliferation, biological composite scaffolds do not affect rat dermal fibroblast proliferation in a time- and dose-dependent manner. The animal experiments show tissue remodeling and early angiogenesis as compared to 3DP scaffolds. Conclusions Our experiment prepares a biological scaffold with both a macro- and microscale structure by ESP and 3DP technology. Thus, the integration of 3DP and ESP techniques provides a new set of smart scaffolds for abdominal wall defect and hernia repair.

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