Early Abdominal Wall Reconstruction with Biologic Mesh is Feasible after Catastrophic Abdominal Wall Disruption from Blunt Trauma

2021 ◽  
Author(s):  
Agon Kajmolli ◽  
Asad Azim ◽  
Matthew McGuirk ◽  
Kartik Prabhakaran ◽  
David Samson ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Blunt Trauma ◽  
Motor Vehicle ◽  
Abdominal Wall Reconstruction ◽  
Surgical Techniques ◽  
Case Series ◽  
Biological Mesh ◽  
Motor Vehicle Crash ◽  
Common Mechanism ◽  
Abdominal Wall Disruption

Introduction: Traumatic abdominal wall hernias (TAWHs) after blunt trauma, while rare, are typically associated with severe injuries, particularly those involved with the seatbelt triad of abdominal wall disruption. The aim of this study is to present a case series of patients with TAWHs that were managed at an early stage post injury with a biological mesh. Materials and Methods: Patients with TAWH undergoing complex abdominal wall reconstruction (CAWR) between 2017 and 2020 were identified from our institutional database. All patients underwent definitive reconstruction using advanced surgical techniques including a posterior component separation with biological mesh (STRATTICE™, Allergan, Inc., Dublin, Ireland) placed in a sublay fashion. Results: Seven patients underwent definitive TAWH repair during their index admission: the median age was 56 years (range 20–77) and the median Injury Severity Score (ISS) was 34 (29–50). The most common mechanism of injury was motor vehicle crash (MVC) at 86%, while the most common intra-abdominal concomitant injury was small bowel. Traumatic hernia location was on the right side of the abdominal wall in three patients, left in three patients, and bilaterally in one patient. There were no hernia recurrences or deaths in this small cohort. Conclusion: Traumatic abdominal wall disruption can be safely reconstructed using advanced surgical techniques with a biological mesh during the acute phase or same index hospitalization.

scholarly journals EP.TH.108A Descriptive Case Series of Incisional Hernia Repair Using Dual Mesh Technique

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chloe Theodorou ◽  
Zia Moinuddin ◽  
David Van Dellen
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Surgical Techniques ◽  
Case Series ◽  
Incisional Hernia Repair ◽  
Fistula Formation ◽  
Mesh Technique ◽  
Dual Mesh

Abstract Aims Incisional hernias are a common complication after surgery that cause significant patient morbidity. Symptomatic patients are offered repair but many surgical techniques exist, with abdominal wall reconstruction becoming preferable for large complex defects. This paper describes our experience of abdominal wall reconstruction using a dual mesh technique. Method 22 patients underwent incisional hernia repair between March 2019 and September 2020. All patients received dual mesh, placed in retrorectus or transversalis fascial/retromuscular space. Absorbable BIO-A GORE mesh was used with a polypropylene mesh above. All patients were followed up to assess for complications and recurrence. Results No patients experienced fistula formation, long-term pain or obstructive symptoms. We report one true hernia recurrence (4.5%) and one case of infected mesh (4.5%), these both await further treatment. One patient had a proven wound infection which resolved with conservative treatment. 4 patients (18.2%) experienced seromas, 3 of these resolved spontaneously, one requiring image-guided drainage. Conclusion Incisional hernia repair using combination polypropylene and bio-absorbable mesh provides a safe and effective repair with low recurrence and incidence of surgical site occurrences in the short term. Longer follow up and further studies are needed to evaluate this mesh technique to support ongoing use of absorbable meshes in complex hernia repair.

Seatbelt Triad: Severe Abdominal Wall Disruption, Hollow Viscus Injury, and Major Vascular Injury

2011 ◽  
Vol 77 (5) ◽  
pp. 534-538 ◽  
Author(s):  
Narong Kulvatunyou ◽  
Roxie M. Albrecht ◽  
Jeffrey S. Bender ◽  
Randy S. Friese ◽  
Bellal Joseph ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Motor Vehicle ◽  
Case Series ◽  
Aortic Injury ◽  
Hollow Viscus ◽  
Vehicle Collision ◽  
Abdominal Aortic ◽  
Hollow Viscus Injury ◽  
Abdominal Wall Disruption ◽  
Missed Diagnosis

The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.

Biological Mesh in Contaminated Fields—Overuse without Data: A Systematic Review of Their Use in Abdominal Wall Reconstruction

2014 ◽  
Vol 80 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Wirt Cross ◽  
Ajay Kumar ◽  
Gopal Chandru Kowdley
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
English Language ◽  
Human Subjects ◽  
Abdominal Wall Reconstruction ◽  
Case Series ◽  
Biological Mesh ◽  
End Points ◽  
Scientific Papers

Ventral hernia repair in contaminated fields is a significant problem for surgeons. We performed a systematic review regarding the use of biological mesh in contaminated fields for abdominal wall reconstruction. The primary end points were recurrence and infection of the hernia repair. An independent search of scientific papers in the English language was performed by three reviewers. Articles were chosen based on reference to ventral hernias, their use in infected fields, and in human subjects. Papers were scored using the Methodological Index for Non-Randomized Studies and those with a score of 8 or more were combined to evaluate the end points. A total of 16 studies from six different mesh products met our criteria. These papers comprised 554 patients with an overall infection rate of 24 per cent and a recurrence rate of 20 per cent. The largest study used 116 patients. All papers were case series. Overall the data for use of biological mesh products in contaminated fields are limited. Further controlled studies are needed to address this important and clinically relevant question. Caution should be used when using biological mesh products in infected fields because there is a paucity of controlled data and none have U.S. Food and Drug Administration approval for use in infected fields.

Patients Who Refuse Transportation by Ambulance: A Case Series

1997 ◽  
Vol 12 (4) ◽  
pp. 45-50 ◽  
Author(s):  
John E. Hipskind ◽  
JM Gren ◽  
DJ Barr
Keyword(s):  
Medical Information ◽  
Life Support ◽  
Motor Vehicle ◽  
Demographic Data ◽  
Vital Signs ◽  
Case Series ◽  
Advanced Life Support ◽  
Care Program ◽  
Motor Vehicle Crash ◽  
Discharge Instructions

AbstractIntroduction:Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.Methods:This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.Results:Overall, 30% (683 of2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11–40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.Conclusion:There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.

scholarly journals Abdominal wall disruption with evisceration after blunt trauma

2014 ◽  
Vol 2014 (jun04 1) ◽  
pp. bcr2014203646-bcr2014203646 ◽  
Author(s):  
S. Cawich ◽  
S. Islam ◽  
P. Harnarayan ◽  
C. Young-Pong
Keyword(s):  
Abdominal Wall ◽  
Blunt Trauma ◽  
Abdominal Wall Disruption

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 The use of pyloric exclusion for treating duodenal trauma: case series

2008 ◽  
Vol 126 (6) ◽  
pp. 337-341 ◽  
Author(s):  
Gustavo Pereira Fraga ◽  
Guilherme Biazotto ◽  
José Benedito Bortoto ◽  
Nelson Adami Andreollo ◽  
Mario Mantovani
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Hypovolemic Shock ◽  
Case Series ◽  
Gunshot Wounds ◽  
University Hospital ◽  
Morbidity Rate ◽  
Cross Sectional ◽  
Pyloric Exclusion

CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

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