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PubMed2001

[Panorama ultrasonography of the abdominal wall for delineation of the anatomy and diagnosis of pathological findings].

PURPOSE: To assess extended field-of-view sonography for delineation of the anatomic structures of the abdominal wall and for the diagnosis of hernia. MATERIAL AND METHODS: In 34 cases (24 probands, 10 patients with abdominal wall defects) extended field-of-view sonography of the abdominal wall was performed with a 7.5 MHz transducer. Dynamic alignment of real-time images allows for depiction of regions of up to 60 cm in a single extended field-of-view image. A standardized axial image was obtained above and below the arcuate line and at the level of the defect, respectively. All images were evaluated by two blinded readers regarding the visibility of the anatomic structures and the delineation and extent of pathological changes. RESULTS: The abdominal wall was delineated with extended field-of-view sonography in all patients with a good image quality. The linea alba, the rectus muscle and the three lateral abdominal muscles, the rectus sheath, the peritoneum, and the subcutaneous fatty tissue were visible. In the patients with abdominal wall defects, the hernial sac with its contents, the extension of the defect, and the surrounding structures were clearly delineated. CONCLUSION: Extended field-of-view sonography allows for easily surveyed and reproducible documentation of the ultrasound examination of the abdominal wall. It is especially useful for the preoperative planning in patients with abdominal wall defects.

Abdominal Muscles↗

PubMed1999

[Surgical repair of abdominal wall].

Surgical repair of abdominal wall defects following tumour resection only raises real problems when the nature of the tumour required wide, or even transfixing excision, as in the case of sarcomas or very advanced carcinomas. Superficial repair is performed according to the algorithm of the simplest technique: secondary healing, partial suture, total suture, transplant, or flap (pedicled or free). In the case of transfixing resection, the combination of a biomaterial for reconstruction of the deep plane and a superficial flap is necessary. For very large transfixing defects of the abdomen, a free flap may be required and, in this case, delayed insertion after initial transfer may further reduce the operative risk ("apple turnover" technique). The complications observed in a detailed series of 9 cases operated at Saint-Louis Hospital consisted of one intraoperative cardio-circulatory arrest during second-stage surgery and one late infection at three years. The authors believe that the indications for delayed insertion of a free flap are still very topical in cases in which a very large grafted free flap is necessary in conjunction with a prosthesis. Large abdominal defects after cancer resection can be reconstructed by modern reconstructive surgery.

Abdominal Muscles↗

PubMed1991

Abdominal wall tenderness: a useful sign in chronic abdominal pain.

The outcome in 72 patients with obscure abdominal pain and a positive Carnett's (abdominal wall tenderness) test, seen in one firm's surgical outpatient clinic between 1975 and 1983, was sought by a combination of hospital note retrieval and general practitioner questionnaire. Full follow-up data to date or death were available for 58 (81 per cent) patients and partial follow-up for 14 patients. The study showed that the patients generated a good deal of investigation and a number of surgical procedures but that seldom were their symptoms attributable to serious pathology. Familiarity with the test, taken in the context of a proper history and examination, has been found helpful in assessing such patients and saves the inconvenience, expense and occasional hazard of investigation, and even surgery.

Abdominal Muscles↗

PubMedDate not supplied

[Current approach in the treatment of desmoid tumors of the abdominal wall].

Desmoids of the abdominal wall are rare tumours with an incidence of 2-4 cases per million. From our experience which is reported here in detail (5 cases observed over the past 20 years), we draw the conclusion that the only completely reliable diagnosis is still histological, in spite of the use of ultrasound, CT scans and the new imaging possibilities afforded by NMR. After comprehensive excision of at least 2 cm of macroscopically healthy tissue from the tumour margins, reconstruction using prosthetic materials, such as Mersilene, PTFE or Prolene was performed. Neither radiotherapy nor chemotherapy were used, since there were doubts as to their usefulness. The functional and cosmetic results were satisfactory in all cases. Over follow-up periods ranging from 3 to 13 years, none of the patients has presented recurrences or incisional hernias.

Abdominal Muscles↗

PubMed2006

[Cystic lymphangioma of the abdominal wall in childhood: case report].

Intra-abdominal lymphangiomas are rare benign tumours that can cause various symptoms, mainly during childhood. They are diagnosed by ultrasonography, CT scanning or at laparotomy; ultrasonographic examination often shows a voluminous tumoral cystic formation with septa. The location of the cyst may be determined either by ultrasonography alone or by CT scanning. The definitive histological diagnosis is confirmed by immunohistochemical staining techniques. Rarely intra-abdominal lymphangiomas can occur in the abdominal wall. Complete resection is the treatment of choice. The case of a 2-year-old-boy with a large lymphangioma involving the lower half of the abdominal wall is reported. The patient underwent the complete removal of lymphangioma with good cosmetic result.

Abdominal Neoplasms↗

PubMed1994

Measurements of ultrasonic pulse arrival time and energy level variations produced by propagation through abdominal wall.

Ultrasonic pulse arrival time and energy level variations introduced by propagation through human abdominal wall specimens have been measured. A hemispheric transducer transmitted an ultrasonic pulse that was detected by a linear array transducer after propagation through an abdominal wall section. The array was translated in the elevation direction to collect data over a two-dimensional aperture. Differences in arrival time and energy level between the measured waveforms and calculated references that account for geometric delay and spreading were found. Plots of waveforms compensated for geometric path, maps of time delay differences and energy level fluctuations, and statistics derived from these for water paths and tissue paths characterize the measurement system and describe the time delay differences and energy level fluctuations caused by 14 different human abdominal wall specimens. Repeated measurements using the same specimens show that individual tissue path measurements are reproducible, the results depend on specimen position, and frozen storage of a specimen for three months does not appear to alter the time delay differences and energy level fluctuations produced by the specimen. Comparison of measurements at room and body temperature indicates that appreciably higher time delay differences occur at body temperature while energy level fluctuations and time delay difference patterns are less affected. For the 14 different abdominal wall specimens, the rms time delay differences and energy level fluctuations have average values of 43.0 ns and 3.30 dB, respectively, and the associated correlation lengths of the time delay differences and energy level fluctuations are 7.90 and 2.28 mm, respectively. The spatial patterns of time delay difference and energy level fluctuation in the reception plane appear largely uncorrelated, although some background variations in energy level fluctuation are similar to features in time delay difference maps. The results provide important new information about the variety and range of ultrasonic wave front arrival and energy variations caused by transmission through abdominal wall.

Abdominal Muscles↗

PubMed2006

Mechanical properties of the human abdominal wall measured in vivo during insufflation for laparoscopic surgery.

BACKGROUND: Carbon dioxide insufflation of the peritoneal cavity for laparoscopic surgery offers a unique opportunity to measure some mechanical properties of the human abdominal wall that hitherto have been difficult to obtain. METHODS: The movement and change of the abdominal wall during insufflation to a pressure of 12 mmHg was studied in 18 patients undergoing laparoscopic surgery using a remote motion analysis system that does not compromise the sterility of the operative filed. These data together with the known abdominal wall thickness of each patient (measured by preoperative ultrasound scanning) enabled estimates of mechanical stiffness. RESULTS: The findings showed that the abdominal wall changes from a cylinder to a dome during inflation, and that its area is increased by 15%. A volume, averaging 1.27 x 10(-3)m(3), results from expansion, reshaping of the abdominal wall, and displacement of the diaphragm. The abdominal wall is stiffer in the transverse plane than in the sagittal plane (Young's modulus, 42.5 +/- 9.0 kPa vs 22.5 +/- 2.6 kPa; p = 0.03; paired t-test). CONCLUSIONS: Measurements of mechanical properties of the abdominal wall in patients undergoing laparoscopic surgery were obtained using a remote motion analysis system.

Abdominal Wall↗

PubMedDate not supplied

Anterior abdominal wall reconstruction with fascia lata.

Anterior abdominal wall is a complex fasciomuscular structure, defects of which may arise as a result of infection, trauma, malignancy and herniation. Different techniques have been devised to repair these defects with varying result, availability and cost implications. In the communication, the use of fascia lata for repair of major anterior abdominal wall defect in five patients is reported. The result suggests that this is a useful technique that is associated with satisfactory outcome and minimal morbidity.

Abdominal Muscles↗

PubMed2003

Spontaneous hematoma of the lateral abdominal wall caused by a rupture of a deep circumflex iliac artery: report of two cases.

Expanding hematoma of the abdominal wall is a rare example of acute abdominal disease. We report two cases of lateral abdominal wall hematoma caused by the rupture of a deep circumflex iliac artery, which is a rare cause of an abdominal wall hematoma. Both patients experienced severe abdominal pain after sneezing or coughing. In both cases, computed tomography (CT) findings suggested that active bleeding was continuing. Emergent angiography was therefore performed, and the hematoma was embolized using Spongel or Microcoils. Ultrasound examinations were repeatedly used to monitor the size of the hematoma. The size of the hematoma and patient's pain gradually decreased after embolization. Ultrasound and CT examinations provided useful information for the differential diagnosis of this disease. We conclude that emergent angiography should be performed to control bleeding and avoid any unnecessary surgical procedures in patients with hematoma of the abdominal wall.

Abdominal Wall↗

PubMed1999

Lower abdominal wall reconstruction using the anterior thigh fasciocutaneous flap.

Full thickness defects of the lower abdominal wall are uncommon. They can occur in congenital abdominal wall defects, acute trauma and following resection of soft tissue tumours. In reconstruction of defects not amenable to primary closure, three problems need to be addressed: (i) the fascial layer needs to be reconstructed; (ii) stable and sensate skin coverage is needed as the lower abdominal waistline area is subject to pressure; (iii) it is desirable to restore the contour of the abdominal wall. We present a case with a large area of radiation dermatitis and recurrence of a malignant ovarian tumour in the lower abdominal wall. After en bloc resection the 25 x 6 cm lower abdominal defect was reconstructed with a sensate anterior thigh fasciocutaneous flap. The vascular supply was reliable and the outcome was good. The reasons for using this fasciocutaneous flap in preference to the other options are discussed.

Abdominal Muscles↗

PubMed2006

High-frequency ultrasound: a useful tool for evaluating the abdominal wall following free TRAM and DIEP flap surgery.

BACKGROUND: This is the first study to use a standardized ultrasound protocol to evaluate hernia and abdominal wall laxity following free transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flap surgery. METHODS: All patients who underwent free TRAM and DIEP flap surgery performed by the senior author between the years 1994 and 2003 were recruited for physical examination and ultrasound of the abdominal wall for the dynamic evaluation of hernia and abdominal wall laxity. RESULTS: A total of 25 of 28 patients were followed up (89 percent). Eleven were in the DIEP flap group (44 percent) and 14 were in the free TRAM flap group (56 percent). Age- and body habitus-matched female volunteers (n = 12) were also used in this study. The mean follow-up was 3.8 years (range, 0.8 to 8.2 years). Although the kappa coefficient was +1 for detection of hernia on physical examination between two independent examiners, the interobserver correlation was poor for detection of bulges (kappa coefficient, +0.53). Ultrasound showed that abdominal wall laxity was statistically highest in the upright position, followed by 30 degrees of truncal flexion, and lowest in the supine position. The amount of abdominal wall laxity detected by ultrasound was significantly higher in the free TRAM flap group than in the free DIEP flap group. Two hernias were detected in the TRAM flap group by ultrasound and one hernia was previously known in the DIEP flap group. CONCLUSION: This is the first study to establish a standardized ultrasound protocol as an adjunct diagnostic tool to clinical examination for the dynamic evaluation of postoperative hernia and abdominal wall laxity.

Abdominal Wall↗

PubMedDate not supplied

Comparison of novel synthetic materials with traditional methods to repair exposed abdominal wall fascial defects.

Repair of large abdominal wall defects is a challenge, particularly when full-thickness tissue loss prohibits coverage of the fascial repair. Two novel synthetic materials (TMS-1 and TMS-2) have been shown to be better accepted than expanded polytetrafluoroethylene (Gore-Tex), and polypropylene (Marlex) in the closure of clean and contaminated fascial wounds that are immediately covered by skin/soft tissue. Therefore, 1-cm2 abdominal wall defects were created in each of the four quadrants of rat groups. Gore-Tex, Marlex, and TMS-1 or TMS-2 were used to repair three defects, the fourth being primarily closed. To ensure that each repair remained exposed, skin edges were sutured to underlying muscle. Additional animal groups underwent the same protocol; however, peritonitis was induced at surgery using a fecal inoculum technique. Animals were sacrificed 2 weeks later, at which time a blinded observer assessed the surface area and severity of adhesions. In clean wounds, the surface area of formed adhesions was less (p < .004) after primary closure than each synthetic material; among the synthetics, TMS-2 caused significantly (p < .01) less extensive adhesions than Marlex. In addition, the severity of adhesions to TMS-2 was comparable to that of defects closed primarily, and less severe (p < .02) than those formed to Gore-Tex and Marlex. In animals with peritonitis, primary closure caused less extensive (p < .03) adhesions than Marlex and Gore-Tex and significantly (p < .002) less severe adhesions than Marlex, Gore-Tex, and TMS-2. However, the severity of adhesions formed to TMS-1 repairs proved comparable to primarily closed wounds. These experiments reaffirm the tenet that, whenever possible, abdominal wounds should undergo primary fascial closure. When soft tissue coverage over the repair cannot be achieved, TMS-2 is well tolerated in clean wounds. However, the superiority of TMS-1 over the other synthetic materials in contaminated wounds suggests it may also ultimately prove to be of clinical utility.

Abdominal Muscles↗

PubMed2004

Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series.

We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.

Abdominal Wall↗

PubMed1985

Comparison of prosthetic materials for abdominal wall reconstruction in the presence of contamination and infection.

Abdominal wall defects resulting from trauma, invasive infection, or hernia present a difficult problem for the surgeon. In order to study the problems associated with the prosthetic materials used for abdominal wall reconstruction, an animal model was used to simulate abdominal wall defects in the presence of peritonitis and invasive infection. One hundred guinea pigs were repaired with either polytetrafluorethylene (PTFE) or polypropylene mesh (PPM). Our experiments included intra-operative contamination with Staphylococcus aureus. We found significantly fewer organisms (p less than 0.05) adherent to the PTFE than to the PPM when antibiotics were administered after surgery, as well as when no antibiotics were given. In the presence of peritonitis, we found no real difference in numbers of intraperitoneal bacteria present whether PTFE or PPM was used. In all instances, the PTFE patches produced fewer adhesions and were more easily removed. From these experiments, it appears that PTFE may be associated with fewer problems than PPM in the presence of contamination and infection.

Abdominal Muscles↗

PubMed1986

Association between abdominal wall defects and cryptorchidism.

To determine whether intra-abdominal pressure may have a role in the process of testicular descent in man, we reviewed retrospectively the records of all male infants who presented during a 10-year period with severe abdominal wall defects, such as gastroschisis (28), omphalocele (29) and umbilical hernia (53), and calculated the incidence of cryptorchidism in these patients. The incidence of cryptorchidism at birth and at 1 year after birth was 18 and 15 per cent, respectively, in patients with gastroschisis, 52 and 33 per cent, respectively, in those with omphalocele, and 6 and 6 per cent, respectively, in those with umbilical hernia. For all 3 disorders the incidence of cryptorchidism was higher than in documented historical controls. From these data we conclude that in male infants there is an association between these 3 abdominal wall defects and cryptorchidism. The demonstration that intra-abdominal pressure is lowered significantly by these abdominal wall defects would suggest a possible role for intra-abdominal pressure in the process of testicular descent in man.

Abdominal Muscles↗

PubMed2003

Abdominal wall defects and congenital heart disease.

OBJECTIVES: To determine the incidence of cardiac disease associated with abdominal wall defects of fetuses and associated parameters including maternal age, sex, gestational age at delivery, outcome, karyotypes, Apgar scores and associated congenital anomalies. METHODS: This was a retrospective study of fetuses with a prenatal diagnosis of gastroschisis or omphalocele. The Maternal-Fetal Medicine Fetal Therapy (MFM) database was reviewed for all fetuses with abdominal wall defects identified prenatally. All available MFM records, fetal echocardiograms, neonatal echocardiograms and neonatal charts were reviewed for the types of abdominal wall defects and associated cardiac disease identified by ultrasound. Other parameters reviewed included: maternal age, sex, gestational age at delivery, outcome, karyotypes (when available), Apgar scores and associated congenital abnormalities. RESULTS: Forty-eight fetuses with an abdominal wall defect and cardiac disease findings were identified. Of these fetuses 26 had gastroschisis and 22 had omphalocele. The mean maternal age was 24.0 +/- 5.40 years in the gastroschisis and 29.2 +/- 7.23 years in the omphalocele group (P < 0.01). Differences in mean gestational age at delivery, mean birth weight and median Apgar scores at 1 and 5 min were not statistically significant. Abnormal cardiac findings were seen in 4/26 (15%) cases of gastroschisis and included one case of peripheral pulmonary stenosis, two cases of supraventricular tachycardia and one case of persistent pulmonary hypertension (PPHN) of the newborn. Abnormal cardiac findings were seen in 10/22 (45%) cases of omphalocele and included one muscular ventricular septal defect, two atrial septal defects of the secundum variety, one ectopia cordis, one coarctation of the aorta, one dysplasia of the tricuspid valve, one large pericardial effusion and four cases of PPHN. CONCLUSIONS: Fetuses with omphalocele appear to have an increased risk not only of congenital heart disease (CHD) but also of perinatal cardiac abnormalities, especially PPHN. A prenatal maternal hyperoxia test may be of predictive value in determining which patients may develop PPHN. The fact that both CHD and PPHN are increased in fetuses with abdominal wall defects may be of value in counseling parents prenatally, and stresses the importance of performing echocardiography both prenatally and postnatally in these cases.

Abdominal Wall↗

PubMed1999

Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias.

BACKGROUND: The assessment of abdominal wall hernias has long been a clinical skill that only occasionally required the supplementary radiological assistance of herniography. However, with the advent of cross-sectional imaging, a new range of diagnostic tools is now available to help the clinician in difficult cases. METHODS: This review explores the ability of computed tomography and magnetic resonance imaging to demonstrate many of the hernias encountered in the anterior abdominal wall. Also discussed is the role of imaging techniques in the management of a variety of hernias. RESULTS AND CONCLUSION: Cross-sectional imaging techniques are being employed with increasing frequency for the assessment of hernias. Although the anatomical detail can usually be delineated clearly, the accuracy of the various methods and their place in the clinical management of hernias has yet to be fully determined.

Cross-Sectional Studies↗

PubMed2003

Small intestinal submucosa in abdominal wall repair after TRAM flap harvesting in a rat model.

The strength of porcine small intestinal submucosa in abdominal wall repair after transverse rectus abdominis myocutaneous flap harvesting was examined in a rat model. Changes in the levels of selected molecular markers of inflammation after small intestinal submucosa implantation were also studied. Eighty-three rats were divided into three groups. In experimental group I, an abdominal wall defect created by removal of the rectus abdominis muscle was repaired with placement of a 1.5 x 5-cm2 patch of small intestinal submucosa. In experimental group II, the muscle defect was repaired with a combination of small intestinal submucosa patch placement and fascial closure. In the control group, the defect was repaired with direct fascial closure. At postoperative times of 3 days, 2 weeks, 1 month, and 2 months, the muscle tissues adjacent to the abdominal wall repair site were subjected to biopsies for assessment of inflammation markers. Full-thickness sections of the abdominal wall from the repair site in each animal were removed for tensile strength testing and histological examinations. The results demonstrated that interleukin-6 and interferon-gamma levels were increased in the two experimental, small intestinal submucosa-treated groups at 3 days and 2 weeks postoperatively. The results of mechanical testing demonstrated that the average tensile strength of the repaired abdominal wall in the repair model with combined small intestinal submucosa placement and fascial repair was significantly greater than the values for repairs with fascial closure or small intestinal submucosa placement alone. The use of small intestinal submucosa placement in combination with fascial repair can significantly improve the strength of the repaired abdominal wall after transverse rectus abdominis myocutaneous flap harvesting.

Animals↗