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PubMed2000

Abdominal wall closure after intestinal transplantation.

Successful surgical closure of the abdominal wall after either combined or isolated intestinal transplantation may present a challenging dilemma for the plastic and reconstructive surgeon because of the following factors: restricted volume of the recipient abdominal cavity; donor-recipient size discrepancies as expressed by the donor to recipient weight ratio; and significant intraoperative edema. The purpose of this investigation is to present clinical experience with 51 consecutive patients who underwent a total of 57 sequential intestinal transplantations at the University of Miami-Jackson Memorial Hospital. A retrospective chart review of 36 pediatric (63 percent) and 21 adult (37 percent) transplantations was performed. Age of the pediatric population ranged from 1 month to 13 years (mean, 2.4 years) and of the adult population from 22 to 55 years (mean, 33.5 years). Several diagnostic classifications necessitated organ transplantation. Because of insufficient donor graft size for the recipient abdominal cavity in 19 transplantations (33 percent), several technical modifications were used to achieve anatomic and functional abdominal wall closure in all patients. In summary, the plastic and reconstructive surgeon should have a significant role in the comprehensive planning and management of abdominal wall closure in this challenging group of patients.

Abdominal Muscles↗

PubMed1993

Laparoscopic injury of abdominal wall blood vessels: a report of three cases.

BACKGROUND: Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques. CASES: Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics. CONCLUSIONS: Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.

Abdominal Muscles↗

PubMed1998

Malignant cutaneous and subcutaneous abdominal wall lesions: a fine-needle aspiration study.

Cutaneous and subcutaneous masses of the abdominal wall are uncommon. However, a variety of benign and neoplastic entities can be encountered in this region. We report a series of 22 fine-needle aspirations (FNA) of malignant cutaneous and subcutaneous lesions involving the abdominal wall. All of these lesions were metastatic neoplasms. There were 14 females and eight males, with an age range of 35-83 years (mean 65 years). Twenty-one had a previous history of malignancy. The mean interval between the primary diagnosis and FNA was 26 months (range 1.5-128 months). The sites of origin in order of decreasing frequency were colon (n = 4), ovary (n = 4), breast (n = 3), endometrium (n = 2), melanoma (n = 2), and one case each of cervix, urinary bladder, kidney, pancreas, gallbladder, and lymphoma. One case was a squamous-cell carcinoma of unknown origin. Fourteen of the 22 patients were dead at the end of this study, with a mean survival of 8.4 months (range 0.5-44 months) following FNA. One patient was alive with disease at 13 months, and seven patients were lost to follow-up. Based on this data and on review of the literature we conclude that the majority of malignant cutaneous and subcutaneous lesions of the abdominal wall subject to FNA biopsy are metastatic tumors which originate from intra-abdominal, pelvic, and retroperitoneal organs and that FNA is a highly useful technique in the assessment of these lesions of the abdominal wall.

Abdominal Muscles↗

PubMed2006

Antenatal magnetic resonance imaging is useful in providing predictive values for surgical procedures in abdominal wall defects.

BACKGROUND: Antenatal magnetic resonance imaging (MRI) is useful for the diagnosis of abdominal wall defects. Its predictive value concerning the possibility of primary closure of the abdominal wall, however, has so far not been reported. METHODS: Between August 2001 and November 2004, antenatal MRI was performed on 9 patients with abdominal wall defects in whom surgical repair was performed immediately after birth. Areas of the abdominal cavity and exteriorized viscera were manually traced from both sagittal and axial MR images, and the data were further transmitted to a Workstation for MRI Volumetry (Advantage Windows 4.1, General Electric Medical Systems, Milwaukee, Wis). We examined the exteriorized ratio (ER), which is calculated by dividing the absolute volume of the abdominal cavity by that of the exteriorized viscera, and evaluated the predictive value by a retrospective comparison with surgical procedure. RESULTS: In the primary closure group (n = 5), mean values of ER were 0.33 +/- 0.31 from axial and 0.45 +/- 0.31 from sagittal MR images. In contrast, in the staged closure group (n = 4), mean values of ER were 1.39 +/- 0.40 from axial and 1.34 +/- 0.42 from sagittal MR images. There was a significant difference (P < .05) between the 2 groups for both sets of images. The ER obtained from antenatal MRI correlated well with surgical procedure. CONCLUSIONS: The ER might be useful for antenatal counseling, planning for delivery, and prediction of the most likely surgical procedure.

Abdominal Wall↗

PubMed1994

[Ultrasonographic findings and integration with computerized tomography in pathology of the abdominal wall].

Ultrasonography (US) plays a major role in the study of the anterior and lateral abdominal wall. Our experience refers to 150 patients examined over a 5-year period, who were divided into two groups according to disease etiology: 72 patients suffered from iatrogenic and 78 from non-iatrogenic conditions. The first group was mainly composed of alterations caused by anticoagulation therapy, e.g., hematomas, and recent or previous surgery, i.e., 19 incisional hernias and 19 inflammatory-abscess processes. The second group included above all 32 cases of abdominal wall hernia, 18 neoplasms, 13 traumas with abdominal wall involvement only and 12 inflammatory processes. US yielded valuable pieces of information to diagnose iatrogenic conditions, even for small or non-relevant conditions. Moreover, US allowed non-iatrogenic conditions to be located and identified, accurately demonstrating abdominal wall layers involvement. US was also very useful in the patients whose physical examination is of no use or difficult, e.g., in the patients with much pain and trauma or obese patients. CT was used in selected cases only, as a complement to US, when a more detailed spatial assessment of wide or deep lesions was necessary.

Abdominal Muscles↗

PubMed2005

[Choice of a method of plasty of the anterior abdominal wall in patients with postoperative ventral hernias].

The individual characteristics of the structure of the anterior abdominal wall were studied for revealing the anatomical preconditions for the formation of postoperative ventral hernias in order to substantiate efficient methods of surgical treatment. It was established that patients with brachiomorphous build had anatomical features facilitating the formation of ventral hernias. The greatest strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with a dolichomorphous constitution, while the least strength of the fascio-aponeurotic complex of the anterior abdominal wall is characteristic of patients with brachiomorphous constitution. Patients with the dolicho- and mesomorphous constitution having postoperative ventral hernias can undergo plasty of the hernial gates with the local tissues. Patients with brachiomorphous constitution after elimination of the postoperative ventral hernias need the strengthening of the anterior abdominal wall with cellular explants.

Abdominal Wall↗

PubMed2006

Concurrent gastric bypass and repair of anterior abdominal wall hernias.

BACKGROUND: Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal wall hernia repair. METHODS: All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair were reviewed. RESULTS: 12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men with average age 54.9 +/- 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 +/- 10.3 kg/m(2) (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect was 14.7 +/- 13.4 cm(2). One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester in 8 patients (67%). With a 14.1 +/- 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia repairs. CONCLUSION: Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections occurred in our series.

Adult↗

PubMed1994

The use of a human dura mater allograft for the repair of a contaminated abdominal wall defect: report of a case.

A case report of an infected full-thickness abdominal wall defect treated successfully with a human dura mater allograft is presented. A review of the literature and a discussion of prosthetic abdominal wall repair is also included. A 46-year-old woman presented with multiple small bowel perforations and a large abdominal wall defect due to a motor vehicle collision. A gamma-irradiated human dura mater prosthesis was used to repair the large abdominal wall defect which had been infected by a jejunal fistula. After more than 4 years of follow-up, the patient is free of complications, including wound infection, herniation, and ileus. The human dura mater allograft is thus considered to be a useful prosthesis for repairing potentially infected wounds.

Abdominal Muscles↗

PubMed1993

Prolonged parenteral meperidine analgesia during pregnancy for pain from an abdominal wall mesh graft.

BACKGROUND: Although successful pregnancy has been reported in women with prosthetic mesh abdominal wall grafts, the complication of severe pain in pregnancy from shearing of the graft has not been described. We report an unusual case of severe pain in pregnancy caused by abdominal wall stretching by the enlarging uterus. Pain was controlled with long-term intravenous meperidine analgesia. CASE: A 21-year-old multigravida with a previously placed mesh graft for multiple abdominal wall hernias presented at 30 weeks' gestation with severe abdominal pain. Meperidine patient-controlled analgesia at a mean dose of 14.2 mg/kg/day controlled the symptoms, allowing pregnancy prolongation for 28 days before induction of labor at 34 weeks when fetal lung maturity was confirmed. CONCLUSION: This is the first reported case of the use of high-dose patient-controlled parenteral narcotic analgesia in a woman whose abdominal wall mesh graft partially sheared from its attachments. The patient went on to have a successful vaginal delivery.

Abdominal Muscles↗

PubMed1983

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction.

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

Abdominal Muscles↗

PubMed1995

Abdominal wall hematoma in an elderly man.

This report describes an abdominal wall hematoma that occurred in an unusual location and resulted in significant hemorrhage in a generally healthy individual. Angiography-directed therapeutic embolization was halted due to an embolic complication. Evidence of continued hemorrhage led to surgical intervention. After a right flank incision was made, fresh blood as well as approximately 1 L of clotted blood were evacuated from the abdominal wall. After resection of a portion of the twelfth rib, the twelfth intercostal artery was noted to be actively bleeding and was ligated. This operative procedure controlled the patient's blood loss. The etiologies, presenting findings, diagnostic studies, and modes of therapy reported for abdominal wall hematomas are reviewed.

Abdomen, Acute↗

PubMedDate not supplied

[Experience with Clotteau-Prémont's technique in abdominal wall hernias. Preliminary report].

BACKGROUND: Incisional hernias account for at least a third of abdominal wall hernias. There are different techniques of repair that include the use of prosthetic materials, which has lowered the hernia recurrence rate. Nonetheless, its use in case of rejection or infection requires other techniques with local tissue. The use of prosthetic material in a contaminated environment is contraindicated because the risk of infection and recurrence rate is unacceptably high. METHODS: In order to compare two repair techniques for abdominal wall hernias in terms of complications and recurrence to be used as an alternative for hernia repair in patients with abdominal wall hernias, we conducted, between January 2000 and January 2004, an observational, longitudinal, retrospective, non-randomized matched control case study in patients with abdominal wall hernia. A total of 30 patients were studied and were divided into two groups of 15 patients each. Subjects were matched for sex, age and hernia type (group A, mesh treated and group B, Clotteau-Prémont treated) who had at least a 5-month postoperative follow-up. Complication and recurrence rate was assessed and compared. RESULTS: There were no differences between the two groups in complications or recurrence (p <0.05). The average follow-up time was 18.9 +/- 8 months for group A and 15 +/- 7.9 months for group B. CONCLUSIONS: Clotteau-Prémont's technique is a safe and feasible alternative procedure with indications in selected patients.

Adolescent↗

PubMedDate not supplied

[The repair of voluminous postoperative abdominal wall defects with synthetic mesh].

Important postoperative abdominal wall defects, especially recurrent or multirecidivated ones, are raising multiple problems to the surgeon. We are presenting a homogeneous trial of 209 patients with such lesions, in which the abdominal wall repair was made with different kind of synthetic materials, with good results. In a single case the mesh was rejected, because a silent quiescent infection. In three patients undergoing iterative abdominal operations for other diseases we performed optical and electronic microscopical studies showing out that the material integration was done by normal biological reaction. This provides the materials' tolerability and a normal reaction of the organism.

Abdominal Muscles↗

PubMed1995

Abdominal wall metastasis following percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy (PEG) has become a widely used method for nutritional support, particularly in patients with advanced head and neck carcinomas. Since the method is easy and widely established it is necessary to assess possible complications, even rare ones. In this paper we report on two patients with vaccination metastasis following PEG insertion. Both patients had advanced squamous cell carcinoma of the head and neck or the upper esophagus. In three patients previous bougienage was performed, because of considerable stenosis of the pharynx and/or esophagus. Fast-growing metastases were found at the site of PEG insertion, with and without involvement of the gastric wall. In neither case was abdominal wall metastasis the cause of death. There is a small but definite risk of tumor seeding into the abdominal wall after PEG insertion for obstructive malignant tumors. The clinical impact of this finding, however, is still undefined and needs further investigation.

Abdominal Muscles↗

PubMed1985

Extended myofascial thigh flaps for repair of large full-thickness abdominal wall defects.

The large, full-thickness abdominal wall defect encompassing the upper and lower quadrants can test the surgeon's ingenuity in providing definitive repair. Two cases are reported of this type of abdominal wall defect closed in one stage using an extended tensor fascia lata myofasciocutaneous flap and an extended rectus femoris myofascial flap, respectively. In addition, a fresh cadaver dye injection study demonstrates the extensive circulatory pattern of these flaps.

Abdominal Muscles↗

PubMedDate not supplied

[Clinical analysis of congenital abdominal wall defects--omphalocele and gastroschisis].

INTRODUCTION: This is a retrospective analysis of therapeutic approaches and treatment outcomes of congenital abdominal wall defects (omphalocele and gastroschisis) in a five year period. The aim of this study was to identify factors which can affect the prognosis of future therapeutic procedures. MATERIAL AND METHODS: We evaluated 13 children, 7 with omphalocele (2 female/5 male; mean birth weight of 2862 g; mean gestational age of 37 weeks), and 6 patients with gastroschisis (2 female/4 male; mean birth weight of 2640 g; mean gestational age of 36/2 weeks). All patients were treated at the Clinic of Pediatric Surgery from 1999 to 2003. RESULTS: In this study, thirteen cases of congenital abdominal wall defects (omphalocele and gastroschisis) were retrospectively investigated. All patients underwent prenatal ultrasound. Omphalocele was prenatally detected in 42.8% of fetuses, and gastroschisis in 16.7%. Coexisting anomalies were present in 57.1% of patients with omphalocele and in 16.7% of newborns with gastroschisis. Three patients with omphalocele were treated operatively, and four only conservatively. The abdominal wall of patients with gastroschisis was primarily closed in three patients. Two patients required a staged abdominal wall closure. One patient with gastroschisis and intestinal atresia underwent primary closure after partial intestinal resection and enterostomy. Based on these responses, a management protocol (algorithm) was recommended. The most common postoperative complication, in 7 cases of omphalocele, was mechanical ileus (n = 1), whereas among patients with gastroschisis the commonest were mechanical ileus (n = 1) and intestinal perforation (n = 1). The mortality of patients with omphalocele was 52% and with gastroschisis 66.7%. CONCLUSION: A strategy designed to optimize antenatal and neonatal factors is expected to increase the survival rate of patients with abdominal wall defects.

Abnormalities, Multiple↗

PubMed1999

Abdominal wall pain caused by cutaneous nerve entrapment in an adolescent girl taking oral contraceptive pills.

The etiology of chronic abdominal pain can be elusive. The diagnostic workup, therefore, often includes superfluous and expensive tests, as well as invasive procedures which do not contribute to the final diagnosis. Studies have shown that some patients suffer from prolonged pain in the abdominal wall and often are misdiagnosed and treated as having a visceral source for their complaints. The abdominal wall might be considered to be an unlikely source of prolonged abdominal pain, but one study reported that in 15% of patients with prolonged, nonspecific abdominal pain, the abdominal wall was the source of the complaint. Abdominal pain resulting from cutaneous nerve entrapment has not been reported previously in children and adolescents, nor has nerve entrapment been reported as a complication of oral contraceptives. The case of a 15-year-old girl who came to the hospital emergency room with abdominal pain of 3 months duration is reported. A comprehensive workup had not established a specific cause for the pain. On the basis of the clinical findings, the possibility of a cutaneous nerve entrapment was suggested. After the involved cutaneous nerve was selectively blocked by subcutaneous infiltration, the pain disappeared immediately and completely. Recognition of this apparently unusual condition can lead to gratifying results. It is proposed that oral contraceptive therapy may have caused changes in the abdominal wall which led to nerve entrapment and the ensuing severe, prolonged pain.

Abdominal Muscles↗

PubMed1990

Use of dura mater allografts in operations of abdominal wall hernias.

Treatment of large and recurrent abdominal wall hernias represents a rather complicated problem in surgical tactics and technique. In an effort to overcome the shortage of autogeneic material for strengthening the abdominal wall it is possible to substitute the defect by different synthetic or biological materials. Our experience with the use of freeze-dried dura mater is dealt with. The total of 18 allogeneic grafts were used in 11 patients with ventral hernias. The therapeutic procedure and clinical results are reported. Minor complications have developed in 2 patients, but they did not influence the good results of surgical treatment.

Aged↗