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PubMed1998

Role of tensor fasciae latae in abdominal wall reconstruction.

The role of the tensor fasciae latae as autogenous tissue in reconstruction of abdominal wall defects is well established. The use of various forms of the tensor fasciae latae (free graft versus pedicled flap versus free flap) is determined by the characteristics of the defect. A review of abdominal wall reconstructions using tensor fasciae latae was completed to determine efficacy and establish guidelines for its use. Abdominal wall reconstructions from 1991 to 1994 using tensor fasciae latae were reviewed. Demographics, wound characteristics, and complications were evaluated. Twenty-seven patients with a mean follow-up of 23.6 months underwent abdominal wall reconstruction with the tensor fasciae latae: free grafts, 12; pedicled flaps, 9; and free flaps, 6. An average defect size of 14.4 x 13.1 cm was seen. Fourteen (52 percent) of the reconstructions were completed in contaminated or infected wounds. One recurrent enteric fistula was seen. Twelve (44 percent) of the patients had flap complications of which 50 percent involved partial flap necrosis. Donor site complications were seen in five patients (18 percent) and included a hematoma, seroma, and two cases of skin graft dehiscence along the edge of the wound. Tensor fasciae latae free grafts are an option for repair of abdominal hernias if abdominal soft tissue is adequate. Pedicled flaps may be used for defects of soft tissue and fascia but are limited by the arc of rotation and size of the defect. Tensor fasciae latae free flaps are versatile in orientation and may be used for supraumbilical defects. Tip necrosis is significant in both types of vascularized flaps.

Abdominal Muscles↗

PubMed1990

Late surgical problems in children born with abdominal wall defects.

During a 17 year period 55 patients with abdominal wall defects were treated. A questionnaire concerning late surgical problems was distributed to the parents of the 47 surviving children and 44 (94%) answers were received. The mean follow up time was 5.4 years. There was no mention of remaining problems regarding 16 of the 28 omphalocoele patients and 10 of the 16 gastroschisis patients. Postoperative abdominal wall hernia was reported in 7 cases with omphalocoele and in 6 with gastroschisis; postoperative intestinal stoma occurred in 1 child with omphalocoele associated with anal atresia, and in 1 with gastroschisis and postoperative intestinal obstruction in 4 cases with omphalocoele and in 1 with gastroschisis. The other complaints related to abdominal pain, cryptorchidism, constipation and difficulties with care of the intestinal stoma. No difference in results was found between the two types of closure of the abdominal wall defects irrespective of the primary treatment. All the remaining problems could be corrected and the long term results in both conditions were good.

Abdominal Muscles↗

PubMed1975

Repair of massive septic abdominal wall defects with Marlex mesh.

Marlex mesh was used to close the abdominal wall defect in six patients with septic wound dehiscence and intra-abdominal infection. The mesh was implanted under local anesthesia and served as a protective covering for the bowel and allowed early ambulation, including prone positioning of the patient for easier wound care. In four surviving patients, the Marlex mesh was covered by full thickness skin flaps after granulation tissue had covered the material. No patients had infected sinus tract formation or extrusion. Two patients had incisional hernias develop when the Marlex mesh was not sutured to the abdominal wall permanently. The use of Marlex mesh to cover infected defects in the abdominal wall when primary closure cannot be accomplished is suggested by our experience.

Abdominal Muscles↗

PubMed2005

Use of prosthetic mesh in difficult abdominal wall closure after small bowel transplantation in adults.

Abdominal wall closure after intestinal transplantation in adult patients can be a difficult procedure. The main possibility offered by international experience is the use of myocutaneous flaps and abdominal wall transplantation. We report our experience in intestinal/multivisceral transplantation, including four difficult cases among 27 adult transplant recipients. Three patients underwent prosthetic mesh alone and one, a myocutaneous flap for abdominal closure after primary mesh positioning. We selected a mesh with a structure that allowed us to close the abdomen without creating adhesions and, at the same time, stimulating tissue repair. Two patients experienced local mesh infection, which has been kept under clinical control by antibiotics and daily medications till neoabdominal wall formation. The mesh was then removed. Another patient underwent mesh substitution for a suspicious fever. The last patient had mesh as a bridge for a subsequent myocutaneous flap from the thigh. All patients are in good health with well-functioning grafts and no need for parenteral nutrition. No enterocutaneous fistulae were detected.

Abdominal Wall↗

PubMed2004

[Morbidity of the abdominal wall after breast reconstruction and elective abdominoplasty].

INTRODUCTION: The free TRAM flap is commonly used in breast reconstruction after mastectomy. Donor-site morbidity of the abdominal wall is usually determined by scars, loss of sensation and functional restrictions. Similar aesthetic and functional problems are described for patients after elective abdominoplasty. Is morbidity of the abdominal wall after breast reconstruction based on muscle lesions or on the trauma from operation? PATIENTS AND METHODS: 21 patients after breast reconstruction and 20 patients after elective abdominoplasty were evaluated concerning the aesthetic results, scars and herniasation. Satisfaction with the result was assessed. In addition, the function of the abdominal wall was noted according to Janda. RESULTS: The postoperative course was uneventful. Three cases after elective abdominoplasty developed a recurrence of rectus muscle diastasis. After breast reconstruction there was one hernia and one patient showed a rectus diastasis. Loss of sensation, functional and aesthetic problems were seen in both groups. DISCUSSION: There are no statistic significant differences between elective abdominoplasty and abdominoplasty after breast reconstruction. In both groups loss of sensation, functional and aesthetic problems were noted. Even in elective abdominoplasty there is a loss of function in the abdominal wall. Donor-site morbidity after breast reconstruction is not only caused by the muscle lesion, but the functional and aesthetic problems are due to the general trauma of the abdominal wall.

Abdominal Wall↗

PubMed2004

Incidence and clinical significance of abdominal wall bruising in restrained children involved in motor vehicle crashes.

BACKGROUND: Children involved in motor vehicle crashes (MVC) can sustain bruising of the abdominal wall associated with seat belt restraint. The incidence of bruising and its relationship with significant intraabdominal injuries are not known. METHODS: An analysis of children involved in MVC between December 1998 and November 2002 was performed, using the crash surveillance database from the Partners for Child Passenger Safety (PCPS) project. Optimally (OR) or suboptimally (S-OR) restrained children aged 4 to 15 years were selected. The incidence of abdominal wall bruising was calculated then correlated with the type of restraint as well as any intraabdominal injury with an Abbreviated Injury Scale score > or =2. RESULTS: A total of 147,985 children in 102,548 crashes met study criteria. An abdominal bruise was noted in 1.33% of the children (n = 1,967; 881 OR and 1,086 S-OR). Significant intraabdominal injury was present in 309 children (0.21%, 95% CI 0.13 to 0.33), including 69 OR and 240 S-OR. The sensitivity, specificity, and positive and negative predictive values of abdominal wall bruising for a significant intraabdominal injury were 73.5%, 98.8%, 11.5%, and 99.9%, respectively. Children with a bruise were substantially more likely to have an intraabdominal injury than children without a bruise. (Odds Ratio 232.1, 95% CI, 75.9 to 710.3) Among those children with an abdominal bruise, 1% required an abdominal operation (n = 20). CONCLUSIONS: Abdominal wall bruising was relatively uncommon in both OR and S-OR children. Among restrained children involved in MVC, those with a bruise were 232 times more likely to have a significant intraabdominal injury when compared with those without a bruise. It is imperative to pursue intraabdominal injury in children with a bruise of the abdominal wall after MVC.

Abdominal Injuries↗

PubMedDate not supplied

Prenatal assessment of anterior abdominal wall defects and their prognosis.

Eighty-eight cases of abdominal wall defect with and without other lesions were ascertained by reviewing all labour room records in the West of Scotland, all surgical admissions to the Royal Hospital for Sick Children, Yorkhill, and all post mortems at Royal Hospital for Sick Children between 1978 and 1981. The affected cases comprised 39 terminations of pregnancy (17 of anterior abdominal wall defect without neural tube defect), 20 spontaneous stillbirths and 29 livebirths. All 10 cases of body stalk anomaly, 37.5 per cent of 16 gastroschisis cases and 53 per cent of 62 exomphalos cases had additional severe abnormalities. Abnormal karyotypes were present in seven out of 19 exomphalos cases but all karyotypes from 10 gastroschisis and 6 body stalk anomaly cases were normal. No correlation was found between the maternal serum AFP levels, the amniotic AFP levels and acetylcholinesterase results and the size of the lesion. It is proposed that anterior abdominal wall defects detected prenatally should have chromosome analysis and careful ultrasound to exclude associated severe anomalies before coming to a decision about termination. This policy was implemented in six pregnancies complicated by fetal gastroschisis without severe associated anomalies which were identified in the second trimester and continued to term. Immediate surgical repair was achieved in each case, although two of the infants succumbed from later complications of gastroschisis closure and one from respiratory distress syndrome. The remaining three infants made a satisfactory recovery.

Abdominal Muscles↗

PubMed2001

Abdominal wall endometriosis--ultrasound research: a diagnostic problem.

Abdominal wall endometriosis (AWE) is a rare event. Only a few reports in the literature mention sonographic features of this clinical entity. We describe a case of a young woman with subcutaneous endometriosis under the surgical scar of a previous cesarean section. Physical examination, ultrasound findings, histopathological features and differential diagnostic problems are discussed. Ultrasound examination, in combination with clinical history, is a useful method in the diagnosis of abdominal wall endometriosis and the avoidance of diagnostic pitfalls.

Abdominal Muscles↗

PubMedDate not supplied

[Synthetic fabrics in reparative surgery of the abdominal wall].

Prosthesis use in surgical repair of abdominal wall is becoming nowadays a worldwide method, being imposed by its efficiency in solving the defects. The authors are speaking in the light of their experience gained with 100 patients that underwent the operation of prosthesis implant inside the abdominal wall between 1990 and 1996. There have been correlated the early and late postoperative results with some features of this surgical procedure (see below), to prove its efficacy. The authors discuss some principles of alloplastic treatment, which represent also the conclusions of the study: the moment of when a prosthesis is recommended, the choice of synthetic material, where and how is placed the prosthesis, some additional measures which contribute to therapeutic success.

Abdominal Muscles↗

PubMed1984

Treatment of abdominal wall eventrations associated with abdominoplasty techniques.

An experimental and clinical study using alloplastic materials (Marlex and Prolene mesh) for repairing large defects of the abdominal wall is reported. A defect was created in the experimental model to simulate an anatomical disarrangement of the musculo-aponeuroticfascial complex of the abdominal wall and the surgical correction of this deformity. Macroscopic and microscopic observations of the operated area were done to demonstrate the good integration of the surrounding tissues with the mesh. In a clinical study, 16 patients, presenting large eventrations of the abdominal wall, were surgically treated using Marlex or Prolene mesh to reinforce the abdominal wall. Two techniques of abdominoplasty, vertical and horizontal, were performed on these patients, according to the location of previous scars. The advantages of using alloplastic materials to reinforce the abdominal wall and the cosmetic results of both abdominoplasty techniques are discussed.

Abdominal Muscles↗

PubMed2006

Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography.

OBJECTIVE: The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MR appearance. MATERIALS AND METHODS: A computerized search of our institution's database over a 5-year period was performed, yielding 12 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography including power Doppler examination. Additional CT was performed in one patient and MRI in four. Pathologic material was preoperatively obtained by sonographically guided puncture in six patients. The clinical data were analyzed, and the imaging studies were reviewed by two radiologists working in consensus. RESULTS: All patients had a history of at least one prior cesarean section. All presented with focal pain near the surgical scar, which was cyclic in three patients. Nine patients presented with a palpable mass near the scar. Sonography detected 11 lesions within the abdominal wall, with a mean diameter of 25 mm. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. The calculated frequency of abdominal wall endometriosis is approximately 0.8% of all women who had a cesarean delivery. CONCLUSION: Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis.

Abdominal Wall↗

PubMed2005

[Elementary evaluation of small intestinal submucosa and polypropylene mesh used for repairing abdominal wall defect in rats].

OBJECTIVE: To compare the effect of small intestinal submucosa (SIS) and polypropylene mesh (PPM) on repairing abdominal wall defects in rats, and to probe into the feasibility of using SIS to repair the abdominal wall defects. METHODS: 100 SD rats (50 males and 50 females)were randomly divided into 2 groups (n = 50). Their weight ranged from 200 to 250 g. Full thickness abdominal wall defects (2 cmX 2 cm) were created by surgery and were repaired with SIS and PPM respectively. At different postoperative time (1st, 2nd, 4th, 8th and 12th week), animals were sacrificed to make histological observation. The tensile strength and the development of adhesions were measured and observed. RESULTS: 95 animals survived and were healthy after surgery. No inflammatory response and obvious immunoreaction were observed in both groups. One week after operation, the tensile strength of abdominal wall in SIS group (204.30+/-5.13 mmHg) was lower than that in PPM group(240.0+/-10.0 mmHg) at 1st week (P<0.05), and there were no difference at 4th, 8th, 12th week. Adhesions were more marked in PPM group than that in SIS group (P<0.05). CONCLUSION: Both SIS and PPM are histologically compatible when used in rats and can maintain sufficient tensile strength. SIS is superior to PPM in regards to tissue compatibility and adhesion formation.

Abdominal Injuries↗

PubMed2002

Computed tomography of traumatic abdominal wall hernia and associated deceleration injuries.

We retrospectively reviewed the computed tomographic (CT) examinations of 15 cases of abdominal wall hernia due to abdominal trauma; 13 patients had been injured in motor vehicle accidents (11 of those were belted in). All hernias were correctly identified on CT and confirmed intraoperatively. Traumatic abdominal wall hernia proved an important indicator of associated visceral injury, especially to the bowel (n = 6) and mesentery (n = 10). Careful review of the bowel and mesentery should thus be undertaken when disruption of the abdominal wall is documented. Radiologists should be aware, however, that CT findings may correlate poorly with severity of injury in these areas. In these instances, close clinical correlation and, sometimes, rescanning may be necessary.

Abdominal Injuries↗

PubMed2003

Traumatic abdominal wall hernia: an unusual bicycle handlebar injury.

Traumatic hernia of the abdominal wall is rare. The mechanism of injury can be severe such as a motor vehicle accident or relatively minor such as a fall onto a bicycle handlebar. In children traumatic abdominal wall hernia can occur even after relatively minor trauma and these cases typically have no associated intra-abdominal injury. We report a traumatic hernia of the anterior abdominal wall in a 7-year-old boy following a fall from a bicycle. A review of the literature revealed only nine similar reports. The presence of localised pain, bruising, and a reducible swelling or a cough impulse suggests the diagnosis. Primary repair with prosthetic material is the preferred treatment.

Abdominal Injuries↗

PubMed2001

Peritoneal regeneration after implant of a composite prosthesis in the abdominal wall.

Prosthetic materials currently used to repair abdominal wall defects occasionally must be placed in direct contact with the visceral peritoneum. The prosthesis-peritoneum interface is the site of several possible problems, including the formation of adhesions and erosion of the intestinal loops, which may lead to the formation of fistulas. This investigation was designed to compare the behavior of two prosthetic biomaterials in composite form at the level of the peritoneum. Defects (7 x 5 cm) were created in the abdominal wall of 18 white New Zealand rabbits weighing approximately 2500 g. The defects (involving aponeurotic and muscular planes and the parietal peritoneum) were repaired with polypropylene (PL) + ePTFE (Preclude dura substitute) or Parietex composite (PC) prostheses. The prostheses were secured to the edges of the defect by continuous PL sutures interrupted at the corners of the implant. Three study groups were established according to the type of implant: group I (n = 6) (controls)--PL; group II (n = 6)--PL + ePTFE; and group III (n = 6)--PC. The animals were sacrificed 14 days after implant, and the prostheses were examined by light microscopy and scanning electron microscopy (SEM). The formation of adhesions at the prosthesis-visceral peritoneum interface were quantified according to a protocol previously described by us. The biomechanical resistance of the implant was evaluated using strips comprising prosthetic material and anchorage tissue. The Mann-Whitney U-test was used to compare data corresponding to each group. There was no postimplant mortality. No infection or rejection of the prosthesis was observed in any of the animals. Firm adhesions were detected in the PL implants, whereas in the PL + ePTFE and PC implants the adhesions were loose. The mean prosthetic surface areas covered by adhesions were 7.67, 0.10 and 0.19 cm2 for groups I, II, and III, respectively, showing a significant difference between values corresponding to groups I and II and to groups I and III (p < 0.05). Comparison of values recorded for groups II and III yielded no significant difference (p > 0.05). In groups II and III, the neoperitoneum was homogeneous and composed of organized and vascularized connective tissue covered by a mesoendothelium that was interrupted by accumulations of fibroblasts and white blood cells. In contrast, a disorganized neoperitoneum of rough texture was observed in the group I specimens. At times, areas of hemorrhage and necrosis corresponding to the sites of adhesion formation could be observed. Resistance to traction of composite implants (mean +/- SD: 15.72 +/- 1.32 and 15.89 +/- 2.73) was similar to that of the PL implants (15.03 +/- 2.92) (Mann-Whitney U-test, p < 0.05). It may be concluded that (1) composite prostheses show optimum behavior in terms of adhesion formation at the prosthesis-visceral peritoneum interface; (2) the neoperitoneum formed after the implant of a composite prosthesis almost physically and functionally replaces the normal peritoneum; (3) a significantly greater degree of peritoneal regeneration is achieved after implant of a PC prosthesis; and (4) there was no significant difference regarding biomechanical resistance between PL prostheses and PL + ePTFE and Parietex composites.

Abdominal Muscles↗

PubMed1994

Abdominal-wall tumor implantation after laparoscopy for malignant conditions.

OBJECTIVE: To determine the incidence of abdominal-wall tumor implantation after laparoscopic procedures in patients with known malignancies. METHODS: We reviewed 557 laparoscopic procedures performed by the Gynecologic Oncology Service between November 1990 and February 1994. In 105 procedures, malignancy was documented cytologically or histologically, 88 with intraperitoneal disease and 17 with retroperitoneal disease. Ovarian cancer represented 80% (70 of 88) of the procedures with intraperitoneal malignancy, and the remaining cases consisted of carcinoma of the fallopian tube (two), endometrium (11), cervix (one), breast (three), and stomach (one). Histologically, ovarian carcinomas ranged from low malignant potential to poorly differentiated. Among 88 patients with intraperitoneal disease, 77 had gross disease and 11 had microscopic disease. Four hundred thirty-seven different abdominal-wall puncture sites were used (38 Veress needle sites and 399 laparoscopic ports). RESULTS: One of the 437 (0.2%) abdominal-wall puncture sites developed implantation, a frequency of 1.0% (one in 105) per procedure; this developed after a second-look laparoscopic procedure for ovarian carcinoma in which only microscopic disease was present. If only intraperitoneal disease is considered, the incidence of implantation was 0.3% (one in 363) per abdominal puncture and 1.1% (one in 88) per procedure. CONCLUSION: Tumor implantation at the abdominal-wall puncture site is an infrequent occurrence after laparoscopy in patients with intraperitoneal and retroperitoneal carcinoma.

Abdominal Muscles↗

PubMed2006

Biocompatibility of bacterial contaminated prosthetic meshes and porcine dermal collagen used to repair abdominal wall defects.

BACKGROUND AND AIMS: A contaminated or infected surgical site is considered a contraindication for the use of the nonabsorbable alloplastic materials employed to repair abdominal wall defects. Therefore, the biocompatibility of new prosthetic materials was investigated. MATERIALS AND METHODS: Meshes measuring 1.5x1.5 cm made of conventional and titanium-coated polypropylene, polyglycol, or porcine dermal collagen were implanted under the abdominal wall of 96 rats (eight groups of 12 animals each) employing the inlay technique. Implantation of all four materials was performed both under semisterile conditions and bacterial contamination of the mesh. The meshes were explanted after 28 days. RESULTS: All the materials implanted under semisterile conditions were incorporated into the abdominal wall with only few intraabdominal adhesions (mean adhesion scores: 1.0, 1.2, 1.0, 0.8 points, respectively, not significant). With the porcine dermal collagen, proliferation rate and the proportion of inflammatory cells were statistically lower (p<0.01). In the bacterial contamination group, all meshes were associated with a suppurating infection and strong adhesions between the bowel and mesh, which were most prominent in the case of dermal collagen (mean adhesion scores: 1.6, 1.7, 1.7, and 1.9 points, respectively, not significant). In this group, two animals died of peritonitis. In comparison with the other materials, the proliferation rate was significantly elevated (p=0.03). No significant differences were seen between the other materials employed. CONCLUSION: Irrespective of the material employed, implantation of alloplastic meshes in an abdominal wall contaminated with bacteria, is associated with suppurating infections, in particular in the case of the membrane-like porcine dermal collagen. Nonabsorbable alloplastic meshes and dermal skin grafts should therefore not be used to repair infected abdominal wall defects.

Abdominal Wall↗

PubMed2004

Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section.

BACKGROUND: Rigor mortis can be a problem when laparoscopy is performed in embalmed cadavers for surgical training. METHODS: To improve the laparoscopic view, a new technique for managing the abdominal wall with a cutaneous-subcutaneous flap, pneumoperitoneum (14-15 mmHg), and a progressive (step-by-step) bilateral section of the lateral muscles of the abdomen was attempted in 10 embalmed cadavers. The degree of abdominal wall increase was calculated by measuring changes in the size of the abdominal wall after each step. Improvement in the peritoneal laparoscopic view was also assessed. RESULTS: For abdominal wall size, no constant relationship was observed between initial (after creation of the pneumoperitoneum) and final increment (after each muscular layer section). Cumulative degrees of increase in the dimensions of the abdominal wall were the only parameters that showed a significant difference among the four groups of cadavers. Bilateral sectioning of both oblique muscles was sufficient to obtain an adequate view of the abdominopelvic cavity; thus, the risk of an unexpected peritoneal opening during sectioning of the transversum abdominis muscle was obviated. CONCLUSIONS: In embalmed cadavers, the laparoscopic view in the presence of a pneumoperitoneum can be facilitated by a section of the lateral muscles of the abdomen, with a previous cutaneous-subcutaneous flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.

Abdominal Wall↗