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At least 523 records · Page 29Linked to original sources
PubMed1993

A new bioprosthesis in large abdominal wall defects.

A collagen-coated Vicryl mesh bioprosthesis was used to repair a 4 x 4 cm full-thickness abdominal wall defect, created in experimental rats. The tensile strength of the repair at 6 months reached 70% of the original abdominal wall. Implant collagen could not be differentiated from host collagen after 2 weeks. The increase in collagen content of the repair was responsible for the increasing tensile strength of the wound with time. All histological sections showed good tolerance of the implant. These results support the use of collagen Vicryl membrane to repair large abdominal wall defects. Clinical trials are indicated.

Abdominal Muscles↗
PubMed2006

Abdominal wall reconstruction with free flaps.

This article addresses the clinical applications of free tissue transfer for abdominal wall reconstruction. Details of indications, techniques, and clinical examples for the coverage of complex abdominal wall defects are presented.

Abdominal Wall↗
PubMed2003

Prosthetic mesh repair should be used for any defect in the abdominal wall.

The case for mesh versus non-mesh repair of defects in the abdominal wall is argued, with the conclusion that the evidence-base is sufficiently strong to recommend that that all defects in the abdominal wall, whether inguinal, incisional or umbilical hernias, and of whatever size, should be repaired with the use of prosthetic mesh.

Abdominal Wall↗
PubMed1994

[Hernias in the abdominal wall].

The authors emphasize the relapse frequency of the front abdominal wall hernias. Umbilical hernias, epigastric hernias, hernias in postoperative scars, as well as diastases of m. rectus abdominis are still not appropriately evaluated problem in surgery. Numeral surgical methods and procedures provide evidence of this fact. In spite of this, the relapses are frequent. In order to prevent relapses of hernias and to support the firmness of the abdominal wall, the authors use the corium graft technique. This study provides the description of the graft preparation. This surgical method was used in 54 patients, in whom no recurrence was recorded within the period of 1-3 years after surgery. The authors consider this procedure as being useful and effective. The methodical procedure is simple and economically advantageous, as autografts are ideal from the biological point of view. (Tab. 1, Fig. 6, Ref. 10.)

Female↗
PubMed2002

Evaluation of a new composite prosthesis (PL-PU99) for the repair of abdominal wall defects in terms of behavior at the peritoneal interface.

This study was designed to evaluate the behavior of a new composite polypropylene-polyurethane (PL-PU99) when placed in direct contact with the visceral peritoneum during the repair of an abdominal wall defect. Full-thickness abdominal wall defects (7 x 5 cm) were created in 36 anaesthetized white New Zealand rabbits. The defects were repaired with polypropylene prostheses or PL-PU99 prostheses (comprised of PL and a polyurethane sheet glued to the PL with acrylic adhesive) to establish two study groups (n = 18 each). Animals were sacrified 14, 30, or 90 days after implantation and prosthesis/surrounding tissue specimens were subjected to light and electron microscopy and morphometric analysis of the newly formed peritoneum. Immunohistochemical analysis was performed using the rabbit specific monoclonal antibody RAM-11. The biomechanical strength of the implants was also assessed. Firm adhesions were detected in the PL implants, whereas adhesions were practically non-existent in the PL-PU99 implants. The surface area covered by adhesions was greater (p < 0.01) in the PL group (7.36 vs. 0.11 cm2). The neoperitoneum formed after the implantation of a PL prosthesis was disorganized in structure, whereas that formed at the interface with the PL-PU99 prosthesis was structurally similar to the host peritoneum. The excellent performance of the PL-PU99 prosthesis shown in this study warrants further investigation into its use for the repair of abdominal wall defects when the prosthetic patch needs to be placed in contact with the intestinal loops.

Animals↗
PubMed1988

[Microvascular architecture of the all-layer free inferior abdominal wall flap].

The authors dissected all layers of the inferior abdominal wall to study the possibility of free transplantation to close combined skin and mucosal defects. They perfused these flaps with a special solution of lead oxide and gelatin (Rees and Taylor 1986). After fixation in formalin the flaps were dissected in their layers and radiographs of these were taken. Networks of small vessels, which originate in the inferior epigastric artery, were found preperitoneally in the deepest compartment, in the muscular compartment and, nourished by perforators via the ventral rectus fascia, epifascially and subdermally in the subcutaneous tissue. On this basis free microvascular transplantation of a full-thickness abdominal wall flap seems to be possible to close combined mucosal and cutaneous defects. To thin this flap the subcutaneous middle third could be removed taking care to protect the epifascial and subdermal plexus of vessels. An isolated pre- and peritoneal microvascular flap also seems to be possible.

Abdominal Muscles↗
PubMed1983

Traumatic abdominal wall hernia.

Traumatic herniation of the abdominal wall is an unusual injury. Early morbidity is related to associated intra-abdominal organ injuries which are common. Late complications due to intestinal incarceration and strangulation can occur. Immediate celiotomy is necessary for hernia reduction and repair and for evaluation of intra-abdominal organ injury. This approach obviates any late complications.

Accidents, Traffic↗
PubMed1990

Evaluation of herniography in the diagnosis of an occult abdominal wall hernia in symptomatic adults.

Outpatient herniography as a means of confirming or refuting the presence of an occult abdominal wall hernia was performed in 50 symptomatic patients, including 13 who had previously undergone hernia repair. Altogether 30 occult hernias were detected in 27 patients, only one of which was considered to be unrelated to the presenting symptoms. On the basis of herniography, 17 patients were spared surgical exploration and, of these 17, 16 obtained a good result. One further patient with a clinically apparent hernia on one side but with contralateral symptoms was spared unnecessary surgery because the contralateral side was radiologically normal. There was one false negative and no false positive examinations. There were three minor complications: two cases of sigmoid colon puncture and one of abdominal wall haemorrhage (all managed conservatively). There were two technical failures. These results support the Scandinavian experience that herniography has a useful role in the management of patients who may have occult hernias as the underlying cause of abdominal wall symptoms.

Abdominal Pain↗
PubMed2005

[Proposal for a new classification of prostheses used in the repair of abdominal wall hernial defects].

Research and development in new biomaterials is currently increasing. The greater use of prostheses for the repair of abdominal wall defects has meant that new designs incorporating novel materials are constantly emerging. Today's surgeon needs to be aware of these novel designs and become familiar with their use. In the present article, we classify the prostheses currently available on the market for the repair of abdominal wall defects, mostly hernias. The new classification scheme we propose takes into account the type of prosthesis, its components, and its ideal site of placement in the abdominal wall.

Biocompatible Materials↗
PubMed2001

Transverse colonic cancer presenting as an anterior abdominal wall abscess: report of a case.

An 81-year-old man who had been aware of a right anterior abdominal mass for 1 week was admitted to our hospital on July 3, 1999, after the mass had perforated and was secreting mucinous purulent material. Computed tomography clearly showed an anterior abdominal wall abscess and a large intraabdominal tumor that contained a fistula-like structure. Barium enema revealed an apple-core sign at the transverse colon, with a fistula that connected the colon to the abscess cavity. Transverse colonic cancer complicated by an anterior abdominal wall abscess was diagnosed, and an extended right hemicolectomy was performed. We did not perform en bloc excision of the full thickness of the anterior abdominal wall, including the abscess, because the defect was determined to be too large to repair. Thus, when curative resection is not feasible, as in our patient, resection of the primary tumor with en bloc partial resection of the adherent parietal wall should be performed if possible, as this procedure has the potential to improve the postoperative quality of life of the patient.

Abdominal Abscess↗
PubMed2005

The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias.

Current classifications of incisional hernias are often not suitable. The aim of our study was to demonstrate that it is important to consider not only the wall defect surface (WDS) but also the total surface of the anterior abdominal wall (SAW) and the ratio between SAW/WDS). Twenty-three patients affected by > 10 cm size incisional hernias were examined for anthropometric analyses. The SAW, the WDS and the ratio SAW/WDS were calculated. All of the 23 patients were operated on 13 patients were treated with the Rives technique using a polypropylene mesh while the remaning ten patients had an intraperitoneal Parietex Composite mesh (PC). The two groups were compared for post-operative pain (with VAS) and intra-abdominal pressure (IAP) 48 h after the operation: bladder pressure, length of the procedure, average hospital stay and return to work were calculated. In the Rives group, WDS being equal, the higher IAP values were, the lower was the ratio SAW/WDS; furthermore, SAW/WDS ratio being equal, IAP values were low in cases where intraperitoneal mesh was used. Post-operative pain, measured with VAS, was critical when there was a low SAW/WDS ratio and a high IAP. In our experience, it is possible to predict a strong abdominal wall tension if the SAW/WDA ratio is below 15 mmHg. In these cases it is advisable to use a technique requiring the use of an intraperitoneal mesh. Our experience with PC was so positive that it is used in our department for all cases where an intraperitoneal mesh is required. At present, our proposal is that the SAW/WDS ratio is to be considered as a new parameter in current classifications of incisional hernias.

Abdominal Wall↗
PubMed1999

Effects of prosthetic reconstruction of the abdominal wall on respiratory mechanics in rats.

Respiratory mechanics and thoracoabdominal morphometry were determined in four sets of animal experiments before and after surgery. In group RRA the rectus abdominus muscles were removed; in RRAH rats the muscle resection was followed by lung hyperinflation; in PPM animals the defect was repaired by suturing a polypropylene mesh (Marlex); and in PPMH lung hyperinflation was performed after abdominal wall reconstruction. Lung and chest wall elastances, and chest wall viscoelastic/inhomogeneous pressures increased in RRA, RRAH and PPM groups. Static lung elastance was progressively smaller in the following order: RRA, PPM, and PPMH. In conclusion, removal of the rectus abdominus muscles and abdominal wall reconstruction could account for higher energy losses against viscoelastic and elastic forces acting on the chest wall, and these are related to a cephalad deviation of the diaphragm. Furthermore, hyperinflation reverses lung elastic modification after abdominal wall reconstruction with PPM, without beneficial effects in the presence of abdominal wall defect.

Abdominal Muscles↗
PubMed1993

Secondary reconstruction of abdominal wall defects associated with exstrophy of the bladder.

Exstrophy of the bladder is a spectrum of congenital anomalies that involve the structures of the lower abdominal wall. The classic bladder exstrophy results in a severe deformity. The purpose of the original surgery is to obtain a secure abdominal wall closure with urinary continence. In present times the abdominal wall is repaired shortly after birth. The occasional patient has residual anatomical deformities that impede their social development and interaction. Secondary reconstructive surgery can be helpful, and this patient report illustrates this.

Abdominal Muscles↗
PubMedDate not supplied

Effects of aging on abdominal wall healing in rats.

PURPOSE: The aim of this study was to assess abdominal wall healing in old and young adult rats. METHODS: On average, young animals were 110 days old and old animals were 762 days old. A 4.0 cm median laparotomy was performed under anesthesia, followed by laparorrhaphy on two synthesis planes, i.e. peritoneum-muscle-aponeurosis and skin, using continuous 5.0 nylon sutures. The animals were evaluated on the 3rd, 7th, 14th and 21st postoperative days. The resistance of the two planes was studied separately and a histopathologic analysis was performed on sections stained with hematoxylineosin and Sirius Red. Immunohistochemical analysis was also carried out using PCNA, LCA and CD34. RESULTS: The skin scars gained resistance in a similar manner at the initial time points, but those of young rats were more resistant on the 21st day (p=0.0029). Total and type III collagen content was similar in the two groups and type I collagen content was higher in young animals on the 14th day. Inflammatory cell infiltration was more marked in the skin wounds of young animals on the 3rd day (p=0.0190). Reepithelialization was similar and angiogenesis was more intense in the skin wounds of young animals on the 14th day (p=0.0062). The peritoneum-muscle-aponeurosis wounds gained similar resistance during the early phases, but were more resistant on the 14th day (p=0.0005) and on the 21st day (p=0.0023) in old rats Collagen concentration was higher in the wounds of old animals on the 3rd day (p=0.0112) and in the wounds of young animals on the 21st day (p=0.0348). The inflammatory reaction was more intense in the wounds of old animals on the 3rd day (p=0.0060) and angiogenesis was more intense on the 14th day (0.0432). CONCLUSION: Although there are some differences in the healing course between young and old animals, age, of itself, does not impair the healing of abdominal wall wounds in rats.

Abdominal Wall↗
PubMed1996

Fishing-rod-type abdominal wall lifter for gasless laparoscopic surgery.

We have designed a new abdominal wall lifter for gasless laparoscopic surgery which consists of stainless steel rods and iron lifters. They elevate the abdominal wall up like a dome-type camping tent, which does not disturb any manipulation of scope or X-ray camera. We received a good view of the peritoneal cavity without CO2 gas insufflation in ten patients with cholecystitis. This will be helpful for general laparoscopic surgery or laparoscopic assisted surgery with the use of conventional forceps or extracorporeal suturing through a valveless trocar.

Abdominal Muscles↗
PubMed2002

Experimental abdominal wall defect repaired with acellular matrix.

In the surgical repair of congenital abdominal-wall defects (AWD), the ready availability of a non-immunogenic and non-prosthetic biomaterial that could guide the regeneration of normal tissue is a fascinating possibility. Biomaterials are already in use, but in our experience, an acellular matrix (ACM) can stimulate exact regeneration of the absent tissue. We explored the possibility of using an ACM to repair a muscular AWD in an animal model. Male New Zealand white rabbits (3-4 kg, n = 18) were anesthetized and the abdominal wall was shaved and scrubbed; a vertical incision was made in the left lower quadrant and a large patch of external-oblique muscle was resected (3 x 3 cm). The animals underwent reconstruction with homologous diaphragm acellular matrix (HDAM) grafts that were previously prepared using a detergent enzymatic method. The patches were evaluated histologically at 9 (n = 6), 40 (n = 6), and 90 (n = 6) days post-surgery in each group; moreover, 90 days post-surgery an electromyogram (EMG) (n = 6) of the implanted matrix was recorded. Histologic analysis demonstrated that the HDAM supported fibroblast migration, deposition of newly-formed collagen, and neovascularization. No signs of necrosis, or evidence of skeletal-muscle-cell ingrowth were detected. The EMG revealed minimum muscular electrophysiologic activity, probably due to muscle underlying the patch. The HDAM we employed was thus not able to produce reconstruction of the skeletal muscle, and was progressively remodeled into fibrous tissue. Since the ultimate reason for failure of muscle regeneration is a lack of myogenesis, future studies will use ACMs preconditioned by various regulators of myoblast proliferation and differentiation.

Abdominal Wall↗
PubMed2004

Safety zones for anterior abdominal wall entry during laparoscopy: a CT scan mapping of epigastric vessels.

OBJECTIVE: To determine the efficacy of CT scan in mapping the superior and inferior epigastric vessels, relative to landmarks apparent at laparoscopy. SUMMARY BACKGROUND DATA: Trauma to abdominal wall blood vessels occurs in 0.2% to 2% of laparoscopic procedures. Both superficial and deep abdominal wall vessels are at risk. The superficial vessels may be located by transillumination; however, the deep epigastric vessels cannot be effectively located by transillumination and, thus, other techniques should be used to minimize the risk of injury to these vessels. METHODS: Abdominal and pelvic CT images of 100 patients were studied. The location of the superior and inferior epigastric vessels from the midline were determined at five levels, correlated with each other and with the patient age, body mass index, and history of midline laparotomy using Pearson's correlation coefficient and multivariate analysis. RESULTS: CT scan was successful in mapping the epigastric vessels in 95% of patients. At the xiphoid process level, the superior epigastric vessels (SEA) were 4.41 +/- 0.13 cm from the midline on the right and 4.53 +/- 0.14 cm on the left. Midway between xiphoid and umbilicus, the SEA were 5.50 +/- 0.16 cm on the right of the midline and 5.36 +/- 0.16 cm on the left. At the umbilicus, the epigastric vessels were 5.88 +/- 0.14 cm on the right and 5.55 +/- 0.13 on the left of the midline. Midway between the umbilicus and symphysis pubis, the inferior epigastric (IEA) were 5.32 +/- 0.12 cm on right and 5.25 +/- 0.11 cm on the left. At the symphysis pubis, the IEA were 7.47 +/- 0.10 cm on the right and 7.49 +/- 0.09 cm away from the midline on the left side. CONCLUSIONS: Epigastric vessels are usually located in the area between 4 and 8 cm from the midline. Staying away from this area will determine the safe zone of entry of the anterior abdominal wall.

Abdominal Wall↗