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A patient who developed clostridial infection of the abdominal wall following laparotomy for small bowel perforation is described. Immediate debridement resulted in the loss of the entire abdominal wall. Dressing of the exposed viscera during the period of stabilization and prior to reconstruction was achieved using amniotic membranes.
The anterolateral thigh flap is a particular flap of the vastus lateralis musculocutaneous flap (perforator flap). This flap was used as a pedicled flap to reconstruct the abdominal wall and to cover the inguinal region following the resection of a voluminous tumor of the womb invading the abdominal wall, the femoral vessels and the skin. The flap included a large facial paddle nourishing a skin island and a little muscle paddle including the perforator vessel. This medially positioned facial paddle allowed to increase the area of useful flap. So it was possible to reconstruct a 10x15 cm abdominal wall defect, and to cover the vascular decking in inguinal region with this only flap. In spite of the harvesting of a small muscular paddle of vastus lateralis (with conservation of the motor nerve) the function of thigh extension has been preserved. Besides the subtlety described to increase the "solid" surface of the fragment, it seems that the anterolateral thigh flap is perfectly useful to cover defects of soft tissues in inguinal region after vascular surgery, indication which was not reported to our knowledge in spite of the high frequency of these losses defects.
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The authors present 6 observations of in utero detected abdominal wall defect : 2 laparoschisis and 4 omphaloceles. In three cases the diagnosis have been done prior week 20, by systematic AFP assay for amniocentesis performed for cytogenetic or metabolic reasons; the pregnancy was terminated. In three other cases, the pregnancy was complicated by hydramnios after week 30; amniocentesis for AFP and echography were performed to detect fetal malformations after associated with hydramnios. The detected abdominal wall anomaly was not alone: two fetus had an abnormal caryotype (trisomy 18), three other presented a polymalformative syndrome, a Beckwith-Wiedemann syndrome was discussed for the last child. The in utero diagnosis of omphalocele or laparoschisis implicates difficulties for genetic counselling, particularly if the diagnosis is done prior week 20. These anomalies can be treated with surgical management, but frequency of associated malformations must be underlined. it is important for genetic counselling to know the family history, the amniotic fluid cells caryotype, and an ultrasound scanning performed to reveal any other malformations.
Injuries of abdominal integuments, operations and reoperations of hernias, injuries of a spleen, defects in the wall of the chest and diaphragm cause that the need for substitute materials and alloplastic materials for completing those defects is large. To satisfy this tests have been made experiments with absorbable--Dexon, made by Davis and Geck enterprise, Ethicon and non-absorbable--Teflon made by Gore-Tex enterprise according to the proposition of H. Kuś. The experimental tests were made on 30 rabbits of the white New Zealand breed which weighted 2-3 kg. On the hypogastrium in the distance of 3 cm from the white line on its both sides defects of the size 2 x 3 cm were made. On the right side both fascial-muscular layers of the external and internal oblique muscle of abdomen were cut out but the peritoneum was left while on the left side only one layer was cut out. The defects were completed with nets and fixed with interrupted sutures and then with continuous suture. During the operation the behaviour of the nets in the operation area and the difficulties in connecting the nets with the animals' tissues were tested. Sections of the animals and macroscopic tests were made 7, 14, 21 and 90 days after the implantation of each surgical net estimating the process of healing and resorption of the absorbable nets. The state of the organs of the abdominal cavity was also estimated. Microscopic tests consisted of estimation of the histological specimens made from the tissues taken during the sections of the animals. At the estimation of the surgical convenience of the tested nets it turned out that each of them is very convenient. The differences were in the fact that the Dexon and Vicryl nets had little elasticity and extensibility and after cutting there was a little shredding of their edges. The Gore-Tex net, on the other hand, due to its specific spongy structure, had little extensibility, good elasticity and a complete lack of shredding of the edges after cutting. The macroscopic tests carried out in the planned terms did not showed any deformation or handicap of the functions of the abdominal integuments. The nets implantation did not cause displacement of the internal organs nor intraperitoneal adhesions. On the basis of the microscopic investigation it was noticed that the absorbable surgical nets underwent progressing resorption in the tissues in the period of 21 to 90 days after the implantation.(ABSTRACT TRUNCATED AT 400 WORDS)
Five cases of abdominal wall reconstruction using the tensor fasciae latae myocutaneous flap are described. This flap provides a deep layer of tissue of sufficient strength to prevent herniation and external cover in a single stage repair. We regard it as the method of choice in the reconstruction of major defects of the abdominal wall.
Failure of the lateral ventral folds to close by the third month of embryonic life results in an omphalocele. Although the abdominal wall defect is easily closed, the survival rate for infants with an omphalocele remains only 79%, largely the result of coexistent anomalies and chromosomal abnormalities. Gastroschisis is a deformation caused by disruption of the right omphalomesenteric artery and a resultant full-thickness defect in the abdominal wall. As a result, small bowel and, on occasion, even large bowel herniate into the amniotic space. Despite evidence of increased bowel irritability manifested by echogenic bowel wall thickening in fetuses with gastroschisis, the survival rate of more than 95% is largely the result of the lack of other severe anomalies associated with this defect. In addition, recent evidence suggests that the improvement in survival rate is also the result of improved perinatal care. The ability of perinatal specialists to categorize the defect along with associated anomalies and improved counseling regarding neonatal outcome have measurably increased the ability of families to assess the reproductive consequences and make informed decisions. This article outlines methods to identify patients at risk for having a fetus with an abdominal wall defect along with sonographic techniques to diagnose the majority of cases. Prompt consultation with individuals skilled in evaluating such defects ensures that appropriate perinatal care is provided.
An extensive muscle-fascia-peritoneum defect of the abdominal wall was closed by means of an implant of preserved human dura mater in rats. The behaviour of the implant was tested by macroscopic, microscopic, and mechanical examination until the 60th week after the operation. Microscopic investigations showed a predominance of absorption to the 12th week later the ingrowing of collagenous fibres. Mechanical investigations demonstrated a considerable reduction of the tensile strength until the 12th week and a slight increase afterwards. An advanced protrusion of the abdominal wall formed in reach of the implant after the 30th week. The implant transformed itself to a scarlike connective-tissue membrane of poor quality in the end. The mechanical function as abdominal wall was not accomplished effectively.
Intra-abdominal injuries of the bowel, mesentery, and mesenteric vessels were found at laparotomy in two patients with nonpenetrating gunshot wounds of the abdominal wall. The mechanism of wounding is thought to be the temporary cavity around the wound tract. The importance of complete angiographic investigation and early exploratory laparotomy is stressed.
The authors encountered a case of primary liver cell carcinoma which metastasized to the abdominal wall at a site corresponding to the location of an indwelling catheter for intra-arterial injections. The patient was a 54-year-old male with primary liver cell carcinoma in the posterior inferior segment. Because of a subsegmentectomy of the liver on September 25, 1986 and postoperative chemotherapy, a catheter for intra-arterial injections was inserted from the right gastroepiploic artery. After anticancer agents were administered postoperatively via this catheter, the same catheter was implanted subcutaneously before discharge. From the latter part of June 1987 after discharge, there was an increase in alpha FP and a subcutaneous tumor, which gradually increased in size, was found at a site in the right hypochondrium corresponding to the location of the arterial catheter. Angiography revealed a tumor nourished by the right 10th intercostal artery, and an operation was performed to remove this tumor. From a pathological examination, this case was diagnosed as metastatic liver cell carcinoma (metastasis to the abdominal wall). The tumor was not connected with the liver and matched the site in the abdominal wall where the arterial catheter was embedded. Therefore, implantation of a catheter cannot be ruled out as a mode of metastasis other than the blood stream.
We report an uncommon case of spontaneous massive hemorrhage of the abdominal wall caused by rupture of a deep iliac circumflex (DIC) artery. Enhanced computed tomography (CT) demonstrated a marked extravasation in a huge hematoma of the abdominal wall. Although a pelvic arteriogram demonstrated no extravasation, a superselective DIC arteriogram subsequently revealed an extravasation of the artery. We successfully performed transcatheter arterial embolization for the artery. There have been few reports in the literature of spontaneous hemorrhage in the abdominal wall resulting from rupture of DIC artery, which were defined by diagnostic imaging and successfully treated by transcatheter arterial embolization.
The interposition of synthetic material represents the most generally acknowledged method for achieving a tension-free surgical repair of major abdominal wall defects. As permanent materials are frequently associated with severe complications (rejection, peritonitis, enterocutaneous fistula, erosive invasion into the intestine), a newly designed absorbable prosthetic (polydioxanone, PDS) has been developed. The ellipsoid implant is composed of a knitted envelope and a filling of loosely arranged filaments. Interpositioning of the implant into an artificial circular abdominal wall defect was carried out on 30 Wistar rats. Explantation was performed 21 days post implantationem (p.i.), 42 days p.i. and 180 days p.i. The aim of the study was to evaluate the use of scanning electron microscopy (SEM) combined with maceration techniques (2 N NaOH for 1, 3 and 5 days) for a spatial assessment of the interactions between the implanted material and the ingrowing tissue components. Application of 2 N NaOH caused the complete dissolution of the PDS-material and a concomitant gradual disappearance of cellular and amorphous tissue components, thereby unmasking the remaining collageneous network. SEM of non-macerated specimens demonstrated that 21 days p.i. the entire implant has been filled with connective tissue components. Additionally, the ventral and dorsal surfaces of the implant were covered by a collageneous layer (neo-fascia). 21 days p.i. the PDS-filaments had developed minor clefts, which increased in number and depth 42 days p.i., and were transformed into small remnants 180 days p.i. Alkali treatment revealed the three-dimensional arrangement of collagen fibers, which ensheathed the PDS-filaments and formed interconnecting networks between them. At the ventral portion of the implant the fibrous network was more elaborate and densely distributed. 180 days p.i. the implant has been transformed into a membranous structure (neo-membrane) composed of the ventral and dorsal neofascia, remnants of PDS-filaments and a continuous connective tissue layer containing wave-like collagenous structures. Whereas 21 and 42 days p.i. no herniation was observed, 130 days p.i. the implant began to bulge out of the ventral abdominal wall. It is therefore concluded that inspite of the advantages of absorbable materials, longer resorption times may be required to allow a sufficient consolidation of the ingrowing connective tissue to resist the tensile forces of the abdominal muscle coat. SEM combined with 2N NaOH maceration proved to be a usefull tool in addition to conventional histological techniques for a three-dimensional assessment of fibrous connective tissue components ingrowing into alloplastic implants.
A case of desmoid fibroma of anterior abdominal wall, an exceptional benign tumor, is reported. Based on results of CT scan imaging of this lesion, differential diagnosis of other expansive processes of abdominal wall are discussed. This benign tumor is a potentially serious lesion due to its infiltrating character and the high incidence of recurrence. The need for total surgical excision is emphasized.
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a safe and easy procedure used to provide enteric nourishment in patients with non-operable, constricting, malignant tumors of the oropharynx or esophagus. However, as a late complication, the development of abdominal wall metastases have been described, the mechanism of which is controversially. PATIENTS AND METHODS: We describe two cases in which abdominal wall metastases developed 9 and 14 months, respectively, following PEG. Both patients suffered from an advanced esophageal carcinoma. One patient had to undergo surgery because of the size of the metastasis. This was followed by several weeks of hospital treatment. The second patient was already in a prefinal condition so that no surgical procedure was performed. Reviewing the current literature, we discuss the question of whether, in certain cases, an operative gastrostomy should be preferred to a PEG. RESULTS: As in our opinion the reason for abdominal wall metastases is direct tumor seeding, we suggest that in certain cases, in order to avoid a possible metastasis resection, an operative gastrostomy should be discussed. This is particularly relevant if the tumor is constricting with a high risk of losing tumor cells. If possible, a minimal-invasive method is to be preferred.
A 13-year-old male received high-voltage electrical burns with a resultant large direct wound on the upper abdomen involving the full-thickness of the abdominal wall, including the peritoneum. Early debridement, exploratory laparotomy and temporary restoration of the excised abdominal wall with a fascial prosthesis were carried out at 6 h post-burn. The bilateral upper and right lower limbs were amputated on the 10th post-burn day. The patient developed a 4x4 cm duodenocutaneous fistula on the 28th post-burn day, but was free of peritonitis. After 5 months of the conservative treatment, the fistula closed, and the abdominal wall defect was reconstructed with a free latissimus dorsi musculocutaneous flap. One month later, the patient was discharged following an uneventful recovery.
An excessively large abdominal wall stoma may prevent the correct fitting of an ostomy appliance causing significant morbidity and embarrassment. Skin excision and V-Y closure is a simple procedure that will increase patient comfort and facilitate management of the stoma. Laparotomy and extensive manipulation of the intestine are avoided.
A technique of abdominal wall reconstruction without the use of prosthetic materials or myocutaneous flaps following severe abdominal trauma is described. Six weeks before abdominal reconstruction, tissue expanders are inserted on either side of the ventral defect and inflated at weekly intervals to increase the amount of local tissue for coverage. Restoration of the abdominal wall is accomplished by denuding the skin graft covering the ventral defect of its dermal elements and suturing this newly created fascial graft to the existing rectus fascia. The fascial graft is covered with full-thickness skin using local advancement flaps. This procedure has been carried out on two patients in conjunction with closure of a colostomy in one and closure of an enterocutaneous fistula in another. Both patients healed without infection, and follow-up at 3 and 12 months postoperatively demonstrated no evidence of hernia formation.
A unique report of an abdominal wall rhabdomyoma is presented. The rarity of this tumor may lead to confusion with a malignant neoplasm. Computerized axial tomography localized the tumor to a specific muscle group and demonstrated absence of invasion into surrounding tissues. Computerized tomography is valuable in the assessment of abdominal wall tumors and provides useful information in planning an operative approach.