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At least 19 recordsLinked to original sources

Serial abdominal closure technique (the "SAC" procedure): a novel method for delayed closure of the abdominal wall.

Abdominal compartment syndrome may occur after any elective or emergent abdominal operations that are complicated by postoperative hemorrhage or in the trauma patient who has massive fluid replacement for intra-abdominal bleeding. Once the abdomen is decompressed the type of closure varies as much as the surgeon performing the procedure. We have devised a simple, reproducible, inexpensive, and safe method to close the abdomen at the bedside. Serial abdominal closure (SAC) was performed on three patients 45, 54, and 14 years of age who had developed abdominal compartment syndrome secondary to an upper gastrointestinal bleed requiring massive transfusion, a tear of the superior mesenteric vein, and a grade 4 liver laceration respectively, all necessitating abdominal decompression. All three patients had their abdominal wounds closed at the bedside over the course of several days with our SAC technique. Subsequent postoperative course was uneventful and the abdominal wall was free of defects at one-year follow-up. SAC is an efficient, inexpensive, and easily reproducible method of managing the open abdomen. The use of SAC prevented abdominal closure-related complications such as enteric fistula and hernia formation in our three patients.

Abdomen↗

[Diagnostic prenatal ultrasonography of malformations of the fetal anterior abdominal wall].

Abdominal wall defects include a broad spectrum of structural malformations with variable severity and prognosis. The purpose of prenatal ultrasound examination is to correctly diagnose and classify these malformations according to their localization (particularly their relation to the umbilical cord insertion), their contents, their size and associated malformations or karyotypic abnormalities. Based on this examination, two groups can be distinguished: gastroschisis or omphalocele (when the latter is isolated, in particular without karyotypic abnormalities) which can be surgically corrected at birth, and for which predictive criteria of outcome must be evaluated (vitality of herniated bowel, size and contents of omphalocele); severe malformations (ectopia cordis, cloacal exstrophy, Beckwith-Wiedemann syndrome, short umbilical cord, amniotic band syndrome) for which pregnancy termination could be proposed.

Abdominal Muscles↗

[Artificial mesh as an aid in abdominal wall closure in postoperative peritonitis, postoperative abdominal wall dehiscence and reconstruction of the abdominal wall].

Plastic mesh was utilized for repairing abdominal wall defects and postoperative wound dehiscence. In case of postoperative peritonitis the insertion of mesh without closing the skin provides a decrease of intra-abdominal pressure and an effective drainage of the abdominal cavity. The use of mesh in 27 patients shows the advantage of an absorbable mesh compared with a non-absorbable one.

Abscess↗

Abdominal wall reconstruction after temporary abdominal wall closure in trauma patients.

We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992. There were 10 deaths (28%) in the study population. Of the 26 survivors, 8 patients (31%) had primary fascial closure at initial hospitalization, whereas 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 have had ventral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operations including prosthetic reconstruction and eventual complex tissue transfer. Complications occurred in 3 patients (14%) and included two wound seromas, which were drained nonoperatively, and a wound infection necessitating removal of prosthetic material and subsequent reconstruction with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure can be done safely and promptly, with good functional and esthetic results.

Abdominal Injuries↗

[Reconstruction of abdominal-wall midline defects--The Abdominal-Wall Components Separation].

AIM OF THE STUDY: The recurrence rate of midline defects like incisional hernias is high. Alloplastic material in sublay or onlay technique is often be used if the suture tension is to high for a primary closure. Free or pedicled musculocutaneous flaps transfer denervated muscle and lack dynamic resistance against the intraabdominal pressure. The separation of the lateral abdominal wall achieves autogenous, dynamic material for a tension free closure in small and moderate midline defects. METHODS: In 1990 Ramirez described a technique, which separates parts of the lateral abdominal wall and advances it towards the midline. The innervation and blood supply of the advanced part is maintained. With this technique it is possible to close defects tension free with dynamic abdominal wall. 9 patients were treated with this technique and followed up. RESULTS: Midline defects up to 16 cm at the waistline could be closed without tension. There were no major complications (one small delayed wound healing). There were no recurrences in a follow up time of 14.2 months. CONCLUSION: The separation of parts of the lateral abdominal wall can achieve tension free closure of e.g. incisional hernias of small and moderate size. The advancement of the medial component provides well innervated muscle for dynamic resistance against the abdominal pressure.

Adult↗

[Dynamic and functional abdominal wall stabilization, reconstruction of extensive abdominal wall defects].

The aim of any abdominal wall reconstruction is maximal functional stability and adequate soft tissue coverage. The anatomy, elevation and clinical application of the myofascial tensor fasciae latae transposition flap and of the microvascular musculocutaneous latissimus dorsi free flap are presented. Repairing extensive fascial defects and recurrent hernias with the tensor fasciae latae transposition flap provides strong, dynamic, and functional reconstruction of fascial continuity to prevent a further recurrence. Adequate functional and aesthetic repair of a full-thickness abdominal wall defect can be optimally managed by the innervated microsurgical latissimus dorsi free flap.

Abdominal Muscles↗

Diagnosis and treatment of expanding haematoma of the lateral abdominal wall after blunt abdominal trauma.

We report a rare case of an expanding post-traumatic lateral abdominal wall haematoma. A superselective arteriogram of the deep circumflex iliac artery showed extravasation from the ascending branch, urging emergency therapy. Microcoil and Gelfoam embolisation was successfully performed. Haematomas of the abdominal wall can be divided in the common rectus sheath haematomas and the rare haematomas of the lateral abdominal wall. Differentiating both entities is essential, since there is a strong difference in their vascular supply. The typical vascular supply of the lateral abdominal wall is discussed, with emphasis on the ascending branch of the deep circumflex iliac artery.

Abdominal Injuries↗

[The role of diagnostic laparoscopy in treatment of penetrating injuries of the lower thoracic wall and anterior abdominal wall].

Penetrating injuries of the lower thoracic wall and anterior abdominal wall cause difficulties in the decision for laparotomy. For gunshot wounds laparotomy without further investigations is in most cases justified, but in other penetrating traumata one should use every diagnostic modality to prevent unacceptably high negative laparotomy rates. We performed diagnostic laparoscopy (DL) on 39 patients with penetrating injuries of the anterior abdominal wall and/or lower thoracic wall. Of these 39 patients, 25 had negative and 14 positive results. We had only one false-negative finding. No false-positive result occurred. We think that DL is a very reliable diagnostic tool which requires a relatively high technology.

Abdominal Injuries↗

Congenital hernia of the abdominal wall: a differential diagnosis of fetal abdominal wall defects.

A 28-year-old woman was referred at 33 weeks of gestation with suspected fetal intestinal atresia. Sonography showed a large extra-abdominal mass on the right of the normal umbilical cord insertion. Following Cesarean section at 36 weeks and immediate surgical treatment, the malformation was not definable either as an omphalocele or as gastroschisis. This reported case involves a previously undocumented malformation of the fetal abdominal wall described as a 'hernia' of the fetal abdominal wall.

Abdominal Muscles↗

Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release.

The management of primary and recurrent giant incisional hernias remains a complex and frustrating challenge even with multiple alloplastic and autogenous closure options. The purpose of this study was to develop a reconstructive technique of restoring abdominal wall integrity to a subcategory of patients, who have failed initial hernia therapy, by performing superior and lateral myofascial release. Over a 1.5-year period, 10 patients with previously unsuccessful treatment of abdominal wall hernias, using either primary repair or placement of synthetic material, were studied. The patients had either recurrence of the hernia or complications such as infections requiring removal of synthetic material. The hernias were not able to be treated with standard primary closure techniques or synthetic material. The average defect size was 19 x 9 cm. Each patient underwent wide lysis of bowel adhesions releasing the posterior abdominal wall fascia to the posterior axillary line, subcutaneous release of the anterior abdominal wall fascia to a similar level, and complete removal of any synthetic material (if present). The abdominal domain was reestablished by releasing the laterally retracted abdominal wall. The amount of available abdominal wall tissue was increased by wide release of the cephalic abdominal wall fascia overlying the costal margin and the external oblique fascia and muscle laterally. If needed, partial thickness of the internal oblique muscle and its anterior fascia were also released laterally to perform a tension-free primary closure of the defect. All repairs were closed with satisfactory functional and aesthetic results. All alloplastic material was removed. Fascial release was limited so as to close only the hernia defect without tension. No significant release of the rectus sheath and muscle was needed. Good, dynamic muscle function was noted postoperatively. All repairs have remained intact, and no further abdominal wall hernias have been noted on follow-up.

Abdominal Muscles↗

Massive abdominal wall desmoid tumor. Treatment by resection and abdominal wall reconstruction.

The management of a massive abdominal wall desmoid tumor in a young woman with Gardner's syndrome is discussed. Treatment options included primary radiation, subtotal excision with radiation, primary chemotherapy, or radical resection with abdominal wall reconstruction. The advantages and disadvantages of the various treatment options are discussed, and the technique of resection and reconstruction is explained.

Abdominal Muscles↗

CT of abdominal wall implantation metastases after abdominal percutaneous procedures.

PURPOSE: Our goal was to report the CT manifestations of abdominal wall implantation metastases occurring after abdominal percutaneous procedure. METHOD: CT scans and clinical data of six patients with abdominal wall implantation metastases at the puncture site following abdominal percutaneous procedure were reviewed. The abdominal percutaneous procedures included drainage of intraperitoneal abscess in patients with colon or gastric cancer (n = 2), transhepatic biliary drainage in a patient with hilar cholangiocarcinoma (n = 1), biopsy of intrahepatic hepatocellular carcinoma (n = 1), biopsy of a metastatic left adrenal gland (n = 1), and laparoscopic cholecystectomy in a patient with unsuspected gallbladder cancer (n = 1). RESULTS: CT enabled the diagnosis of abdominal wall implantation metastasis in all six patients and showed coexisting intraabdominal tumor sites in five patients. All abdominal wall implantation metastases were homogeneous before intravenous administration of iodinated contrast material and became moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. CONCLUSION: Abdominal wall implantation metastases are moderately heterogeneous on contrast-enhanced CT scan with marked enhancement relative to adjacent tissues. In most cases of abdominal wall implantation metastasis following abdominal percutaneous procedure, CT shows additional intraabdominal tumor sites. This complication may occur following a variety of abdominal percutaneous procedures (either radiological or surgical).

Abdominal Muscles↗

A comparison of polypropylene mesh, expanded polytetrafluoroethylene patch and polyglycolic acid mesh for the repair of experimental abdominal wall defects.

Abdominal wall defects created in Sprague-Dawley rats were repaired with either polypropylene mesh (PPM), expanded polytetrafluoroethylene patch (PTFE) or polyglycolic acid mesh (PGA). Tensiometric studies of abdominal wall strength showed that PPM and PTFE provided a strong repair, but that the fibrous response induced by PGA was insufficient to produce a strong support for abdominal wall reconstruction. The size of the overlap at the interface between the abdominal wall fascia and prosthetic material has a greater effect on wound strength with expanded PTFE than with PPM. This is because of the different pattern of collagen infiltration into each material.

Abdominal Muscles↗