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Results for “Abdominal wall reconstruction”

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At least 19 recordsLinked to original sources

PubMed2000

The role of tissue expansion in abdominal wall reconstruction.

Abdominal wall reconstruction of ventral hernia defects with loss of visceral domain and inadequate soft-tissue coverage presents a surgical challenge. Four patients with large, skin grafted ventral hernia defects were treated by staged abdominal wall reconstruction. During the initial stage, tissue expanders were placed under the skin and subcutaneous tissue lateral to the defects. After adequate interval expansion, the second stage was performed. The expanders were removed, the visceral contents reduced easily, and the fascia reapproximated with polypropylene mesh. The expanded skin was closed easily over the fascial repair. All four patients were reconstructed successfully without complications. Tissue expansion can restore abdominal domain and allow soft-tissue closure in complicated ventral hernia defects.

Abdominal Muscles↗

PubMed1994

The use of Mitek anchors to secure mesh in abdominal wall reconstruction.

Abdominal wall complications of TRAM flap breast reconstruction are well described. Synthetic mesh abdominal reinforcement is believed to decrease the incidence of these complications. An innovative technique with commonly available suture anchors has been used in a case of recurrent abdominal laxity after a TRAM flap. Osseous fixation of synthetic mesh with the Mitek GII suture anchor will undoubtedly be used more widely in abdominal wall reconstruction.

Abdominal Muscles↗

PubMed1996

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↗

PubMed2000

An algorithm for abdominal wall reconstruction.

Acquired abdominal wall defects result from trauma, previous surgery, infection, and tumor resection. The correction of complex defects is a challenge to both plastic and reconstructive and general surgeons. The anatomy of the abdominal wall, as well as considerations in patient assessment and surgical planning, are discussed. A simple classification of abdominal wall defects based on size, depth, and location is provided. Publications regarding the various abdominal reconstruction techniques are reviewed and summarized to familiarize the reader with the treatment options for each particular defect. Finally, an algorithm is presented to guide the surgeon in selecting the optimal reconstructive technique.

Abdominal Muscles↗

PubMed1990

Total abdominal wall reconstruction.

Total abdominal wall loss results in a difficult reconstructive problem. To obtain stable, durable soft-tissue coverage and restore fascial integrity, a number of reconstructive techniques are frequently required. Use of these techniques can achieve a functional and cosmetically acceptable reconstruction.

Abdominal Muscles↗

PubMed2005

Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome.

INTRODUCTION: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. METHODS: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and chi analysis. RESULTS: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. CONCLUSIONS: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.

Abdomen↗

PubMed2003

Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model.

This study investigates whether human acellular dermis (Alloderm; LifeCell, Branchburg, NJ) revascularizes when used to reconstruct abdominal wall defects in rabbits. This could prove useful in infected situations in which prosthetic mesh is suboptimal. Twenty-five rabbits were randomly assigned to one of three groups: primary closure (n = 5), expanded polytetrafluoroethylene (GoreTex; W.L. Gore, Flagstaff, AZ) repair (n = 10), or AlloDerm (LifeCell) repair (n = 10). The rabbits in the primary closure group received a 7 cm x 0.5 cm full-thickness abdominal wall defect that was closed primarily. A 7 cm x 3 cm full-thickness abdominal wall defect was created in the other two groups. The defects were repaired with a GoreTex Mycromesh (W.L. Gore), or AlloDerm (LifeCell) patch. At 30 days, the following endpoints were evaluated: (1) incidence of herniation; (2) presence of intra-abdominal adhesions; (3) the breaking strength of the patch-fascial interface; and (4) evaluation of graft vascularization by fluorescein dye infusion and histological analysis. There was no incidence of herniation in any of the rabbits. Visceral adhesions to the patch were found in all animals in the Gore-Tex (W.L. Gore) group but in none in the AlloDerm (LifeCell) group. The size of the patch was unchanged in all the rabbits except for two rabbits in the AlloDerm (LifeCell) group that stretched 1 cm in the transverse dimension. The change in size was not statistically significant (p = 0.17) when compared with the change in size in the Gore-Tex (W.L. Gore) group. The mean breaking strength of the primary closure group was significantly higher (521.2 N/mm2 +/- 223.0) than that of the two patch-repair groups (p < 0.05). But there was no significant difference between the mean breaking strength of the AlloDerm (LifeCell) fascial interface (288.6 N/mm2 +/- 97.1 SD) and that of the Gore-Tex (W.L. Gore) fascial interface (337.0 N/mm2 +/- 141.2). Fluorescein dye infusion and histological analysis confirmed vascularization of the AlloDerm (LifeCell) graft. This study demonstrates that AlloDerm (LifeCell) does become vascularized when used as a fascial interposition graft for abdominal wall reconstruction. AlloDerm (LifeCell) also performs mechanically as effectively as Gore-Tex (W.L. Gore) in ventral hernia repair at 1 month after operation in the rabbit model.

Abdominal Injuries↗

PubMed1986

Abdominal wall reconstruction.

Patients with abdominal wall reconstruction present a difficult management problem to the oncological surgeon. There were 36 patients treated for abdominal wall primary and secondary tumors between the years 1973 and 1982 at the Memorial Hospital. There were 25 abdominal wall sarcomas, 6 recurrent colon cancers, 2 recurrent bladder cancers, 1 cervical cancer, 1 recurrent endometrial cancer and 3 complications of radiotherapy treated by excision and reconstruction of the defect. The desmoid tumors were closed primarily. The recurrent sarcomas after radical excision, were reconstructed with Marlex mesh and local mobilization of skin and subcutaneous tissue. The recurrent colon bladder and endometrial cancers had been treated with over 5,000 cGy each. Three patients had significant full thickness skin loss secondary to radiotherapy. These patients comprised the group that required a myocutaneous flap to provide full thickness skin and fascia. The tensor fascia lata flap was used in eight patients. This group of patients did extremely well in contrast to the group of radiated patients with Marlex mesh reconstruction. There were less complications in the TFL group. We recommended the TFL flap for a large abdominal wall defect and for a previously radiated abdominal wall.

Abdominal Muscles↗

PubMed2006

Abdominal wall reconstruction after temporary abdominal closure: A ten-year review.

Abdominal wall reconstruction (AWR) is often required for hernias created after temporary abdominal closure (TAC). Demographic and clinical data from patients undergoing TAC and AWR between January 1, 1992, and December 31, 2002, were collected and univariate analysis performed. Temporary abdominal closure and AWR were performed in 21 patients. Complications developed in 12 patients (57.1%) after TAC; associated risk factors were mesh placement (P = .04) and skin grafting (P = .04). Successful AWR included mesh (n = 6), component separation (n = 6), primary repair (n = 4), and 3 combination techniques. Six patients (28.6%) developed intraoperative complications, and 14 (66.7%) developed postoperative complications. Intraoperative complications were increased in patients with tissue expanders (P = .01). Postoperative complications (P = .04) were less likely with component separation. The complication rate with TAC and AWR is high. Tissue expanders are associated with an increased risk of intraoperative complications with AWR, whereas component separation is associated with a reduction in postoperative complications.

Abdominal Wall↗

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↗

PubMed1987

One-stage abdominal wall reconstruction with oblique abdominal fasciocutaneous flaps.

The coverage of large soft-tissue defects of the abdominal wall resulting from ablative surgery continues to be a challenging problem. Numerous flaps have been used, but flaps have their limitations in size and as well as arc of rotation, and often require skin grafting of the secondary donor site. Thus, a combination of flaps may be required to close some of the larger defects without resorting to the use of skin grafts. This article reports a patient with an ulcerated abdominal wall tumor defect reconstructed with oblique abdominal fasciocutaneous flaps. Two flaps based on superior and inferior epigastric perforators were contoured to fit the massive defect in one stage without using a skin graft. After surgery the flap healed uneventfully and the patient was discharged from the hospital. She is now undergoing irradiation therapy in an outpatient clinic.

Abdominal Muscles↗

PubMed1999

The use of tissue expanders in staged abdominal wall reconstruction.

Reconstruction of large abdominal wall defects not amenable to primary closure remains a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report the authors describe their experience in treating 11 patients with large abdominal wall defects utilizing prosthetic mesh in conjunction with tissue expanders. Between 1986 and 1997 there were 6 pediatric and 5 adult patients treated with this method. The etiology included three congenital omphaloceles, five cases of necrotizing fasciitis, and three gunshot wounds. All patients initially required insertion of prosthetic mesh to bridge their large abdominal wall defects. This was followed by staged abdominal wall reconstruction with tissue expanders and prosthetic mesh. None of the patients had mesh infection or extrusion, and none developed enteric fistula or recurrent hernia. The tissue expansion process was well tolerated by all patients. One patient had partial exposure of the tissue expander due to thinning of the expanded skin. Our results suggest that the use of tissue expanders provides reliable, well-vascularized soft-tissue coverage and minimizes potential mesh-related complications in abdominal wall reconstruction.

Abdominal Muscles↗

PubMed2006

Anterior abdominal wall reconstruction with a Permacol implant.

Laparostomy wound management is a difficult problem especially with a stoma and the potential risk of infection. A case describing the use of a permanent porcine dermal collagen implant in the repair of a massive ventral hernia, in a patient with a large post-laparostomy defect and colostomy is outlined. The implant was not rejected, and after 12 months, there was no evidence of residual or recurrent hernia. The search for the ultimate biomaterial for reconstructing abdominal wall defects is ongoing. Collagen based implants appear to have many of the requirements that an ideal material should possess.

Abdominal Wall↗

PubMedDate not supplied

Use of homologous acellular dermal matrix for abdominal wall reconstruction in rats.

Homologous acellular dermal matrix graft (HADMG) has been used for the reconstructions of bowel, bladder, or urethra, but its suitability in the reconstruction of abdominal wall has not been tested. Therefore an experimental study was performed to evaluate the use of HADMG for the reconstruction of abdominal wall defects in weanling rats. Thirty weanling Wistar rats were used. A patch of abdominal wall 20 x 20 mm in dimension was removed. The defects were reconstructed with HADMGs that were derived from rat skin and prepared through a detergent enzymatic method. The reconstructed abdominal walls were evaluated as hernia rate and graft take ratio, excised and prepared for histological examination at 21 (n = 10), 40 (n = 10), and 90 (n = 10) days postoperation. The healing of repaired abdominal walls was uneventful. Histological evaluation demonstrated the migration of fibroblasts and neovascularization within the HADMG. Hernia in four rats were developed at 90 days. Neither significant wound contraction nor inflammation was seen at 21, 40, and 90 days after surgery in wounds receiving HADMGs. Thus, the use of a HADMG for reconstructing the abdominal wall in weanling rats has not given rise to any complications. HADMG has progressively remodeled into fibrous tissue. It appears to represent an important alternative substitute for the reconstruction of abdominal wall.

Abdominal Wall↗

PubMedDate not supplied

Abdominal wall reconstruction with a vascular external abdominal oblique myofascial flap.

A myofascial island flap for abdominal wall reconstruction was based on the lumbar component of the external abdominal oblique muscle and supplied by a major neurovascular pedicle consisting of branches of the cranial abdominal artery, cranial hypogastric nerve, and a satellite vein. The flap was elevated and sutured into a 10 cm x 10 cm body wall defect in five dogs. The dogs were observed for 26 to 28 days. Abdominal wall contour and function were preserved. All dogs developed seromas, two of which became infected. One dog developed a hernia at the dorsal margin of the flap, which was repaired. At necropsy, there was no evidence of dehiscence in any of the dogs. Loose adhesions of omentum to the inner surface of the flap occurred in four dogs. Results of histologic examination confirmed the clinical impression of flap viability. The myofascial island flap has a wide range of mobility over the ventral and caudal areas of the abdomen and lateral thoracic wall. It has potential clinical use for reconstruction of defects within its arc of rotation.

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↗

PubMed2004

[Abdominal wall reconstruction with pedicled rectus femoris muscle flap].

INTRODUCTION: Large abdominal hernias or abdominal wall defects often require the use of prosthetic mesh, local tissue transposition or even distant muscle flaps for proper reconstruction of the abdominal wall. The disadvantages of meshes are well known. The use of muscle flaps is an appreciated alternative. PATIENTS AND METHODS: We present 12 cases with reconstruction of the abdominal wall using pedicled rectus femoris muscle flaps after tumor resections, incisional hernias, and infection. Follow up time ranged from 6 months to 4 years. Abdominal wall stability was examined clinically. The aesthetic and the functional result were assessed using a standardized questionnaire. To objectively evaluate the loss of force in the quadriceps muscle the maximal voluntary knee extension torque was measured. RESULTS: In all patients except one a stable abdominal wall was achieved. No major complications occurred. The loss of torque in the operated leg was tolerable. DISCUSSION: The donor site morbidity is relatively low and the flap provides an easy and save possibility to reconstruct the abdominal wall. The rectus femoris muscle flap should be considered as an alternative for abdominal wall reconstruction.

Abdominal Wall↗

PubMed1986

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↗