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Prinz J, Hartmann K, Migliorini F, Hamesch K, Walter P, Fuest M, Kuerten D. Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction. Int Ophthalmol 2023; 43:4729-4737. [PMID: 37721702 PMCID: PMC10724318 DOI: 10.1007/s10792-023-02873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). METHODS In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0-81.0, median 13.0, last follow-up) months in all patients. RESULTS At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. CONCLUSION In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kathi Hartmann
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Karim Hamesch
- Department of Gastroenterology and Hepatology, RWTH Aachen University, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Alheib O, da Silva LP, Mesquita KA, da Silva Morais A, Pirraco RP, Reis RL, Correlo VM. Human adipose-derived mesenchymal stem cells laden in gellan gum spongy-like hydrogels for volumetric muscle loss treatment. Biomed Mater 2023; 18:065005. [PMID: 37604159 DOI: 10.1088/1748-605x/acf25b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND volumetric muscle loss (VML) is a traumatic massive loss of muscular tissue which frequently leads to amputation, limb loss, or lifetime disability. The current medical intervention is limited to autologous tissue transfer, which usually leads to non-functional tissue recovery. Tissue engineering holds a huge promise for functional recovery. METHODS in this work, we evaluated the potential of human adipose-derived mesenchymal stem cells (hASCs) pre-cultured in gellan gum based spongy-like hydrogels (SLHs). RESULTS in vitro, hASCs were spreading, proliferating, and releasing growth factors and cytokines (i.e. fibroblast growth factor, hepatocyte growth factor, insulin-like growth factor 1, interleukin-6 (IL-6), IL-8, IL-10, vascular endothelial growth factor) important for muscular regeneration. After implantation into a volumetric muscle loss (VML) mouse model, implants were degrading overtime, entirely integrating into the host between 4 and 8 weeks. In both SLH and SLH + hASCs defects, infiltrated cells were observed inside constructs associated with matrix deposition. Also, minimal collagen deposition was marginally observed around the constructs along both time-points. Neovascularization (CD31+vessels) and neoinnervation (β-III tubulin+bundles) were significantly detected in the SLH + hASCs group, in relation to the SHAM (empty lesion). A higher density ofα-SA+and MYH7+cells were found in the injury site among all different experimental groups, at both time-points, in relation to the SHAM. The levels ofα-SA, MyoD1, and myosin heavy chain proteins were moderately increased in the SLH + hASCs group after 4 weeks, and in the hASCs group after 8 weeks, in relation to the SHAM. CONCLUSIONS taken together, defects treated with hASCs-laden SLH promoted angiogenesis, neoinnervation, and the expression of myogenic proteins.
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Affiliation(s)
- Omar Alheib
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Lucilia P da Silva
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Katia A Mesquita
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alain da Silva Morais
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rogério P Pirraco
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Vitor M Correlo
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Matsukubo M, Muto M, Yamada K, Nishida N, Kedoin C, Matsui M, Nagano A, Murakami M, Sugita K, Yano K, Onishi S, Harumatsu T, Yamada W, Kawano T, Kaji T, Ieiri S. Abdominal wall defect repair with component separation technique for giant omphalocele with previous relaxing incisions on the abdominal skin. Surg Case Rep 2023; 9:99. [PMID: 37284984 DOI: 10.1186/s40792-023-01679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The repair of large abdominal wall defects that cannot be closed primarily is quite challenging. The component separation technique (CST) is a surgical approach using autologous tissue to close large abdominal wall defects. The CST requires extensive dissection between the abdominal skin and the anterior sheath of the rectus abdominis muscle. Subsequently, incisions are made at both sides of the external oblique aponeurosis, releasing the external oblique muscle from the internal oblique muscle, and then the right and left rectus abdominis muscles are brought together in the midline for defect closure. However, impairment of blood flow in the abdominal wall skin and necrotic changes are recognized as potential complications. CASE PRESENTATION The CST was performed in a 4-year-old boy with a large ventral hernia who had undergone skin closure with abdominal wall relaxing incisions for the primary treatment of giant omphalocele in the neonatal period. Given his history of incisions on the abdominal wall, he was speculated to be at high risk for postoperative skin ischemia. Dissection was therefore kept to a minimum to preserve the blood supply from the superior and inferior epigastric arteries and perforating branches of those arteries through the rectus abdominis muscle. In addition, care was taken to adjust the muscle relaxant dosage while monitoring the intravesical pressure, ensuring that it did not exceed 20 mmHg to avoid impaired circulation in the abdominal wall caused by abdominal compartment syndrome. He was discharged 23 days after the surgery without any complications, and neither recurrence of the ventral hernia nor bowel obstruction was observed in 4 years. CONCLUSIONS A giant omphalocele with primary skin closure was treated by applying the CST. The procedure can be performed safely while preserving the blood flow to the abdominal wall, even in patients with a history of relaxing incisions on the abdominal skin. The CST is expected to be effective for repairing the large abdominal wall defects seen in giant omphalocele when primary closure is not possible.
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Affiliation(s)
- Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan.
| | - Koji Yamada
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 8908520, Japan
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Fernández-Garrido M, Torrano L, González López J, Masia J, Sisternas Hernández L, D'Guilio Arevalo G, Zamora Alarcón P. To bulge or not to bulge: Rectus abdominis functional reconstruction after soft tissue sarcoma resection. J Plast Reconstr Aesthet Surg 2023; 78:10-12. [PMID: 36736105 DOI: 10.1016/j.bjps.2022.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Manuel Fernández-Garrido
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Laura Torrano
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - José González López
- General Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jaume Masia
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lucía Sisternas Hernández
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gabriella D'Guilio Arevalo
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Paúl Zamora Alarcón
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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Winsnes A, Ivarsson ML, Falk P, Gunnarsson U, Strigård K. Similar collagen distribution in full-thickness skin grafts in intraperitoneal and onlay positions, an experimental mice-study. Hernia 2022; 26:1695-1705. [PMID: 36048398 DOI: 10.1007/s10029-022-02664-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Autologous full-thickness skin grafting (FTSG) has the potential to become an option in abdominal wall repair. An understanding of tissue remodelling in the extracellular matrix (ECM) is crucial as this interplay determines such parameters as tissue strength and flexibility. This cross-sectional preclinical laboratory study in mice provides information on the distribution of collagen types and matrix metalloproteinases (MMPs) in the ECM of FTSGs in the intraperitoneal and onlay positions compared with internal controls. The aim was to evaluate morphologic changes after tissue remodelling and repair in FTSGs applied in the two positions and to detect any adverse host response. METHODS ECM components were evaluated as follows: qualitative examination of collagen bundle thickness using Picrosirius Red staining (collagen types I, III and IV); and evaluation of collagen types IV and V, as well as MMPs 1, 8 and 9 using immunohistochemical staining. Full-thickness grafts transplanted between female twin mice were examined as this best mimics autologous transplantation. RESULTS At 8 weeks, FTSGs in the intraperitoneal position did not show any noticeable differences in morphologic appearance to those in the onlay position. Both intraperitoneal and onlay FTSGs showed increases in the amount of thick collagen bundles compared to internal controls. No correlation was seen between distribution of MMPs 1, 8 or 9 and distribution of collagen types I, III, IV or V. CONCLUSION This preclinical study shows that FTSGs in both intraperitoneal and onlay positions are possible application site options and, by extension, promising application site options for abdominal wall reinforcement in hernia surgery. Clinical studies in humans are required to confirm these findings.
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Affiliation(s)
- A Winsnes
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 87, Umeå, Sweden
| | - M-L Ivarsson
- Department of Surgery, University of Gothenburg, Gothenburg, Sweden
| | - P Falk
- Department of Surgery, University of Gothenburg, Gothenburg, Sweden
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 87, Umeå, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 87, Umeå, Sweden.
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Ninkovic M, Ninkovic M, Öfner D, Ninkovic M. Reconstruction of Large Full-Thickness Abdominal Wall Defects Using a Free Functional Latissimus Dorsi Muscle. Front Surg 2022; 9:853639. [PMID: 35372467 PMCID: PMC8968006 DOI: 10.3389/fsurg.2022.853639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The large full-thickness abdominal wall defect has to be treated by considering anatomical and functional requirements. The abdominal wall must regain total physiological function, which means that the full thickness abdominal wall defect must be reconstructed anatomically, not only according to the anatomical requirements but also maintaining the functional dynamic voluntary movement. Defects in the abdominal wall alter respiratory mechanics and can impair the diaphragm function. Additionally, muscles of the anterolateral abdominal wall increase the stability of the lumbar region of the vertebral column by tensing the thoracolumbar fascia and by increasing intraabdominal pressure. Materials and Methods The timing and method of reconstruction must be chosen depending upon the etiology of the defect. Severe traumatic injuries, abdominal wall infections, necrotizing soft tissue loss, or sepsis needs to undergo staged reconstruction following adequate debridement to control the infectious process, establish the zone of injury, and for proper treatment of intraabdominal pathology, thereby achieving temporary primary closure using split-thickness skin grafting to the viscera. At the time of definitive reconstruction, deep skin graft dermabrasion give us a facial-like layer with adequate strength to stabilize the static abdominal wall. This dermal layer is supported by free functional (innervated) latissimus dorsi muscle (fLDM), giving full anatomical coverage and functional stability. After oncologic resections full-thickness abdominal wall reconstruction was performed immediately with a combination of fLDM flaps and meshes. Results A total of 14 patients underwent abdominal wall reconstruction using the fLDM flap. Staged reconstruction was applied in 8 cases. In the remaining six cases, two had no mesh support, three had synthetic mesh, and one had a fascial graft, which were covered with fLDM flap. There were no free flaps failure. One flap revision due to venous anastomosis thrombosis was performed. Donor site seromas occurred in 5 cases and were treated with punction and direct doxycycline injection. Electromyographic testing postoperatively confirmed reinnervation of transplanted LDM. Conclusion Using fLDM as a definitive solution, we are not only able to repair soft tissue defects, but also reconstruct voluntary contractility and dynamic natural functional abdominal wall. Transplanted LDM offers enough contractile capacity and strength to replace the function of the missing abdominal wall muscles.
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Affiliation(s)
- Marijana Ninkovic
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
- *Correspondence: Marijana Ninkovic
| | - Marina Ninkovic
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, München Klinik Bogenhausen, Munich, Germany
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Winsnes A, Falk P, Gunnarsson U, Strigård K. Full-thickness skin grafts to reinforce the abdominal wall: a cross-sectional histological study comparing intra- and extraperitoneal onlay positions in mice. J Wound Care 2022; 31:48-55. [PMID: 35077208 DOI: 10.12968/jowc.2022.31.1.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In the repair of complex abdominal wall hernia, there can be a strong preference to avoid synthetic or biological implants as reinforcement material. Autologous full-thickness skin grafts (FTSG) have shown promising results. However, there are few clinical data on the use of FTSG in an intraperitoneal position and rudimentary knowledge about postoperative histological appearance of tissue remodelling and repair. OBJECTIVE To investigate the histological appearance of FTSG in the intraperitoneal onlay mesh (IPOM) position. METHODS Isogeneic FTSG was positioned in the IPOM (10 mice) and the onlay position (10 mice). After eight weeks, tissues were harvested for histological analysis. Tissue structure, inflammation and cell survival were investigated with histological and immunohistochemical staining. RESULTS Morphology was similar in both positions. Luciferase staining indicated both onlay and IPOM graft cell survival, with microvascular networks present. In both positions, FTSG showed ongoing tissue remodelling processes and cystic formations containing hair and epidermis. Low-grade acute phase and chronic inflammation were present. Integration was observed in 50% of the mice with similar appearances in IPOM and onlay grafts. CONCLUSION FTSG is tolerated, with comparable results either inside or outside the abdominal cavity, and in line with historic histological evaluations. The results suggest further research on FTSG as a potential future reinforcement material in selected cases of complex abdominal wall hernia repair.
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Affiliation(s)
- Annika Winsnes
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 85, Umeå, Sweden
| | - Peter Falk
- Fibrinolysis Lab/Tissue Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85 Gothenburg, Sweden
| | - Ulf Gunnarsson
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 85, Umeå, Sweden
| | - Karin Strigård
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Daniel Naezéns väg, 901 85, Umeå, Sweden
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Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves' orbitopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3365-3373. [PMID: 35588330 PMCID: PMC9477929 DOI: 10.1007/s00417-022-05696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the use of fascia lata (FL) grafts for inferior rectus muscle (IRM) tendon elongation in patients with large vertical squint angles with Graves' orbitopathy (GO). METHODS In this retrospective study, we included a consecutive series of 20 eyes of 13 patients with GO who underwent IRM tendon elongation with FL. Orthoptic and ophthalmologic examinations including measurement of the head posture, the extent of deviation in primary position (PP), elevation, motility, and binocular diplopia at the tangent of Harms were conducted preoperatively and after a mean postoperative time of 10.8 (5.0-35.0) months in all patients. RESULTS The mean total repositioning distance was 9.3 ± 3.6 (3.5-16.0) mm. Postoperatively, we found a significant increase in elevation (5.4 ± 2.4 vs. 2.7 ± 2.4 mm preoperatively, p = 0.011). A significant reduction in vertical squint angle (2.8 ± 3.7 vs. 20.2 ± 18.8 Δ preoperatively, p = 0.004), chin elevation (2.3 ± 3.7 vs. 12.9 ± 6.3° preoperatively, p < 0.001), extorsion in PP (0.1 ± 3.8 vs. 8.4 ± 7.8° preoperatively, p = 0.002), and in elevation (1.8 ± 4.8 vs. 11.1 ± 10.9° preoperatively, p = 0.004) occurred postoperatively. A mean dose-effect relation of 2.6 ± 2.9 Δ/mm was calculated. Postoperatively, the lower eyelid retraction was significantly increased (1.5 ± 1.4 vs. 0.4 ± 0.5 mm preoperatively, p = 0.005). CONCLUSION IRM tendon elongation with FL is a feasible and effective procedure without relevant risk for surgery-related complications.
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Mesh Migration into the Neobladder and Ileum with Complicated Fistula Formation following Incisional Hernia Repair. Case Rep Surg 2021; 2021:5683621. [PMID: 34733565 PMCID: PMC8560301 DOI: 10.1155/2021/5683621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Tension-free repair using mesh has become the standard treatment for abdominal wall incisional hernias. However, its postoperative complications reportedly include mesh infection, adhesions, and fistula formation in other organs. Here, we report an extremely rare case of mesh migration into the neobladder and ileum with entero-neobladder and neobladder-cutaneous fistulas. Case Presentation. An 80-year-old male who had undergone radical cystectomy 5 years ago and abdominal wall incisional hernia repair 3 years ago presented with fever and abdominal pain. Computed tomography (CT) scan revealed mesh migration into the neobladder and ileum. He was treated conservatively with antibiotics for a month but did not show improvement; hence, he was transferred to our hospital. He was diagnosed with mesh migration into the neobladder and ileum with complicated fistula formation. He underwent mesh removal, partial neobladder resection, and partial small bowel resection. He developed superficial incisional surgical site infection, which improved with drainage and antibiotics, and he was discharged 40 days after the surgery. Conclusions We reported a rare case of mesh migration into the neobladder and ileum with fistula formation. Successful conservative treatment cannot be expected for this condition because mesh migration into the intestinal tract causes infection and fistula formation. Hernia repair requires careful placement of the mesh such that it does not come into contact with the intestinal tract. Early surgical intervention is important if migration into the intestinal tract is observed.
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Song Z, Yang D, Song H, Dong W, Wu J, Yang J, Gu Y. Surgical treatment strategy for locally advanced colorectal cancer with abdominal wall invasion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:874. [PMID: 34164508 PMCID: PMC8184446 DOI: 10.21037/atm-21-2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The incidence of abdominal wall metastasis from colorectal cancer (CRC) is very low, but it has a poor prognosis. Despite the advances in radiotherapy, chemotherapy, and targeted therapy, patient prognosis has not improved significantly. Through surgical treatment, some patients with locally advanced CRC with abdominal wall invasion can achieve tumor-free survival or an improved quality of life. Methods The clinical data of 15 patients in our department from January 2015 to January 2020 were retrospectively analyzed. All patients underwent preoperative three-dimensional reconstruction of the tumor and abdominal wall after discussion with a multidisciplinary team (MDT). Patient information, including tumor size, defect size, operation time, intraoperative bleeding, hospital stay, and other factors, was collected. Results All 15 patients underwent resection followed by reconstruction for locally advanced CRC with abdominal wall invasion. The average tumor area and abdominal wall defects were 98.13±71.70 and 270.07±101.95 cm2, respectively; and accurate abdominal wall classification and zoning were obtained for all patients. The average operation time was 431.7±189.2 min, and the average blood loss was 513.3±244.6 mL. The recurrence rates in the incisional hernia and abdominal wall were 6.0% and 13.3%, respectively. The patient survival rate was 87.7%. Conclusions Surgical treatment of locally advanced CRC with abdominal wall invasion is feasible, but requires accurate and comprehensive preoperative evaluation.
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Affiliation(s)
- Zhicheng Song
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongchao Yang
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Song
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenpei Dong
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jugang Wu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Yang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Gu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Inferior Pedicled De-epithelialized Dermal Flap for Abdominal Wall Support in Recurrent Abdominal Hernias. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Ultrasound-guided Hydro-dissection Facilitates Tissue Expander Placement and Components Separation in Complex Ventral Hernia Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3051. [PMID: 33133933 PMCID: PMC7544377 DOI: 10.1097/gox.0000000000003051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
Tissue expanders are known adjuncts in ventral hernia repair, used in a staged approach where tissue closure or coverage of the defect is preferred but inadequate. Placement of tissue expanders in the correct tissue plane can be difficult, especially in thin patients or with loss of domain. This case series describes a technique in which tissue expander placement is facilitated by ultrasound-guided hydro-dissection, following the placement of a transversus abdominis plane (TAP) block. In short, after induction of anesthesia, the same needle used for the ultrasound-guided TAP block can be repositioned by the anesthesiologist to instill tumescent solution into the fascial plane between the internal and external oblique muscles. This allows for identification of the fascial planes in the ensuing operation. Our technique may prove to be an alternative tool in the placement of tissue expanders for ventral hernia repair, or in other procedures requiring device placement.
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13
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Surgical treatment of massive stoma site tumors after a curative operation for rectal cancer. Eur J Surg Oncol 2020; 46:e40-e46. [PMID: 32843278 DOI: 10.1016/j.ejso.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical and oncological outcomes of selected rectal cancer patients with massive stoma site tumors who underwent radical resection and reconstruction. METHODS We reviewed 8 cases of massive stoma site tumors in patients who had permanent gastrointestinal stoma in the abdominal wall following radical resection of rectal cancer between March 2013 and May 2018 at the Peking University Cancer Hospital and Peking University Shougang Hospital. RESULTS There were seven males and one female patient, with a median age of 50.6 years. The average time between the initial surgery and the development of a malignant tumor at the stoma site was 5 years (range, 0.5-14 years). The average diameter of the stoma site tumors was 8.1 cm, and the diameter of the largest tumor was 12 cm. After tumor resection, the area of the largest abdominal wall defect was about 15 × 14 cm2. Abdominal wall repair included the use of a tensor fasciae latae muscle flap, local fasciocutaneous rotational flap, and pedicled anterolateral thigh flap. No patient died in the 30 days following surgery. The longest follow-up period was 81 months, and 5 patients died. CONCLUSIONS Multidisciplinary clinical management fosters positive outcomes in treating massive stoma site tumors. Local R0 resection and abdominal wall reconstruction are safe and feasible, and function to removes local disease, allowing patients to live a higher quality of life.
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14
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Song YH, Huang WJ, Xie YY, Hada G, Zhang S, Lu AQ, Wang Y, Lei WZ. Application of double circular suturing technique (DCST) in repair of giant incision hernias. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:764. [PMID: 32647689 PMCID: PMC7333136 DOI: 10.21037/atm-20-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Our study aims to explore the feasibility and safety of a double circular suturing technique (DCST) in the repair of giant incision hernias. Methods The clinical data of 221 patients (95 men and 126 women; the average age was 61.6 years) receiving DCST in the repair of giant incision hernia between January 2010 and December 2018 was analyzed retrospectively. One hundred and five primary and 16 recurrent patients underwent herniorrhaphy with anti-adhesion underlay mesh repair using DCST. Results All the 221 operations were performed successfully. The average preparation time before the operation and hospital stays were 3.7 days (range, 1-6 days) and 7.5 days (range, 2-16 days), respectively. The average diameter of the hernia ring defect observed intraoperatively was 16.4 cm (range, 12-22 cm). The average time of operation was 83.6 min (range, 43-195 min). There were 2 cases of intestinal fistula, 4 cases of wound infection, 2 cases of mesh infection, 7 cases of serum tumescence, 3 cases of pulmonary infection, and 2 cases of wound dehiscence occurred. One hundred and ninety-five patients were followed up for 6.7 years (range, 0.8-9.5 years) postoperatively. Of them, 9 patients recurred; 14 patients had chronic pain whose visual analog scale (VAS) was 2-4 cm (average 2.7 cm). Conclusions With limited preparation time before operations, few postoperative complications, and recurrence rate, DCST in the repair of giant incision hernia is safe and possible clinically.
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Affiliation(s)
- Ying-Han Song
- Department of Day Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Jia Huang
- West China School of Medicine, Sichuan University, West China Hospital of Sichuan University, Chengdu, China
| | - Yan-Yan Xie
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Gonish Hada
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Sen Zhang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - An-Qing Lu
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yong Wang
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Zhang Lei
- Hernia Center of Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
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15
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Bitterman N, Ben-Nun O, Calderon N, Brodsky A, Galis I, Matter I, Sroka G. Use of autologous dermal flap as mesh coverage in the treatment of large abdominal-wall defect in patients following massive weight loss: presentation of a novel surgical technique. Hernia 2020; 24:387-393. [PMID: 32062712 DOI: 10.1007/s10029-020-02127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh. METHOD All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD). RESULTS Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months. CONCLUSION Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible.
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Affiliation(s)
- N Bitterman
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel.
| | - O Ben-Nun
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - N Calderon
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - A Brodsky
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Galis
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Matter
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - G Sroka
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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16
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De Luna Gallardo D, Cárdenas Salomon CM, Barrera García G, Posada Torres JA, Poucel Sánchez Medal F. Bilateral Fascia Lata Flap: An Alternative for Massive Abdominal Wall Defect Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2577. [PMID: 32309068 PMCID: PMC7159935 DOI: 10.1097/gox.0000000000002577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/18/2019] [Indexed: 11/26/2022]
Abstract
The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.
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17
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Kaufman T, Kaplan B, Perry L, Shandalov Y, Landau S, Srugo I, Ad-El D, Levenberg S. Innervation of an engineered muscle graft for reconstruction of muscle defects. Am J Transplant 2019; 19:37-47. [PMID: 29856531 DOI: 10.1111/ajt.14957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 01/25/2023]
Abstract
Autologous muscle flaps are commonly used to reconstruct defects that involve muscle impairment. To maintain viability and functionality of these flaps, they must be properly vascularized and innervated. Tissue-engineered muscles could potentially replace autologous muscle tissue, but still require establishment of sufficient innervation to ensure functionality. In this study, we explored the possibility of innervating engineered muscle grafts transplanted to an abdominal wall defect in mice, by transferring the native femoral nerve to the graft. Six weeks posttransplantation, nerve conduction studies and electromyography demonstrated increased innervation in engineered grafts neurotized with the femoral nerve, as compared to non-neurotized grafts. Histologic assessments revealed axonal penetration and formation of neuromuscular junctions within the grafts. The innervation process described here may advance the fabrication of a fully functional engineered muscle graft that will be of utility in clinical settings.
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Affiliation(s)
- Tal Kaufman
- Department of Plastic Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Kaplan
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel.,Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Luba Perry
- Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Inter-departmental Program in Biotechnology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yulia Shandalov
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shira Landau
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Dean Ad-El
- Department of Plastic Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shulamit Levenberg
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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18
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Genetically engineered human muscle transplant enhances murine host neovascularization and myogenesis. Commun Biol 2018; 1:161. [PMID: 30320229 PMCID: PMC6172230 DOI: 10.1038/s42003-018-0161-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 08/24/2018] [Indexed: 11/30/2022] Open
Abstract
Engineered tissues are a promising tool for addressing the growing need for tissues and organs in surgical reconstructions. Prevascularization of implanted tissues is expected to enhance survival prospects post transplantation and minimize deficiencies and/or hypoxia deeper in the tissue. Here, we fabricate a three-dimensional, prevascularized engineered muscle containing human myoblasts, genetically modified endothelial cells secreting angiopoietin 1 (ANGPT1) and genetically modified smooth muscle cells secreting vascular endothelial growth factor (VEGF). The genetically engineered human muscle shows enhanced host neovascularization and myogenesis following transplantation into a mouse host, compared to the non-secreting control. The vascular, genetically modified cells have been cleared for clinical trials and can be used to construct autologous vascularized tissues. Therefore, the described genetically engineered vascularized muscle has the potential to be fully translated to the clinical setting to overcome autologous tissue shortage and to accelerate host neovascularization and integration of engineered grafts following transplantation. Luba Perry et al. report transplantation of engineered prevascularized human muscle into mice to repair an abdominal muscle defect. They show that genetically engineering smooth muscle cells to secrete VEGF and endothelial cells to secrete ANGPT1 significantly improves host neovascularization and myogenesis.
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19
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Sun BJ, Kamal RN, Lee GK, Nazerali RS. Quality measures in ventral hernia repair: a systematic review. Hernia 2018; 22:1023-1032. [PMID: 29961197 DOI: 10.1007/s10029-018-1794-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The US healthcare system is shifting towards reimbursement for quality over quantity of care. Quality measures are tied to financial incentives in these healthcare models. It is important that surgeons become familiar with quality measures addressing ventral hernia repair and understand candidate measures that may drive future quality measure development. STUDY DESIGN We performed a systematic review of society websites, quality measure databases, and the literature (Pubmed, Embase/Scopus, and Google Scholar) for quality measures addressing ventral hernia surgery. Clinical practice guidelines were included as candidate quality measures. All measures were categorized as structure, process or outcome according to Donabedian domains, as well as within the six National Quality Strategy (NQS) domains. RESULTS Thirty quality measures and candidate measures were identified. Eight candidate measures from the American Hernia Society addressed ventral hernia repair, and 22 quality measures in general surgery were also relevant to ventral hernia repair. Of the candidate measures, 6 (75%) were outcome and 2 (25%) were process measures. Of existing general surgery quality measures, 9 (41%) were outcome and 13 (59%) were process measures. No structural measures were identified. Overall, the majority of measures addressed NQS priorities of effective clinical care (33%) and patient safety (27%), while few addressed other domains. CONCLUSION Both the Donabedian domains of quality and NQS priorities were unequally represented in the current measures addressing ventral hernia repair. Recognizing and addressing the under-represented areas will provide a more balanced framework for developing quality measures and ensure that ventral hernia surgery is appropriately evaluated in value-based payment models.
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Affiliation(s)
- B J Sun
- UC Irvine School of Medicine, 101 The City Dr, Orange, CA, 92868, USA.
| | - R N Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063, USA
| | - G K Lee
- Department of Surgery-Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Rd, Suite 400, Palo Alto, CA, 94304, USA
| | - R S Nazerali
- Department of Surgery-Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Rd, Suite 400, Palo Alto, CA, 94304, USA
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20
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Köhler G, Fischer I, Kaltenböck R, Lechner M, Dauser B, Jorgensen LN. Evolution of Endoscopic Anterior Component Separation to a Precostal Access with a New Cylindrical Balloon Trocar. J Laparoendosc Adv Surg Tech A 2018; 28:730-735. [DOI: 10.1089/lap.2017.0480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gernot Köhler
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Ines Fischer
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Richard Kaltenböck
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Linz, Austria
- Academic Teaching Hospital of the Medical Universities, Vienna, Austria; Graz, Austria; Innsbruck, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Dauser
- Department of Surgery, St John of God Hospital, Vienna, Austria
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21
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Scheuerlein H, Thiessen A, Schug-Pass C, Köckerling F. What Do We Know About Component Separation Techniques for Abdominal Wall Hernia Repair? Front Surg 2018; 5:24. [PMID: 29637073 PMCID: PMC5881422 DOI: 10.3389/fsurg.2018.00024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction The component separation technique (CST) was introduced to abdominal wall reconstruction to treat large, complex hernias. It is very difficult to compare the published findings because of the vast number of technical modifications to CST as well as the heterogeneity of the patient population operated on with this technique. Material and Methods The main focus of the literature search conducted up to August 2017 in Medline and PubMed was on publications reporting comparative findings as well as on systematic reviews in order to formulate statements regarding the various CSTs. Results CST without mesh should no longer be performed because of too high recurrence rates. Open anterior CST has too high a surgical site occurrence rate and henceforth should only be conducted as endoscopic and perforator sparing anterior CST. Open posterior CST and posterior CST with transversus abdominis release (TAR) produce better results than open anterior CST. To date, no significant differences have been found between endoscopic anterior, perforator sparing anterior CST and posterior CST with transversus abdominis release. Robot-assisted posterior CST with TAR is the latest, very promising alternative. The systematic use of biologic meshes cannot be recommended for CST. Conclusion CST should always be performed with mesh as endoscopic or perforator sparing anterior or posterior CST. Robot-assisted posterior CST with TAR is the latest development.
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Affiliation(s)
- Hubert Scheuerlein
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Andreas Thiessen
- Department for General and Visceral Surgery, Vincenz Hospital, Paderborn, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Berlin, Germany
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22
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A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia 2018. [DOI: 10.1007/s10029-018-1757-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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D'Amore A, Fazzari M, Jiang HB, Luketich SK, Luketich ME, Hoff R, Jacobs DL, Gu X, Badylak SF, Freeman BA, Wagner WR. Nitro-Oleic Acid (NO 2-OA) Release Enhances Regional Angiogenesis in a Rat Abdominal Wall Defect Model. Tissue Eng Part A 2018; 24:889-904. [PMID: 29187125 DOI: 10.1089/ten.tea.2017.0349] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ventral hernia is often addressed surgically by the placement of prosthetic materials, either synthetic or from allogeneic and xenogeneic biologic sources. Despite advances in surgical approaches and device design, a number of postsurgical limitations remain, including hernia recurrence, mesh encapsulation, and reduced vascularity of the implanted volume. The in situ controlled release of angiogenic factors from a scaffold facilitating abdominal wall repair might address some of these issues associated with suboptimal tissue reconstruction. Furthermore, a biocomposite material that combines the favorable mechanical properties achievable with synthetic materials and the bioactivity associated with xenogeneic tissue sources would be desirable. In this report, an abdominal wall repair scaffold has been designed based on a microfibrous, elastomeric poly(ester carbonate)urethane urea matrix integrated with a hydrogel derived from decellularized porcine dermis (extracellular matrix [ECM] gel) and poly(lactic-co-glycolic acid) (PLGA) microspheres loaded with nitro-oleic acid (NO2-OA). NO2-OA is an electrophilic fatty acid nitro-alkene derivative that, under hypoxic conditions, induces angiogenesis. This scaffold was utilized to repair a rat abdominal wall partial thickness defect, hypothesizing that the nitro-fatty acid release would facilitate increased angiogenesis at the 8-week endpoint. The quantification of neovascularization was conducted by novel methodologies to assess vessel morphology and spatial distribution. The repaired abdominal wall defects were evaluated by histopathologic methods, including quantification of the foreign body response and cellular ingrowth. The results showed that NO2-OA release was associated with significantly improved regional angiogenesis. The combined biohybrid scaffold and NO2-OA-controlled release strategy also reduced scaffold encapsulation, increased wall thickness, and enhanced cellular infiltration. More broadly, the three components of the composite scaffold design (ECM gel, polymeric fibers, and PLGA microparticles) enable the tuning of performance characteristics, including scaffold bioactivity, degradation, mechanics, and drug release profile, all decisive factors to better address current limitations in abdominal wall repair or other soft tissue augmentation procedures.
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Affiliation(s)
- Antonio D'Amore
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Fondazione RiMED , Palermo, Italy .,3 Dipartimento Innovazione Industriale e Digitale (DIID), Università di Palermo , Palermo, Italy
| | - Marco Fazzari
- 2 Fondazione RiMED , Palermo, Italy .,4 Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Hong-Bin Jiang
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Samuel K Luketich
- 5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Michael E Luketich
- 5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Richard Hoff
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Daniel L Jacobs
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Xinzhu Gu
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Bruce A Freeman
- 4 Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - William R Wagner
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
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24
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Abstract
Management of a patient with an open abdomen is difficult, and the primary closure of the fascial edges is essential to obtain the best patient outcome, regardless of the initial etiology of the open abdomen. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with mesh-mediated fascial traction as the proposed standard of care. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. As shown for other high-risk patient subgroups, such as obese patients, patients with an abdominal aneurysm, and patients with former -ostomy sites, the prevention of incisional hernias might be key to further optimize patient outcomes after open abdomen treatment. In this overview, current available modalities to decrease the incidence of incisional hernia are discussed. Most of these preventive options have been shown effective in giant ventral hernia repair and might work effectively in this patient cohort with open abdomen as well.
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Affiliation(s)
- Frederik Berrevoet
- Ghent University Hospital, Department of General and HPB Surgery and Liver Transplantation, Ghent, Belgium
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The Use of Bilayered Fascia Lata With an Interpositional Omental Flap for Autologous Repair of Contaminated Abdominal Fascial Defects. Ann Plast Surg 2017; 79:486-489. [PMID: 28953519 DOI: 10.1097/sap.0000000000001192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Contaminated abdominal fascial defects, such as those seen in enterocutaneous fistula, or wound dehiscence with mesh exposure, are a significant source of morbidity and present unique reconstructive challenges. We present our technique of using the fascia lata, augmented with an interpositional omental flap, for complete autologous reconstruction of contaminated fascial defects, and the postoperative results of 3 cases. METHODS Three patients with contaminated abdominal defects underwent wound debridement/fistula resection and immediate reconstruction with fascia lata and omentum flap. Defect size ranged from 15 × 8 cm (120 cm) to 25 × 12 cm (300 cm). The fascia lata graft was inset using an underlay technique, and the omentum was tunneled through a subcostal slit in the semilunar line to augment the vascularity of the subcutaneous plane and protect the graft. Skin coverage was achieved by undermining and direct closure or local myocutaneous flaps. RESULTS Three patients underwent abdominal wall reconstruction with our technique. The median follow-up was 12 months. There were no recurrent infections, fistulae, or herniae. All patients experienced full functional recovery with return to independent activities of daily living by 6 months postoperatively. CONCLUSIONS Since the use of synthetic material is contraindicated in contaminated abdominal fascial defects. We propose that our combination of fascia lata and an interpositional omental flap is a useful technique for the reconstruction of these challenging defects.
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Martis G, Damjanovich L. Significance of Autologous Tissues in the Treatment of Complicated, Large, and Eventrated Abdominal Wall Hernias. Hernia 2017. [DOI: 10.5772/intechopen.68874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Freiman A, Shandalov Y, Rosenfeld D, Shor E, Ben-David D, Meretzki S, Levenberg S, Egozi D. Engineering vascularized flaps using adipose-derived microvascular endothelial cells and mesenchymal stem cells. J Tissue Eng Regen Med 2017; 12:e130-e141. [DOI: 10.1002/term.2436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 12/14/2016] [Accepted: 03/30/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Alina Freiman
- Inter-departmental Program in Biotechnology; Technion - Israel Institute of Technology; Haifa Israel
- Biomedical Engineering Department; Technion - Israel Institute of Technology; Haifa Israel
| | - Yulia Shandalov
- Biomedical Engineering Department; Technion - Israel Institute of Technology; Haifa Israel
| | - Dekel Rosenfeld
- Biomedical Engineering Department; Technion - Israel Institute of Technology; Haifa Israel
| | - Erez Shor
- Biomedical Engineering Department; Technion - Israel Institute of Technology; Haifa Israel
| | | | | | - Shulamit Levenberg
- Biomedical Engineering Department; Technion - Israel Institute of Technology; Haifa Israel
| | - Dana Egozi
- Department of Plastic and Reconstructive Surgery; Kaplan Hospital; Rehovot Israel
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Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life After Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh: The COBRA Study. Ann Surg 2017; 265:205-211. [PMID: 28009747 PMCID: PMC5181129 DOI: 10.1097/sla.0000000000001601] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate biosynthetic absorbable mesh in single-staged contaminated (Centers for Disease Control class II and III) ventral hernia (CVH) repair over 24 months. BACKGROUND CVH has an increased risk of postoperative infection. CVH repair with synthetic or biologic meshes has reported chronic biomaterial infections and high hernia recurrence rates. METHODS Patients with a contaminated or clean-contaminated operative field and a hernia defect at least 9 cm had a biosynthetic mesh (open, sublay, retrorectus, or intraperitoneal) repair with fascial closure (n = 104). Endpoints included overall Kaplan-Meier estimates for hernia recurrence and postoperative wound infection rates at 24 months, and the EQ-5D and Short Form 12 Health Survey (SF-12). Analyses were conducted on the intent-to-treat population, and health outcome measures evaluated using paired t tests. RESULTS Patients had a mean age of 58 years, body mass index of 28 kg/m, 77% had contaminated wounds, and 84% completed 24-months follow-up. Concomitant procedures included fistula takedown (n = 24) or removal of infected previously placed mesh (n = 29). Hernia recurrence rate was 17% (n = 16). At the time of CVH repair, intraperitoneal placement of the biosynthetic mesh significantly increased the risk of recurrences (P ≤ 0.04). Surgical site infections (19/104) led to higher risk of recurrence (P < 0.01). Mean 24-month EQ-5D (index and visual analogue) and SF-12 physical component and mental scores improved from baseline (P < 0.05). CONCLUSIONS In this prospective longitudinal study, biosynthetic absorbable mesh showed efficacy in terms of long-term recurrence and quality of life for CVH repair patients and offers an alternative to biologic and permanent synthetic meshes in these complex situations.
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Gnaneswaran N, Perera M, Jenkin A, Lau H, Presley R. Ventral hernia repair with lateral component separation and onlay Biodesign graft. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Large Contaminated Ventral Hernia Repair Using Component Separation Technique with Synthetic Mesh. Plast Reconstr Surg 2015; 136:796e-805e. [DOI: 10.1097/prs.0000000000001793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bodin F, Dissaux C, Romain B, Rohr S, Brigand C, Bruant-Rodier C. Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection. Microsurgery 2015; 37:38-43. [PMID: 26037038 DOI: 10.1002/micr.22434] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE Extended and full-thickness abdominal wall defects are commonly reconstructed using free flaps. Published surgical outcomes involving the latissimus dorsi (LD) free flap procedure are limited and are less numerous than those with free flaps involving the thigh. The aim of this report was to describe the immediate and long-term evaluation of complex abdominal wall reconstruction using a LD free flap with mesh. PATIENTS AND METHODS Between 2005 and 2013, nine patients with extended malignant tumors of the abdominal wall underwent surgeries. After the surgical resection, the mean defect size was 385 cm2 (range: 190-650 cm2 ). Full-thickness abdominal wall reconstruction was performed with a combination of LD free flaps and meshes. The immediate and long-term outcomes were assessed regarding the complications, sustainable strength of the abdominal wall and cancer recurrence. RESULTS The meshes measured 927 cm2 in average (range: 500-1036 cm2 ). Eight Parietex Composite® and 1 Bard Collamend Implant® were used. No donor site complications occurred, and complete LD flap survival was achieved without partial necrosis or thrombosis. One obese patient who received a porcine dermis mesh developed an eventration four days postoperatively and exhibited a limited amount of abdominal skin necrosis around the flap. Two patients died from cancer evolution. After a mean follow-up of 60.4 months (range: 29-94 months), clinical evaluation of the abdomen revealed 2 patients without anomalies, 4 cases of abdominal bulging without functional discomfort and 1 case of major abdominal distension. CONCLUSIONS Complex abdominal reconstruction with LD free flap and mesh allows extended satisfactory coverage with a low incidence of flap and donor site complications. However, patients should be advised of the significant risk of abdominal bulging. © 2014 Wiley Periodicals, Inc. Microsurgery 37:38-43, 2017.
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Affiliation(s)
- Frédéric Bodin
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Dissaux
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Benoît Romain
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Serge Rohr
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General Surgery, Strasbourg Academic Hospital, Strasbourg, France
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Abdominal compartment syndrome as a rare complication following component separation repair: case report and review of the literature. Hernia 2015; 19:293-9. [DOI: 10.1007/s10029-015-1362-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
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Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PHC, Jeekel J, Lange JF. A systematic review of the surgical treatment of large incisional hernia. Hernia 2014; 19:89-101. [PMID: 25380560 DOI: 10.1007/s10029-014-1321-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 10/26/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. METHODS A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. RESULTS Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6%, recurrence hazard <0.5% per year). Wound complications were frequent and most often seen after complex LIH repair. CONCLUSIONS The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.
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Affiliation(s)
- E B Deerenberg
- Department of Surgery, Erasmus University Medical Center Rotterdam, ErasmusMC, Room Ee-173, Postbus 2400, 3000 CA, Rotterdam, The Netherlands,
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Laparoscopic repair for a congenital lumbar hernia with free fascia lata graft reinforcement. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Repair of huge ventral hernias is technically challenging for the surgeon and a major operation for the patient and should be performed by experienced surgeons in centers that are used to caring for patients who are commonly massively obese with significant comorbidities. Preoperative medical optimization of patients is an important part in the overall management of these large hernias. Conventional component separation with retromuscular mesh repair is the workhorse operation, which successfully deals with many giant ventral hernias, but multiple alternative strategies must be available to address situations in which myofascial elements are completely deficient or there is significant loss of domain The complexity of this surgery is reflected by recurrence rates ranging from 10% to 30% and wound complication rates as high as 40% to 50% in experienced centers.
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Affiliation(s)
- Jai Bikhchandani
- Department of General Surgery, Creighton University Medical Center, 601 N 30th Street, Omaha, NE 68131, USA.
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Takiyama N, Mizuno T, Iwai R, Uechi M, Nakayama Y. In-body tissue-engineered collagenous connective tissue membranes (BIOSHEETs) for potential corneal stromal substitution. J Tissue Eng Regen Med 2013; 10:E518-E526. [PMID: 24668614 DOI: 10.1002/term.1859] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/07/2013] [Accepted: 11/10/2013] [Indexed: 01/15/2023]
Abstract
There is a severe shortage of donor cornea for transplantation in many countries. Collagenous connective tissue membranes, named BIOSHEETs, grown in vivo were successfully implanted in rabbit corneal stroma for in vivo evaluation of their suitability as a corneal stromal substitute to solve this global donor shortage. BIOSHEETs were prepared by embedding silicone moulds into dorsal subcutaneous pouches in rabbits for 1 month and stored in glycerol. After re-swelling in saline and trephining, disk-shaped BIOSHEETs (4 mm diameter) were allogeneically implanted into stromal pockets prepared in the right cornea of seven rabbits. Clinical tests for corneal thickness and transparency, and tissue analyses were performed. Because the BIOSHEETs (thickness, 131 ± 14 µm) obtained were opaque immediately after implantation, the transparency of the cornea decreased. The total thickness of the BIOSHEET-implanted cornea increased from 364 ± 21.0 µm to 726 ± 131 µm. After 4 weeks' implantation, the thickness of the cornea stabilized (493 ± 80 µm at 4 weeks and 447 ± 46 µm at 8 weeks). The transparency of the cornea increased progressively with time of implantation. The random orientation of collagen fibrils in the original BIOSHEETs tended to be homogeneous, similar to that of the native stroma. No inflammatory cells accumulated and fibroblast-like cells infiltrated the implant. The BIOSHEETs showed high biocompatibility with stromal tissues; however, further studies are needed to test its functional aspects. Although this research is only intended as a proof of concept, BIOSHEETs may be considered a feasible corneal stromal replacement, especially for treating visual impairment caused by stromal haze. Copyright © 2013 John Wiley & Sons, Ltd.
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Affiliation(s)
- Naoaki Takiyama
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Takeshi Mizuno
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan.,Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Ryosuke Iwai
- Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Masami Uechi
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kanagawa, Japan.,Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Yasuhide Nakayama
- Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan.
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Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H. Criteria for definition of a complex abdominal wall hernia. Hernia 2013; 18:7-17. [PMID: 24150721 DOI: 10.1007/s10029-013-1168-6] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 10/03/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE A clear definition of "complex (abdominal wall) hernia" is missing, though the term is often used. Practically all "complex hernia" literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allow comparison of different surgical approaches. The aim of this study was to reach consensus on criteria used to define a patient with "complex" hernia. METHODS Three consensus meetings were convened by surgeons with expertise in complex abdominal wall hernias, aimed at laying down criteria that can be used to define "complex hernia" patients, and to divide patients in severity classes. To aid discussion, literature review was performed to identify hernia classification systems, and to find evidence for patient and hernia variables that influence treatment and/or prognosis. RESULTS Consensus was reached on 22 patient and hernia variables for "complex" hernia criteria inclusion which were grouped under four categories: "Size and location", "Contamination/soft tissue condition", "Patient history/risk factors", and "Clinical scenario". These variables were further divided in three patient severity classes ('Minor', 'Moderate', and 'Major') to provide guidance for peri-operative planning and measures, the risk of a complicated post-operative course, and the extent of financial costs associated with treatment of these hernia patients. CONCLUSION Common criteria that can be used in defining and describing "complex" (abdominal wall) hernia patients have been identified and divided under four categories and three severity classes. Next step would be to create and validate treatment algorithms to guide the choice of surgical technique including mesh type for the various complex hernias.
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Affiliation(s)
- N J Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Slade DAJ, Carlson GL. Takedown of Enterocutaneous Fistula and Complex Abdominal Wall Reconstruction. Surg Clin North Am 2013; 93:1163-83. [DOI: 10.1016/j.suc.2013.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Clinical experience using a tensor fascia lata flap in oncology patients. Surg Today 2013; 44:1438-42. [DOI: 10.1007/s00595-013-0733-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Kunishige T, Takayama T, Matumoto S, Wakatsuki K, Enomoto K, Tanaka T, Migita K, Kuwahara M, Iioka H, Nakajima Y. A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel Patch. Int J Surg Case Rep 2013; 4:793-7. [PMID: 23911588 DOI: 10.1016/j.ijscr.2013.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/22/2013] [Accepted: 05/29/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia. PRESENTATION OF CASE The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap. DISCUSSION Enterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted. CONCLUSION Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.
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Reis PDSBD, Chagas VLA, Silva JM, Silva PC, Jamel N, Schanaider A. Nonwoven polypropylene prosthesis in large abdominal wall defects in rats. Acta Cir Bras 2013; 27:671-80. [PMID: 23033127 DOI: 10.1590/s0102-86502012001000002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 08/14/2012] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate, in large abdominal wall defects surgically shaped in rats, if a synthetic polypropylene nonwoven prosthesis could be used as a therapeutic option to conventional polypropylene mesh. METHODS Twenty four (24) Wistar rats were enrolled into three groups. Group 1 (Simulation group) with an abdominal wall defect of 3 X 3 left untreated and Groups 2 and 3, respectively treated with a conventional polypropylene mesh and a polypropylene nonwoven (NWV) prosthesis to cover the breach. At the 45th postoperatively day, adhesion (area and strength) and vascularization of Groups 2 and 3 were evaluated. The histological preparations with Hematoxylin-Eosin, Tricromium of Masson, Pricrosirius red and polarization with birefringence, and also the structural analysis of the prostheses carried on by Thermogravimetry and Differential Scanning Calorimetry were also assessed. RESULTS There were no significant differences between the Groups 2 and 3. CONCLUSION In rats, the polypropylene nonwoven prosthesis showed to be safe and has to be considered as an alternative to conventional mesh manufactured by weaving in the treatment of great defects of the abdominal wall.
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Abstract
BACKGROUND Biologic grafts hold promise of a durable repair for ventral hernias with the potential for fewer complications than synthetic mesh. This systematic review was performed to evaluate the effectiveness and safety of biologic grafts for ventral hernia repair. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for studies on biologic grafts for the repair of ventral hernias. Outcomes are presented as weighted pooled proportions. RESULTS Twenty-five retrospective studies were included. Recurrence depended on wound class, with an overall rate of 13.8% (95% confidence interval [CI], 7.6-21.3). The recurrence rate in contaminated/dirty repairs was 23.1% (95% CI, 11.3-37.6). Abdominal wall laxity occurred in 10.5% (95% CI, 3.7-20.3) of patients. The surgical morbidity rate was 46.3% (95% CI, 33.3-59.6). Infection occurred in 15.9% (95% CI, 9.8-23.2) of patients but only led to graft removal in 4.9% of cases. CONCLUSIONS No randomized trials are available to properly evaluate biologic grafts for ventral hernia repair. The current evidence suggests that biologic grafts perform similarly to other surgical options. Biologic grafts are associated with a high salvage rate when faced with infection.
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Moullot P, Philandrianos C, Gonnelli D, Casanova D. [Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap]. ANN CHIR PLAST ESTH 2012. [PMID: 23182334 DOI: 10.1016/j.anplas.2012.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.
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Affiliation(s)
- P Moullot
- Service de chirurgie plastique, hôpital de la Conception, 147, boulevard Baille, 13385 Marseille, France.
| | - C Philandrianos
- Service de chirurgie plastique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - D Gonnelli
- Service de chirurgie plastique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - D Casanova
- Service de chirurgie plastique, hôpital de la Conception, 147, boulevard Baille, 13385 Marseille, France
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David AI, Gouvea ES, Batista FR, Barros PHFD, Martini Filho D, Arias V, Corsi PR, Szutan LA. Análise da rejeição do transplante de aponeurose em coelhos. EINSTEIN-SAO PAULO 2012; 10:302-5. [DOI: 10.1590/s1679-45082012000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 05/31/2012] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar a viabilidade de aponeurose heteróloga para fechar parede abdominal de coelhos, com ênfase no processo de rejeição. MÉTODOS: Este projeto foi aprovado pelo Comitê de Cuidados Animais da Faculdade de Ciências Médicas da Santa Casa de São Paulo e realizado na Unidade Técnica e Cirurgia Experimental. Quatro coelhas vermelhas trocaram aponeurose da parede abdominal com outros quatro animais machos brancos. Em dois coelhos, foi retirada e substituída a aponeurose como controle do processo cicatricial. Eles foram avaliados 1 vez por dia e sacrificados após 7 dias. Foi realizada a imunoistoquímica com CD20 e CD79. RESULTADOS: Os animais não tiveram celulite, abscesso, hematoma, deiscência da ferida ou hérnia. O local do enxerto mostrou hiperemia intensa. A análise histológica mostrou um processo inflamatório, com a presença de miofibroblastos em amadurecimento e colágeno, que variou de incipiente a moderado. O número de vasos estava reduzido e as células inflamatórias foram, em sua maioria, células plasmáticas e macrófagos. Não havia sinais morfológicos da rejeição aguda com a agressão do endotélio vascular. O músculo adjacente mostrou sinais de degeneração, com reação inflamatória dos núcleos e condensação do citoplasma. A análise imunoistoquímica (CD20 e CD79) mostrou que o processo inflamatório não foi mediado por linfócitos. O teste não paramétrico de Mann-Whitney mostrou que não se pode rejeitar a hipótese de igualdade (p>0,05). CONCLUSÃO: Não houve complicações pós-operatórias (fístulas, deiscência etc.) e a análise histológica revelou processo inflamatório inespecífico. A análise imunoistoquímica mostrou que o processo inflamatório não foi em razão de uma possível rejeição.
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Diaz-Siso JR, Bueno EM, Pomahac B. Abdominal wall reconstruction using a non-cross-linked porcine dermal scaffold: a follow-up study. Hernia 2012; 17:37-44. [PMID: 22707311 DOI: 10.1007/s10029-012-0927-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 05/25/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE In a previous study, we have shown that non-cross-linked porcine dermal scaffolds (NCPDS) are a safe and effective alternative to prosthetic mesh in the reconstruction of complicated abdominal wall defects. Here, we report the long-term outcomes of abdominal wall reconstruction using NCPDS in a larger patient population. METHODS Patients who underwent abdominal wall reconstruction with NCPDS between May 2006 and December 2010 were retrospectively reviewed. Analysis of demographics, indications for NCPDS placement, surgical technique, complications, and follow-up data was performed. RESULTS NCPDS was used for abdominal wall repair in 40 patients. In all patients, NCPDS was positioned using an intraperitoneal technique. At a mean follow-up time of 40.1 months, most patients had successful outcomes. Complications included seroma (21 %), recurrence (7.9 %), and infection (5.2 %); these rates are comparable to our initial report. Two patients died from multi-organ failure unrelated to NCPDS placement. CONCLUSIONS This study shows that complex abdominal wall defects can be successfully reconstructed using NCPDS with a low rate of recurrence and complications.
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Affiliation(s)
- J R Diaz-Siso
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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47
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Components separation technique combined with a double-mesh repair for large midline incisional hernia repair. World J Surg 2012; 35:2399-402. [PMID: 21882019 PMCID: PMC3191289 DOI: 10.1007/s00268-011-1249-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The surgical treatment of large midline incisional hernias remains a challenge. The aim of this report is to present the results of a new technique for large midline incisional hernia repair which combines the components-separation technique with a double-prosthetic-mesh repair. Methods The records of all consecutive patients who received a double-mesh combined with the components-separation technique for ventral hernia repair were reviewed. The clinical, surgical, and follow-up data were analyzed. Results Nine patients [3 women, 6 men; median age = 62 years (range = 26–77)] were included in the study. Median transverse defect size was 20 cm (range = 15–25). The median duration of hospital stay was 8 days (range = 5–17). Postoperative complications occurred in 66% (6/9). Follow-up [median = 13 months (range = 3–49)] showed no recurrent hernias, but one patient had a small hernia after a relaparotomy for colon carcinoma recurrence. The overall occurrence of wound infections was 44% (4/9). There was no mortality. Conclusion The components-separation technique in combination with a double-mesh has shown a low recurrence rate in the short-term follow-up. However, there is a considerable occurrence of postoperative wound infections. Long-term results of the hernia recurrence rate have to be awaited.
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48
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Lambe G, Russell C, West C, Kalaiselvan R, Slade DAJ, Anderson ID, Watson JS, Carlson GL. Autologous reconstruction of massive enteroatmospheric fistulation with a pedicled subtotal lateral thigh flap. Br J Surg 2012; 99:964-72. [DOI: 10.1002/bjs.8759] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2012] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Reconstruction of massive contaminated abdominal wall defects associated with enteroatmospheric fistulation represents a technical challenge. An effective technique that allows closure of intestinal fistulas and reconstruction of the abdominal wall, with a good functional and cosmetic result, has yet to be described. The present study is a retrospective review of simultaneous reconstruction of extensive gastrointestinal tract fistulation and large full-thickness abdominal wall defects, using a novel pedicled subtotal thigh flap.
Methods
The flap, based on branches of the lateral circumflex femoral artery, was used to reconstruct the abdominal wall in six patients who were dependent on artificial nutritional support, with a median (range) of 4·5 (3–23) separate intestinal fistulas, within open abdominal wounds with a surface area of 564·5 (204–792) cm2. Intestinal reconstruction was staged, with delayed closure of a loop jejunostomy. Median follow-up was 93·5 (10–174) weeks.
Results
Successful healing occurred in all patients, with no flap loss or gastrointestinal complications. One patient died from complications of sepsis unrelated to the surgical treatment. All surviving patients gained complete nutritional autonomy following closure of the loop jejunostomy.
Conclusion
Replacement of almost the entire native abdominal wall in patients with massive contaminated abdominal wall defects is possible, without the need for prosthetic material or microvascular free flaps. The subtotal pedicled thigh flap is a safe and effective method of providing definitive treatment for patients with massive enteroatmospheric fistulation.
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Affiliation(s)
- G Lambe
- Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Manchester, UK
| | - C Russell
- Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Manchester, UK
| | - C West
- Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Manchester, UK
| | - R Kalaiselvan
- National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - D A J Slade
- National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - I D Anderson
- National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - J S Watson
- Department of Plastic and Reconstructive Surgery, University Hospital of South Manchester, Manchester, UK
| | - G L Carlson
- National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Abstract
Hernia repair is one of the most frequently performed operations in surgical clinics. Tissue engineering provides insights for the treatment of abdominal wall hernias and other disorders involving deficiencies in the musculature. The present review summarizes the mechanisms of muscle development and regeneration and provides an overview of tissue engineering strategies for the construction of muscles.
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Affiliation(s)
- Lu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lateral thigh fascia lata as interpositional graft for temporomandibular joint ankylosis. J Maxillofac Oral Surg 2011; 11:354-7. [PMID: 23997493 DOI: 10.1007/s12663-011-0304-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022] Open
Abstract
Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft is commonly used in neurosurgical practice and in other surgical specialities. We present a case of lateral thigh fascia lata used as interpositional graft for the treatment of a unilateral fibrous temporomandibular joint ankylosis.
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