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Louis V, Alhammadi F, Sauvinet G, Charleux-Muller D, Rohr S, Brigand C, Romain B, Delhorme JB. How I do it: using a hammock mesh in the reconstruction of inguinal ligament during a wide en-bloc resection of a groin mesenchymal tumor. Hernia 2024; 28:261-267. [PMID: 37368184 DOI: 10.1007/s10029-023-02829-5] [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: 03/04/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE In case of soft tissue sarcomas (STS), an en-bloc resection with safe margins is recommended. To ensure safe removal without tumor rupture, STS of the groin area, retroperitoneal or pelvic mesenchymal tumors may require incision or resection of the inguinal ligament. Solid reconstruction is mandatory to prevent early and late postoperative femoral hernias. We present here a new technique of inguinal ligament reconstruction. METHODS Between September 2020 and September 2022, patients undergoing incision and/or resection of inguinal ligaments during a wide en-bloc resection of STS of the groin area in the Department of General Surgery in Strasbourg were included. All patients had an inguinal ligament reconstruction with biosynthetic slowly resorbable mesh shaped as a hammock, pre- or intraperitoneally, associated or not with loco-regional pedicled muscular flaps. RESULTS A total of 7 hammock mesh reconstructions were performed. One or several flaps were necessary in 57% of cases (4 patients): either for inguinal ligament reconstruction only (n = 1), for recovering of femoral vessels (n = 1), and for both ligament reconstruction and defect covering (n = 2). The major morbidity rate was 14.3% (n = 1), related to a thigh surgical site infection due to sartorius flap infarction. After a median follow-up of 17.8 months (range 7-31), there was neither early nor late occurrence of post-operative femoral hernia. CONCLUSIONS This is a new surgical tool for inguinal ligament reconstruction with the implementation of a biosynthetic slowly resorbable mesh shaped as a hammock, which should be compared to other techniques.
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Affiliation(s)
- V Louis
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.
| | - F Alhammadi
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - G Sauvinet
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
| | - J-B Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
- INSERM UMR_S1113, Université de Strasbourg, FMTS, 3 Avenue Molière, 67200, Strasbourg, France
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Pu LLQ, Song P. Advancing the Specialty of Plastic Surgery While Helping and Supporting Other Surgical Services at an Academic Medical Center. Ann Plast Surg 2021; 87:369-376. [PMID: 33512821 DOI: 10.1097/sap.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT While helping and supporting other surgical services at our academic medical center, we noticed that many clinical problems presented to our plastic surgery team are truly unique and challenging. Many of the necessary reconstructive procedures, performed by the senior author, had never been published in plastic surgery textbooks or the literature before. Because of the plastic surgeon's creative problem-solving ability, we use reconstructive treatment plans that also innovate and advance the field of plastic surgery. In this case series, we share our experience with creative solutions for the management of novel and challenging clinical problems faced by our plastic surgery service. The resultant and effective solutions for each challenging case have all been published in reputable plastic surgery journals by the senior author. Once published, our inventive reconstructive solutions can be harnessed by other plastic surgeons and trainees and new standardized techniques or solutions for these unique and challenging clinical problems can be established. Ultimately, plastic surgeons can evolve their specialty through helping and supporting other surgical services at an academic medical center by establishing innovative solutions for ever arising challenging clinical problems. Once again, the plastic surgery team in a tertiary hospital supports many surgical services so that more complex surgical procedures can be performed safely and complications from other surgical services can be managed successfully. Therefore, adequate support for a plastic surgery service, by the hospital or department, is critical in developing a strong plastic surgery program at an academic medical center.
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Affiliation(s)
- Lee L Q Pu
- From the Division of Plastic Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
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Dung PTV, Cuong NN, Quang TD, Canh PH, Linh LT, Duc NM. Combination of Lymph Node Embolization and Musculocutaneous Flap Operation for Managing Groin Lymphorrhea. Ann Vasc Dis 2021; 14:267-269. [PMID: 34630772 PMCID: PMC8474087 DOI: 10.3400/avd.cr.21-00036] [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: 05/15/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Lymphorrhea complications are common following femoral exposure for endovascular procedures. In patients unresponsive to either non-operative or operative therapy, treatment can be complicated. A 86-year-old male patient experienced lymphorrhea after stent graft to treat an abdominal aortic aneurysm, and five operative debridement attempts failed. Intranodal lymphangiography revealed leakage points from two lymph nodes directly into the wound, which were resolved by lymph node embolization using glue. Because the wound was large, a pedicled anterolateral thigh flap (ALT) operation was indicated. Percutaneous lymph node embolization combined with ALT operation may be effective for patients with large wounds and high-flow lymphatic leaks.
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Affiliation(s)
- Pham-Thi Viet Dung
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Ha Noi, Vietnam
| | - Nguyen Ngoc Cuong
- Department of Radiology, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Thai Duy Quang
- Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Ha Noi, Vietnam
| | - Pham Hong Canh
- Department of Radiology, Hanoi Medical University Hospital, Ha Noi, Vietnam
| | - Le Tuan Linh
- Department of Radiology, Hanoi Medical University Hospital, Ha Noi, Vietnam.,Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
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Sörelius K, Schiraldi L, Giordano S, Oranges CM, Raffoul W, DI Summa PG. Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo 2019; 33:1-9. [PMID: 30587595 DOI: 10.21873/invivo.11431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. MATERIALS AND METHODS A systematic literature search was performed according to the PRISMA statement between 1996-2016. RESULTS A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. CONCLUSION Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Luigi Schiraldi
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pietro G DI Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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