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Kranz J, Grundl S, Wußow F, Steffens J, Anheuser P, Schneidewind L. Permanent Flank Bulge after Flank Incision: Patient- and Physician-Reported Outcome. Urol Int 2021; 106:387-396. [PMID: 34284406 DOI: 10.1159/000517288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for postoperative flank bulging and associated physiologic/psychologic consequences as well as to establish a clinical flank bulge classification system after open retroperitoneal surgery. METHODS In this retrospective study, a postal patient survey was sent to 240 patients who underwent open retroperitoneal surgery between 2007 and 2017. Patients, who reported a flank bulge, were invited for further evaluation, which included a clinical examination and standardized photo documentation. RESULTS Forty-three of 120 patients (35.8%) reported a flank bulging after retroperitoneal surgery. During clinical examination, a flank bulge could be confirmed in 25 patients, whereas in 18 patients, no bulging could be detected, leading to a corrected rate of flank bulge-positive patients of 20.8%. The corresponding relaxation values ranged from 1 to 1.44 and correlated with the clinical degree of bulging. A body mass index of ≥25 was identified as a risk factor. No correlation was found regarding age, gender, surgery side, access to the retroperitoneum, surgical procedure, and pathology. Thirty-seven patients complained about chronic pain or suffered from the cosmetic impact of bulging. Thirteen of those patients had shown a flank bulge during clinical examination, resulting in a symptomatic bulge rate of 10.8% (13/120 patients). CONCLUSION Chronic pain and postoperative flank bulging are 2 of the most common long-term complications after open retroperitoneal access. If an open retroperitoneal approach is required, particularly obese patients should be thoroughly informed about the risk of flank bulging and chronic pain.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany.,Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle, Germany
| | - Sebastian Grundl
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Friederike Wußow
- Department of Obstetrics, Bethlehem Health Center gGmbH, Stolberg, Germany
| | - Joachim Steffens
- Department of Urology and Paediatric Urology, St.-Antonius Hospital gGmbH, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Laila Schneidewind
- Department of Urology, University Medical Center Rostock, Rostock, Germany
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Inkiläinen A, Blomqvist L, Ljungberg B, Strigård K. Patient-reported outcome measures of abdominal wall morbidity after flank incision for open partial nephrectomy. BJU Int 2021; 128:497-503. [PMID: 33825298 DOI: 10.1111/bju.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures in patients with and without abdominal wall complications after open partial nephrectomy (OPN) via flank incision. PATIENTS AND METHODS Patient-reported outcome measures were collected in 2017 from all patients operated on with OPN via flank incision between 2004 and 2016 in Västerbotten County, Sweden. Patients were mailed the ventral hernia pain questionnaire (VHPQ) and an abdominal wall asymmetry (AWA) questionnaire to evaluate postoperative AWA, attributed to bulge or incisional hernia. Demographic and follow-up data were retrieved from patient records. RESULTS A total of 198 patients were eligible for the study, and 146 questionnaires were returned (74%). Forty-five patients (31%) reported postoperative AWA and 27 (18%) reported ongoing pain. Three patients who reported AWA had a known incisional hernia. Pain and abdominal wall stiffness were more common in patients with AWA than in those without (P < 0.01 and P < 0.01, respectively). Of the 45 patients with AWA, 25 (56%) reported this as being negative cosmetically and 16 (36%) as negative regarding activities. Patients that reported AWA were younger and had a higher body mass index at surgery (P = 0.03 and 0.04, respectively). CONCLUSION Abdominal wall asymmetry is a common sequel of flank incision for OPN and is associated with a higher incidence of chronic pain and abdominal stiffness compared to absence of postoperative AWA. Some patients reported that the effect on daily activities and the cosmetic effect caused by AWA had a negative impact on their quality of life.
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Affiliation(s)
- Aapo Inkiläinen
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Kriegmair MC, Younsi N, Hiller K, Leitsmann C, Kowalewski KF, Siegel F, Rothamel M, Ritter M, Bolenz C, Kriegmair M, Trojan L, Michel MS. Single- vs multiple-layer wound closure for flank incisions: results of a prospective, randomised, double-blinded multicentre study. BJU Int 2020; 127:64-70. [PMID: 32564459 DOI: 10.1111/bju.15148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficial-layer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. PATIENTS AND METHODS The study was a randomised controlled, patient- and assessor-blinded, multicentre trial. Between May 2015 and February 2017, 225 patients undergoing flank incisions were randomised 1:1 to a multiple-layer closure (SIMULAC-I) or a single superficial-layer closure (SIMULAC-II) group. The primary outcome was the occurrence of a flank bulge 6 months after surgery. RESULTS Overall, 177 patients (90 in SIMULAC-I, 87 in SIMULAC-II) were eligible for final assessment. The cumulative incidence of a flank bulge was significantly higher in the SIMULAC-II group (51.7%) compared to the SIMULAC-I group [34.4%; odds ratio (OR) 2.04, 95% confidence interval (CI) 1.11-3.73; P = 0.02]. Rate of severe postoperative complications (4.4% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.21) or hernia (6.7% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.59) was similar between the groups. There was no difference in pain (visual analogue scale) and the requirement for pain medication at 6 months postoperatively. Quality of life assessed with the European Quality of Life 5 Dimensions Questionnaire was higher in the SIMULAC-I group compared to the SIMULAC-II group at 6 months postoperatively, with a (median range) score of 80 (30-100) vs 75 (5-100) (P = 0.012). CONCLUSION The overall risk of a flank bulge after flank incision is high. Multiple-layer closure after flank incision should be performed as a standard procedure.
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Affiliation(s)
| | - Nina Younsi
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Kiriaki Hiller
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Conrad Leitsmann
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Karl F Kowalewski
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
| | | | - Manuel Ritter
- Department of Urology, University of Bonn, Bonn, Germany
| | | | | | - Lutz Trojan
- Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Hospital Manheim, Mannheim, Germany
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Mantica G, Leonardi R, Pini G, Esperto F, Proietti S, van Deventer H, Giusti G, Gaboardi F, van der Merwe A, Terrone C. The current use of human cadaveric models in urology: a systematic review. MINERVA UROL NEFROL 2020; 72:313-320. [DOI: 10.23736/s0393-2249.19.03558-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mull AB, Nicoson MC, Moore AM, Hunter DA, Tung TH. Rectus Abdominis Motor Nerves as Donor Option for Free Functional Muscle Transfer: A Cadaver Study and Case Series. Hand (N Y) 2018; 13:150-155. [PMID: 28387164 PMCID: PMC5950971 DOI: 10.1177/1558944717702467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current management of brachial plexus injuries includes nerve grafts and nerve transfers. However, in cases of late presentation or pan plexus injuries, free functional muscle transfers are an option to restore function. The purpose of our study was to describe and evaluate the rectus abdominis motor nerves histomorphologically and functionally as a donor nerve option for free functional muscle transfer for the reconstruction of brachial plexus injuries. METHODS High intercostal, rectus abdominis, thoracodorsal, and medial pectoral nerves were harvested for histomorphometric analysis from 4 cadavers from levels T3-8. A retrospective chart review was performed of all free functional muscle transfers from 2001 to 2014 by a single surgeon. RESULTS Rectus abdominis nerve branches provide a significant quantity of motor axons compared with high intercostal nerves and are comparable to the anterior branch of the thoracodorsal nerve and medial pectoral nerve branches. Clinically, the average recovery of elbow flexion was comparable to conventional donors for 2-stage muscle transfer. CONCLUSION Rectus abdominis motor nerves have similar nerve counts to thoracodorsal, medial pectoral nerves, and significantly more than high intercostal nerves alone. The use of rectus abdominis motor nerve branches allows restoration of elbow flexion comparable to other standard donors. In cases where multiple high intercostal nerves are not available as donors (rib fractures, phrenic nerve injury), rectus abdominis nerves provide a potential option for motor reconstruction without adversely affecting respiration.
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Affiliation(s)
- Aaron B. Mull
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Amy M. Moore
- Washington University School of Medicine, St Louis, MO, USA
| | - Dan A. Hunter
- Washington University School of Medicine, St Louis, MO, USA
| | - Thomas H. Tung
- Washington University School of Medicine, St Louis, MO, USA,Thomas H. Tung, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Inkiläinen A, Styrke J, Ljungberg B, Strigård K. Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study. Scand J Urol 2017; 52:54-58. [DOI: 10.1080/21681805.2017.1376352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aapo Inkiläinen
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Sundsvall Hospital, Sundsvall, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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Leland HA, Kulber DA. Abdominal Bulge After Retroperitoneal Dissection: The Definitive Management Using Bone Anchored Mesh. Ann Plast Surg 2016; 76:S200-4. [DOI: 10.1097/sap.0000000000000770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- L Gauduchon
- Service de chirurgie digestive et oncologique, CHU d'Amiens, place Victor-Pauchet, 80000 Amiens, France
| | - C Sabbagh
- Service de chirurgie digestive et oncologique, CHU d'Amiens, place Victor-Pauchet, 80000 Amiens, France
| | - F Mauvais
- Service de chirurgie viscérale, centre hospitalier de Beauvais, avenue Léon-Blum, 60021 Beauvais, France
| | - J-M Regimbeau
- Service de chirurgie digestive et oncologique, CHU d'Amiens, place Victor-Pauchet, 80000 Amiens, France; Unité Inserm EA 4294, université de Picardie Jules-Verne, 80054 Amiens cedex 1, France.
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Timmermans L, Deerenberg EB, van Dijk SM, Lamme B, Koning AH, Kleinrensink GJ, Jeekel J, Lange JF. Abdominal rectus muscle atrophy and midline shift after colostomy creation. Surgery 2014; 155:696-701. [DOI: 10.1016/j.surg.2013.12.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/30/2013] [Indexed: 12/01/2022]
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