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Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect.
Material and Methods
Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position.
Results
The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months.
Conclusion
The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - Z Loncar
- Emergency Center, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. The combination of the three modifications of the component separation technique in the management of complex subcostal abdominal wall hernia. Hernia 2022; 26:1369-1379. [PMID: 35575863 DOI: 10.1007/s10029-022-02622-w] [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: 11/12/2021] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of this study is to present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall hernia. METHODS Between January 2010 and January 2020, seven patients presenting at the high-volume academic center with complex subcostal hernia underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the "method of wide myofascial release" at the side of the hernia defect; (b) "open-book variation" of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position. RESULTS The median length and width of the complex subcostal hernias were 15 cm (10-19) and 15 cm (8-24), respectively. The overall morbidity rate was 57.1% (wound infection occurred in three patients, seroma in two patients, and skin necrosis in one patient). There was no hernia recurrence during the median follow-up period of 19 months. CONCLUSION The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall hernia.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia. .,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia.
| | - Z Loncar
- Emergency Center, University Clinical Center of Serbia, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
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Nesic S, Loncar Z, Jovanovic M. Canine Brachial Plexus Neuritis. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bras M, Loncar Z, Gregurek R, Milunovic V, Boban M, Djordjevic V. P01-265 - Chronic low back pain in chronic combat related posttraumatic stress disorder. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bras M, Brajkovic L, Ratkovic A, Kargacin A, Loncar Z, Gregurek R. 989 MIND‐BODY RELATIONSHIP IN PATIENT WITH PHANTOM LIMB PAIN. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Bras
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
| | - L. Brajkovic
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
| | - A.S. Ratkovic
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
| | - A. Kargacin
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
| | - Z. Loncar
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
| | - R. Gregurek
- Clinic for Psychological Medicine University Hospital Centre Zagreb, Zagreb, Croatia
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Bras M, Loncar Z, Mickovic V. 876 THE INTERRELATIONSHIPS BETWEEN PAIN, ANXIETY AND DEPRESSION IN BURN INJURED PATIENTS. Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stefanović B, Karamarković A, Loncar Z, Mijatovic S, Stefanovic B, Jeremić V, Savić P. [Second hemorrhage in patients with splenic injuries]. Acta Chir Iugosl 2003; 49:55-61. [PMID: 12587450 DOI: 10.2298/aci0203055s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although the diagnosis of spleen injuries is not a considerable clinical problem today, subsequent ruptures of this organ may occur in a smaller number of patients (2-5% of total proportion of spleen injuries) following the so-called "free interval". Such injuries are most commonly explained by present hematoma localized in the central spleen, which becomes larger in time, and eventually causes its rupture. This form of lesion may be found both in isolated blunt abdominal injuries and in associated injuries. When it is the question of delayed hemorrhage, our results as well as data obtained from foreign literature, suggest three basic rise factors of the etiology of this type of injury. These are as follows: a) spleen injuries in severe trauma or polytrauma, b) older patients (over 65 years of age), and c) in cases when more than a single blood unit had to be administered for the initial hemodynamic stabilization of a patient. Delayed hemorrhage, which is occult in polytraumatized patients since it is frequently "disguised" by severity of clinical picture and traumatic shock, may subsequently cause sudden fall of hemogram and hemodynamic parameter values, and if immediate surgery is not performed, it may lead to heavy bleeding and lethal outcome of the patient.
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Affiliation(s)
- B Stefanović
- Centar za urgentnu hirurgiju, Urgentni Centar, KCS Beograd
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Kvesić A, Vuckov S, Bagarić I, Hebrang A, Rebac Z, Tomasić Z, Loncar Z. Transformation of health services from civilian to wartime medical corps--example from Bosnia and Herzegovina. Coll Antropol 2002; 26:429-40. [PMID: 12528266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
In the multiethnic Bosnia and Herzegovina, Croats and Muslims, attacked by the Yugoslav army and Serbs, had to employ rationally their poorly provisioned civilian health services so that they could respond to the extremely numerous and prompt needs of war conditions. The health services in the areas controlled by Croats and Muslims had to be reorganized twice because of sudden changes of wartime conditions. With further development of the situation, when all three sides participated in the conflict, the number of wounded increased rapidly. In the meantime, a large-scale population shift on an ethnic basis occurred in all parts of Bosnia and Herzegovina, thus giving rise, along with a greater number of the wounded, to a severe humanitarian crisis. Civilians were therefore another heavy burden to the wartime health services. This created enormous problems for the inadequately provisioned health services of Bosnia and Herzegovina in the area under the control of Croats and Muslims. However, poorly equipped with personnel as well as everything else, the health services in the area controlled by Croats and Muslims, through appropriate reorganization, successfully accomplished their task in the wartime medical corps. Besides this correctly executed transformation from civilian health services into a wartime medical corps, high motivation of medical staff also greatly contributed to successful operation of the medical corps in the war zone despite the long duration of the war. In the majority of cases, the wounded were within 30-40 minutes from the moment of injury in the hands of a surgical team and within the next ten minutes were already in the operating theater. After primary wound dressing, the wounded were sent to one of the well-organized main war hospitals for further treatment. This resulted, along with secure evacuation routes, in a minimum number of lifelong invalidity among the wounded.
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Affiliation(s)
- A Kvesić
- Department of Surgery, University Hospital Center, Mostar, Bosnia and Herzegovina
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Kropec I, Kosuta D, Anić T, Loncar Z. [Meckel's diverticulum observations and the therapeutical attitude (author's transl)]. Lijec Vjesn 1977; 99:599-602. [PMID: 593051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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