The Biomechanical and Histological Effects of Diabetes on Tendon Healing: Experimental Study in Rats

The aim of this study was to investigate the biomechanical and histological perspectives of healing of Achilles tendon in diabetic rats and compare the results with non-diabetic subjects. Fifty four adult Wistar Albino rats weighing 300–350 g were used throughout the study. Six animals were excluded from the study and replaced. Rats were randomly assigned to either the experimental or the control group comprised of 24 rats in each. Diabetes was induced in experimental group with streptozotocin. 3 days after the induction of diabetes, both Achilles tendons were transected 5 mm proximal to their insertions to the calcaneal bone and repaired by using 6/0 polypropylene sutures with modified Kessler method. At weeks 2, 4 and 6, eight rats from each group were euthanized. Left Achilles tendons including the repair site were prepared for histological evaluation and right legs were prepared for mechanical testing. When compared to control group, diabetic animals displayed a lower peak force for failure in each of the second, fourth and sixth week. The differences between the groups in each week were found to be significant in statistical assessments (p < 0.05). Histologic assessment revealed that the diabetic animals had significantly less amount of fibroblast proliferation and lymphocyte infiltration compared to the control group. There is significant delay in tendon strength at the end of week 2, 4 and 6 postoperatively in the diabetic rats. Therefore diabetic individuals require specific postoperative follow up and rehabilitation procedures.     

肥胖患者剖宫产腹壁脂肪处理与伤口缝合修复的效果

探讨肥胖患者剖宫产腹壁脂肪处理与伤口缝合修复方法对切口愈合的影响。方法 选择2018年6月-2023年6月石家庄市鹿泉人民医院收治的110例肥胖剖宫产患者为研究对象,依据缝合方式不同分为对照组和研究组,各55例。对照组腹壁脂肪处理时采用间断缝合脂肪全层且伤口缝合修复行皮内间接缝合,研究组腹壁脂肪处理时不缝合脂肪层且伤口缝合修复行直接皮内连续缝合,比较两组切口愈合情况、手术时间、住院时间、并发症发生率、舒适度、术后疼痛评分及满意度。结果 研究组切口甲级愈合占比高于对照组,手术时间及住院时间短于对照组,差异有统计学意义（P ＜0.05）;研究组脂肪液化、切口处红肿、切口对合不良及线结反应发生率低于对照组,差异有统计学意义（P ＜0.05）;研究组术后3 d的BCS评分高于对照组,VAS评分低于对照组,差异有统计学意义（P ＜0.05）;研究组满意度为94.55%,高于对照组的78.18%,差异有统计学意义（P ＜0.05）。结论 腹壁脂肪处理时不缝合脂肪层且在伤口缝合修复行直接皮内连续缝合有助于促进切口愈合,缓解术后疼痛,降低并发症风险,提高患者的舒适度及满意度。     

腹壁竖切口美容缝合在妇科手术中的应用效果

目的 分析在妇科手术中应用腹壁竖切口美容缝合的临床效果。方法 选取2021年2月-2022年2月于淄博市中心医院行妇科手术的140例患者为研究对象,随机分为对照组和观察组,每组70例。对照组采用常规缝合,观察组采用腹壁竖切口美容缝合,比较两组缝合时间、出血量、切口愈合情况及满意度。结果 观察组缝合时间、出血量及切口愈合情况均优于对照组（P＜0.05）;观察组对瘢痕外观、疼痛程度、牵拉感的满意度均优于对照组（P＜0.05）。结论 腹壁竖切口美容缝合在妇科手术中的应用效果确切,能够有效缩短缝合时间,减少出血量,促进切口愈合,对于提升术后切口美观度具有积极意义,且患者对缝合效果的满意度较高,值得临床应用。     

The Effects of Melatonin on Angiogenesis and Wound Healing

Purpose The pineal gland hormone melatonin is a well-known neoroendocrine hormone. In addition to its immunomodulator effect, it also has a positive effect on monocyte, cytokine, and fibroblast proliferations, which also influence angiogenesis. This study investigated the effects of melatonin hormone on angiogenesis in wound healing on 100 Wistar-Albino rats.Methods The rats were divided into two groups. Melatonin dissolved in 0.9% NaCl was administered to the study group in a dose of 0.4mg/kg/rat per day (0.25cc/rat per day), and 0.9% NaCl to the control group in a dose of 0.25cc/rat per day. Incisions 5cm in length were made on the back skin of the rats and the wounds were closed with a skin stapler. Excisional biopsies from healing tissues were taken on the 3rd, 7th, 10th, 14th, and 21st postoperative days. Angiogenesis was evaluated in healing tissues by light and electron microscopy and by hydroxyproline level measurements.Results The commencement of neovascularization and a significant increase (P 0.05) in the number of vessels were observed at all stages of the study group but not in the control group. The tissue hydroxyproline levels were also higher in the study group than in the control group.Conclusions Melatonin may have a positive effect on both angiogenesis and wound healing.The preliminary results of this study have been published in the Turkish Journal of Surgery     

Smokers, Risks, and Complications in Abdominal Dermolipectomy

Cigarette smoke has many detrimental effects on health, with consequences such as cardiovascular diseases, respiratory diseases, and tumors. In plastic surgery, these effects appear during the wound healing process. This retrospective study showed wound healing in 57 patients who had undergone abdominal dermolipectomy surgery. The patients were divided into two groups: smokers and nonsmokers. According to the results, smokers face a great complication risk for surgical wounds, which cause aesthetically more undesirable scars than observed in nonsmokers. The authors hypothesize that abstinence from smoking for 4 to 12 weeks before surgery would improve the quality of the scars.     

Abdominal Wall Endometrioma Found During Abdominoplasty

Extrauterine manifestations of endometriosis are well-recognized and frequently encountered by gynecologists, but are not necessarily familiar to the plastic surgery community. With the current increase in gastric bypass procedures performed and the subsequent increase in abdominal wall reconstructions secondary to massive weight loss, the plastic surgeon should have some familiarity with the diverse presentations of this common disease. To help with this, the authors present the case of an abdominal wall endometrioma diagnosed during abdominoplasty.     

Influence of Leukotriene Inhibitor Montelukast on Wound Contraction and Cutaneous Healing Process in Rats

Background  Wound contractures can cause severe deformities and disabilities. Recent studies have suggested that leukotriene receptor antagonists have an inhibitory effect on the healing contraction process. This study aimed to evaluate the influence of the leukotriene inhibitor montelukast on the cutaneous healing process and the wound contraction phenomenon in rats. Methods  For this study, 60 male rats were randomly divided into four groups (MK-7d, SF-7d, MK-14d, and SF-14d) according to the drug given through a rigid orogastric tube (MK group: montelukast 10 mg/kg/day; SF group: normal saline solution) and the day the animals were killed (7d: postoperative day 7; 14d: postoperative day 14). An excisional wound (2 × 2 cm) was created on the dorsum of each rat. The wounds were left open to heal spontaneously and documented by standard digital photographs on different postoperative days. Wound contraction rates were calculated with specific software, and specimens were histologically evaluated using picrosirius red stain. Results were analyzed using the Aspin-Welch, Mann–Whitney, and t tests, assuming a significance level of 5%. Results  The wound contraction rates were similar between the control and study groups (p > 0.05). On postoperative day 7, the wounds showed a marginally significant reduction in collagen maturation in the study group (40.1% ± 6.88% vs 61.2% ± 8.02%; p = 0.0607). On postoperative day 14, this reduction was statistically significant in the MK group (26% ± 5.66% vs 68.3% ± 7.76%; p = 0.0001). Conclusions  Montelukast does not alter the contraction rate of excisional wounds in rats but has a significant and progressive inhibitory effect on collagen maturation. This study was developed by the Post-Graduate Program in Surgery and Plastic and Reconstructive Surgery Unit of Federal University of Paraná, Curitiba, Brazil.     

Scar Endometriosis in the Abdominal Wall: a Predictable Condition for Experienced Surgeons

Purpose: Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall.

Methods: Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed. Results: This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 ± 6.0 years (range, 23–48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close to the right side and three were close to the left side; two were in the middle of the Pfanenstiel incision and two were in trocar tracts. The patients’ surgical histories included Caesarean section in thirteen, bilateral laparoscopic ovarian cyst excision in one, and laparoscopic appendectomy in one.

Conclusions: If a patient presents with incision pain and a palpable mass after gynaecologic surgery, an incisional endometrioma should be considered. Surgical excision and hormone therapy are effective treatment approaches in these patients.     

Abdominal Wall Abscess Associated with Perforated Jejunal Diverticulitis: Report of a Case

We report a case of abdominal wall abscess caused by diverticulitis of the jejunum penetrating through the abdominal wall. A 53-year-old Japanese woman visited a local hospital complaining of abdominal pain and a mass in the left lower abdomen. An abdominal computed tomography scan showed a tumor with isodensity in the left lower abdominal wall. Magnetic resonance imaging showed a mass in the abdominal wall with isointensity in the T1-intensified image and high intensity in the T2-intensified images. The mass was heterogeneous inside and protruded partially toward the intraperitoneal cavity. Ultrasound examination showed a heteroechoic mass extending into the intraperitoneal cavity. Laparotomy revealed a tumor in the abdominal wall with a fistulous tract extending to the jejunum. We resected the abdominal wall tumor with partial resection of the small intestine. The resected specimen contained a tumor with a fistulous tract passing through the abdominal wall. Histological examination revealed remarkable infiltration of neutrophils and a bacterial mass in the abdominal wall tumor, with a fistulous tract connected to the area adjacent to the mesenteric border of the jejunum. These findings suggested that diverticulitis of the jejunum had penetrated through the abdominal wall, leading to the formation of an abscess. We report this case to highlight the need for complete gastrointestinal evaluation with gastrointestinal barium studies and imaging analysis to examine extension of intra-abdominal lesions in patients with an unexplained abdominal wall abscess.     

The Importance of Peripheral Blood Leukocytes and Macrophage Infiltration on Bronchial Wall Wound Healing in Rats Treated Preoperatively with Anticancer Agents

Preoperative chemotherapy is commonly used for small cell lung cancer or advanced non-small cell lung cancer. This study was conducted to investigate the effects of preoperative antineoplastic agents on the postoperative would healing of bronchial anastomoses in a rat model. Cisplatin (CDDP), doxorubicin (ADM), or cyclophosphamide (CPA) was administered either 3 days preoperatively (experiment 1) or 7 days preoperatively (experiment 2). Wound healing was assessed on postoperative days (POD) 3, 5, and 7 after anastomosis of the bronchus, by examining the bursting strength and hydroxyproline tissue content. In experiment 1, significant impairment of wound healing was seen on POD 3 in the CPA-treated rats, but no significant changes were seen in the other groups. Severe leukopenia and marked reduction of macrophage infiltration into the wound were also observed in the CPA-treated rats. The impairment of wound healing coincided with the time of leukopenia and reduced macrophage infiltration into the wounds. In experiment 2, induction chemotherapy did not impair wound healing. Our experimental results suggest that preoperative chemotherapy producing mild leukopenia, or when followed by a sufficient interval to allow for the recovery of myelosuppression, did not impair wound healing of the bronchial anastomoses. The findings of this study also showed that the depletion of macrophages at the anastomotic site is one of the most important causes of impaired wound healing. Received: September 16, 1999 / Accepted: November 20, 2000     

A Single Center Experience of Abdominal Wall Graft Rejection After Combined Intestinal and Abdominal Wall Transplantation

We report our outcomes following combined intestinal and abdominal wall transplantation, focusing on the presentation and treatment of acute rejection of the abdominal wall vascularized composite allograft (VCA). Retrospective analysis of all patients with combined intestinal/VCA transplantation was undertaken. Graft abnormalities were documented photographically and biopsies taken, with histological classification of rejection according to Banff 2007 guidelines. We have performed five combined intestinal and abdominal wall transplants to date. Two patients developed erythematous, maculopapular to papular eruptions confined to the VCA, histologically confirmed as grade II/III rejection, yet with normal bowel on endoscopy. Both patients' rashes resolved within 72 h of increasing immunosuppressive treatment. One patient later developed a recurrence of the rash, confirmed as skin rejection, but did not immediately seek medical attention. Treatment was therefore delayed, and mild intestinal rejection developed. We describe the rash associated with VCA rejection, and propose that while the skin of an abdominal wall VCA may reject independently of the intestinal allograft, delay in treatment of rejection episodes may result in rejection of the intestinal graft.     

Local Granulocyte-Macrophage Colony-Stimulating Factor Improves Incisional Wound Healing in Adriamycin-Treated Rats

Purpose Neoadjuvant treatment is often given for locally advanced malignancies; however, clinical and experimental studies have shown that some chemotherapeutic agents impair wound healing. It has been reported that granulocyte-macrophage colony-stimulating factor (GM-CSF) applied locally improves dermal wound healing. Thus, we investigated the effects of locally injected GM-CSF on abdominal wounds impaired by adriamycin, a widely used chemotherapeutic agent. Methods We divided 120 female Sprague-Dawley rats into five treatment groups of 24 rats. Group 1 received saline 8 mg/kg intravenously (i.v.) + laparotomy 14 days later (control); group 2 received 8 mg/kg i.v. adriamycin + laparotomy 14 days later; group 3 received adriamycin 8 mg/kg i.v. + laparotomy + local GM-CSF 50 μg 14 days later; group 4 received saline 8 mg/kg i.v. + laparotomy + local GM-CSF 50 μg 14 days later; and group 5 received adriamycin 8 mg/kg i.v. + laparotomy + systemic GM-CSF 50 μg 14 days later. Sutures were removed on postoperative day (POD) 7 in all five groups, and the abdominal bursting pressures were measured and recorded. Tissue samples were taken from the incision line for histopathological evaluation and hydroxyproline content measurement. Results The bursting pressure was significantly lower in groups 2 and 5 than in groups 1, 3, and 4. The hydroxyproline content and histopathological findings supported this result. Conclusion The local injection of GM-CSF improved impaired wound healing in adriamycin-treated rats.     

Experimental Wound Healing with Electrical Stimulation

The effect of alternating current (AC) and direct current (DC) stimulation was studied on experimental pressure ulcer healing in a new monoplegic pig model. The study was conducted in 30 healthy young Hanford minipigs. The rate of wound healing, histology, vascularization, collagen formation, microbiology, perfusion, and the mechanical strength of the healed wounds were studied. Normal pigskin was compared to denervated control and denervated AC and DC stimulated healed skin. Hind limb denervation was by right unilateral extradural rhizotomies from the L2 to S1 nerve roots. Reproducible uniformly controlled Stage III or higher tissue ulcers were created. When compared to the control wounds, both the AC and DC stimulated wounds showed reduced healing time and increased perfusion in the early phases of healing. DC stimulation reduced the wound area more rapidly than AC, but AC stimulation reduced the wound volume more rapidly than DC. The electrical stimulation did not reduce the strength of the healing wounds below those of the nonstimulated controls. The applied current appears to orient new collagen formation even in the absence of neural influences.     

Inflammatory Myofibroblastic Tumor of the Abdominal Wall Simulating Rhabdomyosarcoma: Report of a Case

We report the case of a 6-year-old boy with a progressively enlarging mass in the anterior abdominal wall. Computed tomography showed an intensely enhancing heterogeneous lesion arising from the anterior abdominal wall muscles with intraperitoneal extension. Based on the location of the tumor and the radiological findings we made a provisional diagnosis of rhabdomyosarcoma. However, the findings of fine-needle aspiration and Trucut biopsy were inconclusive for malignancy. We performed complete excision of the mass, including the involved left costal segment. Microscopically, the tumor was composed mainly of spindle-shaped cells without malignant features, and immunohistochemical analysis revealed positive staining for actin. These findings confirmed a diagnosis of an inflammatory myofibroblastic tumor (IMT). To our knowledge, this is the first case report of an extrapulmonary IMT arising from the anterior abdominal wall.     

探讨剖宫产术后腹壁切口子宫内膜异位症的治疗方法

目的：探讨腹壁子宫内膜异位症的临床特点、治疗方法和预防措施。方法：回顾性分析2008年～2010年本院收治的30例具有足月剖宫产史的手术病例,其中89．9％患者在月经期间腹壁肿物有周期性疼痛,就诊年龄（33．3±4．8）岁,就诊时距剖宫产（70．2±44．7）月。30例病例分为A实验组17例和B对照组13例,A实验组于腰硬联合麻醉下行病灶切除术,术后未应用治疗子宫内膜异位症方面药物;B对照组口服孕三烯酮2．5mg,每周2次,6个月,对所有患者在治疗后2年内每年随访2次,以评价治疗效果。结果：实验组术前诊断均与术后病理检查相符,术后无复发,术后切口均为Ⅰ期愈合,7d正常拆线出院。对照组7例发生闭经,1例存在肝功能损伤,实验组治愈率明显高于对照组,差异有统计学意义（P〈0．05）。结论：剖宫产术后腹壁切口子宫内膜异位症治疗首选手术切除,术前严格掌握剖宫产指征,术中认真操作是关键,同时提倡该种疾病以预防为主。     

Evaluation of Cutaneous Abdominal Wall Sensibility After Abdominoplasty

Changes in cutaneous sensibility are common after diverse plastic surgical procedures. Although prior studies examined aesthetic results, combined procedures, and new abdominoplasty techniques, few examined the effect of undermining on cutaneous sensibility. This study aimed to analyze and quantify cutaneous sensibility after classic abdominoplasty. Two groups of patients were studied: a control group of 10 patients without surgery and another group of 25 patients who had undergone classic abdominoplasty. The abdominal wall surface was divided into nine regions. Pain sensibility was evaluated by tests with needles, and thermal sensibility by test tubes containing hot and cold water. Superficial tactile sensibility was tested using the Pressure-Specified Sensory Device (PSSD), which is capable of determining the cutaneous pressure threshold. Statistical analysis was conducted using Student’s ‘t-test’. The results showed a decrease in the three types of sensibility. Statistical analysis showed a significant difference (p < 0.05) between the groups for all regions tested. The centermost regions of the abdominal wall presented the highest index of analgesia and thermal anesthesia, as well as higher cutaneous pressure thresholds.