Abdominal wall compliance after Marlex® mesh implantation for incisional hernia repair

Summary In view of the poor results of suturing techniques, incisional hernias are often best repaired with biomaterials. Their use brings the recurrence rate to below 10%, but patients sometimes complain of discomfort and restricted abdominal mobility. We report our experience with 41 patients after implantation of a Marlex®-mesh in a preperitoneal, retromuscular position (mean follow-up period 16.7 months). The effect of implanted meshes on abdominal wall mobility was measured noninvasively with the aid of three dimensional stereography and compared with a non-operated healthy control group (n = 21). The commonest early postoperative complication was seroma in 32% of cases, usually relieved by aspiration. Infection and hematoma were less frequent at 4.9% and 12.2% respectively. Three patients developed a recurrent hernia. During follow-up 7.3% experienced pain during heavy activities, 29.3% during daily activities and 4.9% at rest. Three dimensional stereography showed a highly significant (p < 0.001) decrease in abdominal wall mobility following mesh implantation, compared to a non-operated control group. Improved composition of the mesh material involving a smaller proportion of polypropylene and greater elasticity, should be considered for the future, in order to reduce patient discomfort.The study was supported by BIOMAT (Interdisciplinary Centre of Clinical Investigation, RWTH Aachen).     

腹壁整形加聚丙烯网片修复巨大下腹壁缺损

目的探讨应用横切口腹壁整形术与聚丙烯网片联合修复下腹壁缺损的方法。方法应用横行切13腹壁整形加聚丙烯网片的手术方法，修复27例下腹壁缺损，其中6例下腹壁病灶切除，21例下腹横行腹直肌肌皮瓣（以下简称TRAM瓣）供区。结果随访3～20个月，腹壁病灶均彻底切除，术后未见复发，所有患者无腹壁薄弱、腹壁膨隆或腹壁疝形成，腹壁切口、一期愈合，无并发症。结论横行切口腹壁整形加聚丙烯网片修复下腹壁缺损，方法简单、效果可靠。     

腹壁肿瘤切除术后巨大/超大腹壁缺损的外科修复重建策略

腹壁肿瘤、尤其是恶性肿瘤R0切除术后会导致巨大、甚至超大腹壁缺损,选择合理的腹壁修复重建技术是治疗关键。本文总结了腹壁恶性肿瘤的临床特点、治疗现状、肿瘤扩大切除后腹壁缺损的术前评估和腹壁缺损修复重建的术式选择;重点阐释了腹壁缺损类型、缺损大小、缺损周围组织情况和患者全身情况对术式选择的重要性。     

Prune belly syndrome and abdominal wall reconstruction

The prune belly syndrome was first reported by Frolich in 1839 (Frolich F, Der Mangel der Muskeln insebesondere der Setinbauchmuskeln Dissertation, 1839) and is characterized by a triad of deficient abdominal musculature, intraabdominal testes, and dilatation of the urinary collecting system. These patients who often require urological procedures and subsequent reconstruction of the abdominal wall can prove to be an interesting plastic surgery challenge. The standard techniques for abdominal wall reconstruction can be used, but these must be modified to meet the needs of each individual patient. A 3-year-old boy with prune belly syndrome is presented who was referred to the plastic surgeons for abdominal wall reconstruction. He had already undergone multiple urological procedures and had a Mitrofanoff microstoma at the umbilicus. There have been no techniques described previously to deal with the umbilical stoma. The patient underwent a two-stage reconstruction. This included plication of the fibrous abdominal wall and deepithelialization of excess skin to provide a double layer of dermis. The patient is now 17 years old and has achieved a good result. In the techniques previously described, “redundant” excess skin was excised and discarded, together with some form of plication. We feel that excess skin in prune belly patients should not necessarily be thought of as redundant and may be used as a double layer of dermis to protect and enhance the underlying abdominal wall repair.     

Personal technique of abdominoplasty applicable in specific cases

Summary A personal modification of the original dermolipectomy technique of Rockay [8] is presented for specific cases of patients with severe lipodistrophies, metabolic or cardiovascular disorders, patients with prior supraumbilical scars, etc., frequently associated with alterations to the musculoaponeurotic wall. The technique results in an anchor-shaped scar, and in our experience it permits very large cutaneousadipose resection with a very low incidence of complications, rapid patient recovery and correct remodeling of the abdomen.     

复合补片修补腹壁肿瘤切除后巨大腹壁缺损的临床疗效

目的探讨复合补片修补腹壁肿瘤切除后巨大腹壁缺损的临床疗效。 方法回顾性分析2015年2月至2017年8月,新疆医科大学第四附属医院收治的55例腹壁肿瘤切除术后巨大腹壁缺损患者临床资料,根据植入补片的不同分为试验组（35例）和对照组（20例）,2组患者均行腹壁肿瘤切除术,试验组植入Proceed补片,对照组植入Composix Kugel补片。比较2组手术相关临床参数、手术前后不同时间疼痛程度、切口愈合情况、并发症、肿瘤复发及转移情况。 结果2组铺置补片时间及术后自主活动时间比较,差异无统计学意义（P>0.05）。术后12 h至7 d,2组患者视觉模拟评分均呈逐渐降低趋势,且均明显低于术前（P<0.05）,但2组间均无明显差异（P>0.05）。拆线后伤口均达到一期愈合,2组总并发症发生率比较,差异无统计学意义（P>0.05）。随访1年,试验组肿瘤原位复发1例,对照组肿瘤远处转移1例,2组患者腹壁修复材料腹腔面光滑,且均未见腹壁修复材料与肠管黏连。 结论采用Proceed补片和Composix Kugel补片对腹壁肿瘤切除后巨大腹壁缺损进行修复和重建,效果均较好,安全性高。     

The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure

Operation for gastrointestinal cutaneous fistula almost always requires resection and anastomosis. Those of use who do this surgery frequently have learned the hard way that closure of the abdominal wall, preferably with native tissue, is essential for refistulization to not occur. What is one to do when component separation or an Abramson type of approach is insufficient and flaps either can not be done or are not available? Recently, it has been proposed that inert biological material may be the answer for abdominal closure and somehow it is more resistant to infection and less likely to fistulize than totally synthetic material. However, data has slowly been coming available that suggests that use of inert biological material may in fact not be satisfactory and may in fact have an increased tendency to infection, wound breakdown, and refistulization.     

生物补片在治疗感染和污染腹壁缺损方面的体会（附34例病例）

目的观察生物补片在感染或污染状态下腹壁缺损中的应用的情况。方法回顾分析我院疝和腹壁外科治疗和培训中心从2007年3月至2011年1月期间收治的34例腹壁感染或污染伴有腹壁缺损的患者,进行腹壁修复时采用了脱细胞组织生物型补片治疗。对手术方式,术后的恢复情况,术后的并发症,随访复发的情况进行分总结。结果Ⅰ期愈合31例,Ⅱ期愈合3例。在Ⅱ期愈合中无补片取出的情况。术后随访3～30个月不等,术后3个月起发现膨出10例。结论生物补片为这类患者的治疗,提供了有益的帮助。     

Component separation in the management of the difficult abdominal wall

BACKGROUND: Abdominal compartment syndrome (ACS) and mesh implantation in abdominal wounds are creating abdominal wall problems not seen in the past. Component separation (CS) is an alternative technique used to manage these difficult wounds. METHODS: From January 2001 to July 2003, 27 patients were identified who had undergone CS. Charts were reviewed for defect etiology and characterization, surgical results, and outcome from reconstruction. RESULTS: Etiology of the defect was ACS in 14, infected mesh in 5, and multiple failed repairs in 8 patients. Twenty-three were closed completely with CS, 2 required prosthetic mesh, and 2 had a porcine implant placed. Three wound complications occurred that required reoperation. Three hernia recurrences have been identified. All patients are completely recovered and are currently functioning without limitation. CONCLUSIONS: Large and/or complex abdominal wall defects can be managed with a single-stage procedure using CS, thus many complications associated with implantation of prosthetic mesh are avoided. Functional outcome is excellent.     

The use of three different mesh materials in the treatment of abdominal wall defects

Abstract Abstract. Various prosthetic materials have been proposed for the repair of abdominal wall defects. These materials offer tension-free repair and significantly lower recurrence rate. Their respective properties are related to such complications as seroma, infection, fistula formation, intestinal adhesions and removal. We compared the final outcome in treating abdominal wall defects in 56 patients with three different prosthetic materials: conventional polypropylene in a preperitoneal location, expanded polytetrafluoroethylene mesh, and hydrophilic membrane coated polyester mesh in an intraperitoneal location. The hydrophilic coated polyester group exhibited the lowest complication rate and the polypropylene group the highest. Electronic Publication     

Repair of giant abdominal wall hernias with full-thickness skin transplants in high-risk patients

The repair of giant abdominal hernias in high-risk obese patients remains a great challenge. There is no single simple surgical procedure to provide correction for this condition, and the risk for recurrence of hernia is high. Moreover, the insertion of a foreign material, i.e., synthetic mesh, adds an increased risk of infection, particularly in the presence of concomitant immunosuppressant therapy or diabetes. Eight patients, classified ASA 3–4, with giant abdominal wall hernias had 3 months pre-treatment with a custom-made compressive garment before abdominal wall repair. Four patients had a stoma at the time of surgery. Abdominal wall reconstruction was undertaken by realignment of the rectus muscles and fascia under tension. The fascia repair was stabilized with a full-thickness skin overlay graft. Early complications included two wound infections and one seroma. Two patients had pulmonary insufficiencies and required intensive care management. One complete recurrence of hernia was noted at follow-up. Full-thickness skin overlay grafts can be recommended in high-risk patients with abdominal wall hernias when the use of foreign material such as synthetic mesh is contraindicated.     

Repair of a full-thickness abdominal wall defect with an innervated latissimus dorsi free flap

A 38-year-old man developed an infection that led to necrosis of the abdominal wall after perforation of a gastric ulcer. A split-thickness skin graft over the abdominal viscera was used to achieve temporary primary closure. After full systemic and local stabilisation, it was reconstructed with a free innervated latissimus dorsi myocutaneous flap.     

Use of tissue expanders in the repair of complex abdominal wall defects

Background/Purpose

Closure of abdominal wall defects in children poses a challenge for pediatric surgeons. We describe a technique using tissue expanders placed either intraperitoneally or in the abdominal wall to aid in the reconstruction of a variety of complex abdominal wall defects.

Methods

The tissue expanders are inserted under general anesthesia. Initial expansion is done in the operating room with attention to peak airway pressure, urine output, and end-tidal carbon dioxide. The expanders are inflated in the outpatient setting via percutaneous access until the calculated inflation volume is achieved. They are then removed; and definitive closure is accomplished using a combination of native tissue flaps, abdominal component separation techniques, biomaterials, and synthetic material.

Results

Six children underwent tissue expansion for treatment of abdominal wall defects (omphalocele, n = 3), trauma (n = 1), and thoracopagus twins (n = 1 pair). One to 4 expanders were used per patient, with all having a successful reconstruction of their abdominal walls. Two to 3 operations were required to restore abdominal domain and consisted of expander insertion, removal with reconstruction, and possible revision of the reconstruction.

Conclusions

Tissue expanders possess a broad range of applications for abdominal wall reconstruction and can be used in patients of all ages.     

The external oblique muscle flap technique for the reconstruction of abdominal wall defects

PurposeSeveral modifications to the anterior component separation technique (ACST) have been reported to facilitate the closure of abdominal wall defects. In this study, the external oblique (EO) muscle flap for modified ACST during major abdominal wall defect reconstructions has been described.MethodsA retrospective review of consecutive patients undergoing modified ACST was conducted. The clinical data were collected and retrospectively analyzed.ResultsAmong the 36 patients admitted to our hospital from December 2014 to December 2020, 9 cases had rectus abdominis tumors, 1 case had rectus abdominis trauma, and 26 cases had incisional hernias. The average age was 61.17 ± 13.76 years, and the mean BMI was 24.25 ± 3.18 kg/m². The average width of the defect was 14.33 ± 2.90 cm. Unilateral EO muscle flap technique was used to reconstruct the abdominal wall. 3 cases of surgical site infection (8.3%), 4 cases of grade III or IV seroma (11.1%) and 2 cases of intestinal obstruction (5.5%)were reported postoperatively. Ischemic necrosis of the abdominal EO muscle flap, incision dehiscence, intestinal fistula, or other complications were not observed. 1 case of incisional hernia recurrence (2.8%) was reported. Recurrence of tumors or abdominal wall bulging were not noted during the follow-up period of 32.53 ± 14.21 months.ConclutionsThe EO muscle flap technique is associated with low postoperative morbidity and recurrence rate, which approves it a reliable technique for selected groups of patients. Further research are needed to confirm the effectiveness of this technique.     

Reconstruction of the abdominal wall for incisional hernia repair

BACKGROUND: Abdominal wall reconstruction with mobilization of autologous tissue has evolved as a reliable option for patients with incisional hernias. METHODS: With the aim of evaluating morbidity and recurrence rates in patients who underwent abdominal wall reconstruction for incisional hernia repair, we retrospectively reviewed the charts of 188 patients treated between 1996 and 2003. RESULTS: Primary approximation of the fascial defect was achieved in 77% and was reinforced by either mesh placement or rectus muscle advancement. The remaining 23% were reconstructed either by mesh placement, components separation, or distant flap mobilization. Median follow-up was 15 months. Overall morbidity rate was 38%; recurrence rate was 13%. Dimensions of the hernia and intraoperative enterotomies were associated with postoperative complications. Lack of complete restoration of the myofascial abdominal wall continuity was associated with recurrence. CONCLUSIONS: In patients with incisional hernias, techniques involving autologous tissue mobilization are safe and associated with low recurrence rates.     

Acute abdominal pain following fracture of a heterotopically formed bone incorporating a prolene mesh

A case is presented of severe abdominal pain around a healed scar following fracture of a heterotopically formed bone. This should be considered an unusual differential diagnosis in patients with acute pain of unknown origin who had open abdominal surgery in the past. To our knowledge, we have also reported the first case of hetertopic bone formation incorporating a prolene mesh.