Marlex mesh for repair of abdominal wall defects.

The best synthetic material available for repair of abdominal wall defects associated with an insufficiency of tissue is Marlex mesh. Among 14 patients with large hernias and 3 who underwent tumour resection only 2 manifested recurrence of the defect. In three of these patients infection developed, but its control made it unnecessary to remove the Marlex. In another three with gross infection of the abdominal wall, Marlex was used successfully to provide abdominal wall closure.     

Carbon-fibre versus Marlex mesh in the repair of experimental abdominal wall defects in rats

Large abdominal wall defects were created in Porton-Wistar rats and either left unrepaired (9 rats), or repaired with polypropylene (Marlex) mesh (11 rats), or with an open darn of filamentous carbon (11 rats). A further ten animals had a simple midline skin incision. At 5 months there were gross hernias in the unrepaired animals. Neither repair had resulted in gross recurrence although four of the carbon-repaired animals had bulges through the open weave. Tensiometry of the excised abdominal wall showed no difference in the strength of the two repairs. However, microscopy showed a striking difference-the Marlex had induced a chronic inflammatory response with disorganized collagen, whereas the carbon was not only well-tolerated but acted as a scaffold for well-organized and orientated collagen.     

Repair of massive septic abdominal wall defects with Marlex mesh

Marlex mesh was used to close the abdominal wall defect in six patients with septic wound dehiscence and intra-abdominal infection. The mesh was implanted under local anesthesia and served as a protective covering for the bowel and allowed early ambulation, including prone positioning of the patient for easier wound care. In four surviving patients, the Marlex mesh was covered by full thickness skin flaps after granulation tissue had covered the material. No patients had infected sinus tract formation or extrusion. Two patients had incisional hernias develop when the Marlex mesh was not sutured to the abdominal wall permanently. The use of Marlex mesh to cover infected defects in the abdominal wall when primary closure cannot be accomplished is suggested by our experience.     

Repair of abdominal wall defects: Gore-Tex vs. Marlex graft

The purpose of this study was to provide experimental evidence for the role of Gore-Tex polytetraflourethylene as an abdominal wall prosthesis. This was achieved by evaluating tissue reaction in animals to the plastic and comparing it to that of Marlex mesh. Ten Wistar rats received especially prepared Gore-Tex implants, and another ten received Marlex. The materials were inserted in a fashion that yielded results both intraperitoneally and extraperitoneally. Gross and microscopic data were recorded at the time of sacrifice, which ranged from two to ten weeks postoperatively. Grossly, both plastics were found to be similar in intraperitoneal tissue reaction. Microscopically, all of the Gore-Tex grafts retained their original shape and demonstrated focal adherence to the muscle. In contrast, strands of Marlex showed disorganization in the host in 90 per cent of the specimens and no focal adherence to muscle. Instead, it was seen walled off in fibrous tissues. It was concluded that specifically formulated Gore-Tex may provide the more suitable abdominal wall prosthesis and that further research is necessary.     

Repair of massive abdominal wall defects. Combined use of pneumoperitoneum and Marlex mesh.

The most important aspects of repairing massive hernias, eventrations, or surgically created abdominal wall defects are preoperative preparation of the patient and conservative judgment in indications for use of prosthetic material. Before operation, most patients (excluding those with trauma or severe sepsis) can be prepared electively by progressive preoperative pneumoperitoneum. The procedure is safe, simple, and effective. As described, it involves no special techniques or equipment and may be carried out as an inpatient or outpatient procedure. Prosthetic material should be used only to obviate tension on a suture line, for this must scrupulously be avoided. It should not be used routinely as onlay grafts in small or moderate hernias as primary fascial suturing gives better results with few wound complications when closure without tension is possible. Progressive preoperative pneumoperitoneum, combined when necessary with Marlex mesh to obviate tension, enables closure of even gigantic defects. The technique avoids the severe and sometimes fatal preliminary complications resulting from sudden increase in abdominal pressure and diaphragmatic elevation that accompany replacement of abdominal viscera that have lost their "right of domain" with large hernias or abdominal wall defects. This technique also markedly diminishes postoperative pain and aids satisfactory pulmonary management and thus permits early postoperative mobilization and discharge from the hospital.     

Autologous tissue repair of large abdominal wall defects

BACKGROUND AND METHOD: Techniques for autologous repair of abdominal wall defects that could not be closed primarily are reviewed. Medline and PubMed were searched for English or German publications using the following keywords: components separation technique (CST), Ramirez, da Silva, fascia lata, tensor fasciae latae, latissimus dorsi, rectus femoris, myocutaneous flap, ((auto)dermal) graft, dermoplasty, cutisplasty, hernia, abdominal wall defect, or combinations thereof. Publications were analysed for methodological quality, and data on surgical technique, mortality, morbidity and reherniation were abstracted. RESULTS AND CONCLUSIONS: The CST is the best documented procedure; it is associated with a high morbidity rate of 24.0 per cent and a recurrence rate of 18.2 per cent. Although the results of the da Silva technique are good (morbidity 5-20 per cent and reherniation 0-3 per cent), the poor methodological quality of the studies precludes firm conclusions. Repair with free fascia lata or dermal grafts is an alternative if the above techniques cannot be used, but wound complications affect 42 per cent of patients and recurrent hernia up to 29 per cent. Pedicled or free vascularized flaps are reserved for complex situations.     

生物可降解支架在修复腹壁缺损中的应用

<正>腹壁缺损作为外科的常见症状,其发生率在过去的75年里仍维持在一定的水平。统计表明美国每年约施行200万例腹部手术,而其中约10万人需要在术后进行腹壁缺损的修复[1-2]。使用不可降解的合成材料(聚丙烯、聚四氟     

植入性修补材料在腹壁肿瘤切除术后腹壁缺损修补的应用进展

<正>尽管腹壁肿瘤的临床发病率较低,但总体发生率呈上升趋势,而目前主要采用以手术为主的综合治疗方式。腹壁肿瘤切除后形成的腹壁缺损修补对外科医师来说是一个具有挑战性的问题,尤其是复杂缺损。随着材料科学和生物工程技术的快速发展,用在临床中修复人体腹壁缺损的新型组织工程材料不断出现,给腹壁肿瘤切除术所造成的腹壁缺损提供了新的选择。本文主要阐述植入性修补材料在腹壁肿瘤切除术后腹壁缺损修补的应用进展。一、腹壁肿瘤的定义腹壁肿瘤定义为腹壁皮肤及附属器、皮下组织、肌肉、腱膜等腹壁全层的软组织,都可在各种致瘤因素的作用下,     

Plastic surgery repair of abdominal wall and pelvic floor defects

Urologists often encounter large perineal and abdominal wall defects, the treatment of which may require close collaboration with the plastic surgeon. These complex defects can be successfully treated using a variety of techniques. Ventral hernias or freshly created abdominal wall defects can be treated with the basic principles of tension-free closure using abdominal wall components separation, synthetic mesh reconstruction, and, more recently, biosynthetic acellular dermis reconstruction. Pelvic floor defects often require flap reconstruction using gracilis flaps, vertical rectus abdominis myocutaneous flaps, or local fasciocutaneous flap. In this article, we seek to familiarize the urologists with the most common techniques used by plastic and reconstructive surgeons in the treatment of these complicated pelvic floor and abdominal wall defects.     

Excision of abdominal wall tumours and reconstruction with Marlex mesh

Because metastatic abdominal wall tumours are rare and their biologic activity is unpredictable, they must be managed aggressively (a) for potential cure of isolated recurrences and (b) to obtain good palliation, as fetid exophytic lesions alter the patient's self-image and life-style. An aggressive surgical approach often leaves a large abdominal wall defect. The authors describe 19 patients (10 men, 9 women) with these tumours who had their abdominal wall reconstructed with Marlex mesh. All patients received antibiotics preoperatively, but 16 had either mechanically unprepared bowel due to obstruction or abdominal contamination from the intestine intraoperatively. The commonest complication was wound abscess in 10 patients; it was controlled without removing the Marlex mesh. The majority of patients had prolonged palliation with greatly reduced symptoms, a reasonable quality of life and acceptable cosmesis. Potentially life-threatening intra-abdominal complications were reduced. One patient was considered cured. The authors believe that there is a definite role for aggressive surgical management of abdominal wall metastases and that Marlex mesh may be used for reconstruction even when there has been peritoneal contamination.     

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.     

Expanded polytetrafluoroethylene patch for the repair of large abdominal wall defects

Expanded polytetrafluoroethylene (ePTFE) was used to repair 11 large abdominal wall defects in ten patients. Three patches were fixed to the adjacent abdominal aponeurosis with a single row of sutures; seven patches were implanted with a 1-2 cm overlap of patch and aponeurosis and a double row of sutures. Recurrent buttonhole hernias were found in two patients, in both of whom a single row of sutures had been used. This reherniation was due to insufficient anchorage of the patch to the fascia. It is concluded that ePTFE is a useful material to repair large abdominal wall defects provided the patch is fixed to the aponeurosis with an overlap and a double row of sutures to prevent buttonhole hernias.     

Method of repair of anterior abdominal wall defects in children]

Experimental studies were conducted on 60 cadavers of children whose ages ranged from 0 to 14 years. A defect measuring 6-10 cm was formed in the muscles of the anterior abdominal wall (an approximate model of a hiatal opening). Several rows of crimping sutures were then applied to the aponeurosis of the rectus abdominis muscle above and below the defect. The force of stretching of the edges of the defect was studied by an elaborated tensiometric device after application of each row of crimping sutures. It was found that application of two or three rows of crimping sutures above and below the ventral defect ensures reliable decrease of the stretching load exerted on its edges and allows them to be sutured without tension. The optimal zones in the operative field for applying the crimping sutures were also determined. On the basis of experimental study the authors developed and used in the clinic a method for autoplasty of ventral hernias based principally on placing sutures through the edges of the ventral defect only after their approximation, after preliminary removal of the stretching load experienced by the laparotomic wound. The authors used this method of plasty successfully in 9 children with ventral hernias whose ages ranged from 2 to 14 years.     

构建组织工程肌腱膜与腹壁缺损修复

<正>随着外科技术手段的进步,腹壁缺损的治疗已由传统的单纯直接缝合修补,转变为以材料学为基础、利用各种补片进行的无张力修复。传统的手术治疗主要是将腹壁缺损周围的肌肉或韧带强行缝合,术后病人疼痛明显,恢复时间长,复     

生物材料在修补复杂性腹壁缺损中的使用

感染、污染或可能污染的腹壁缺损一直是疝和腹壁外科的治疗难点,主要包括补片感染、肠瘘合并疝、腹腔内脓肿、粪便性腹膜炎病史、造口旁疝修补术、无肠坏死或穿孔的嵌顿性疝、疝修补过程中实施肠切除和复发性切口疝等,上述情况统称为复杂性腹壁缺损.采用传统的合成材料如聚丙烯、聚酯或聚四氟乙烯等来修补,面临着感染、再取出材料和复发的危险.成分分离技术、可吸收补片和自体组织移植等方法由于各种局限性和并发症的存在,应用受到一定的限制.近年来,脱细胞异体真皮基质(acellular dermal matrix,ADM)和其他生物材料的出现,使外科医生能够较安全地一期重建上述复杂性腹壁缺损[1-2].