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Abdominal wall reconstruction

Desiree Raygor, James Cunningham, Joseph Costa, Marie Crandall, David Skarupa
A 69-year-old obese man was involved in a high-speed head-on motor vehicle collision. He was tachycardic and normotensive on arrival. He subsequently developed hemodynamic instability requiring blood transfusion. On examination he had bilateral pneumothoraces, an anterior-posterior compression (APC) pelvic fracture, an open wound at the left groin, and gross hematuria after Foley catheter placement.CT imaging revealed hemoperitoneum, right hepatic lobe grade II lacerations, splenic laceration, mesenteric root injury with extravasated contrast, intraperitoneal and extraperitoneal bladder rupture, bilateral ureteral injuries at the level of the pelvic inlet (see figure 1), APC pelvic fracture, bilateral rib fractures, pneumothoraces, and pulmonary contusions...
2018: Trauma surgery & acute care open
Jeong-Moo Lee, Kwang-Woong Lee, Suk Kyun Hong, Kyung Chul Yoon, Jae-Hyung Cho, Nam-Joon Yi, Kyung-Suk Suh
BACKGROUND: Status in terms of major vascular structure invasion is a crucial factor for successful major hepatic resection. In particular, surgery for advanced tumors with inferior vena cava (IVC) invasion is difficult and may even be dangerous for the patient, having high risk of massive bleeding and greater chance of embolic complications such as stroke, bowel ischemia, and pulmonary venous thrombosis. For such reasons, many surgeons hesitate to carry out such surgical resection, and even if they do so, may not totally remove the tumor including the part inside the IVC, achieving R1 resection...
July 17, 2018: Annals of Surgical Oncology
J C Kloppers, J Ej Krige, M M Bernon, S Burmeister, E Jonas, S R Thomson, P C Bornman
BACKGROUND: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. OBJECTIVE: To assess the outcome of surgical resection of BMCNs. METHOD: A prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur Hospital Complex for BMCN from 1999 to 2015. Demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, postoperative complications and outcome...
June 2018: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Mohamed Abdel Wahab, Ahmed Shehta, Reham Adly, Mohamed Elshoubary, Tarek Salah, Amr M Yassen, Mohamed Elmorshedi, Moataz M Emara, Mostafa Abdelkhalek, Mahmoud Elsedeiq, Usama Shiha, Ahmed N Elghawalby, Mohamed Eldesoky, Ahmed Monier, Rami Said
INTRODUCTION: Biliary reconstruction is a cornerstone of living-donor liver transplantation (LDLT). The routine uses of trans-anastomotic biliary catheters in biliary reconstruction had been a controversial issue. We describe a rare complication related to the use of trans-anastomotic biliary catheter after LDLT. In this case, intestinal obstruction occurred early after LDLT due to internal herniation of the small bowel around trans-anastomotic biliary catheter. PRESENTATION: A 42 years male patient with end stage liver disease underwent LDLT utilizing a right hemi-liver graft...
June 28, 2018: International Journal of Surgery Case Reports
R Alvo, K Serror, R Bern, M Chaouat, M Mimoun, D Boccara
The hands are the most commonly affected area in burn injuries and are involved approximately 80% of the time. Because of the thinness of the skin and superficial location of critical structures, the dorsum of the hand needs an optimal coverage to preserve maximum articular mobility and range of motion. The aim of this article is to detail the therapeutic alternatives to skin graft in cases of very deep burns on the dorsum of the hand, and to specify the indications. We reviewed all articles referenced on PubMed, and included all the original articles related to the management of acute burned hands and their different coverage techniques (dermal substitutes and flaps)...
December 31, 2017: Annals of Burns and Fire Disasters
Seyed Amirhossein Razavi, Karan A Desai, Alexandra M Hart, Peter W Thompson, Albert Losken
The goal in abdominal wall reconstruction (AWR) is to minimize morbidity and prevent hernia recurrence. Components separation and mesh reconstruction are two options, however, with advantages and disadvantages. The purpose of this review was to investigate outcomes in patients with abdominal wall hernia undergoing primary closure with component separation (CS) versus CS with acellular dermal matrix (ADM) reinforcement (CS + mesh). Medical records of consecutive patients who underwent abdominal wall reconstruction using CS with or without ADM reinforcement were retrospectively reviewed...
June 1, 2018: American Surgeon
J-B Schaff, E Fontaine, C Dariane, A Mejean, L Lantieri, M Hivelin
Classical bladder exstrophy (CBE), affecting 1 birth out of 30,000, is characterized by an evaginated bladder plate through a defect in the lower abdominal wall, multiple abdominal wall anomalies including a pubic bone arch dehiscence. Numerous approaches from childhood to adulthood are thus required, depending on the severity of the deformity, including the associated genital anomalies. We report the case of a 19-year-old woman with CBE with a history of three-failed primary closure. We performed a secondary neck closure with a concomitant suspension of the bladder neck and reconstruction of the lower abdominal wall using a bilateral gracilis muscle flap transposition...
July 3, 2018: Annales de Chirurgie Plastique et Esthétique
Shawn Moshrefi, Suhail Kanchwala, Arash Momeni
BACKGROUND: Autologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to become pregnant postoperatively because of concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction...
June 9, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Xiyu Sun, Huizhong Qiu, Bin Wu, Guole Lin, Haifeng Shi, Yi Xiao
OBJECTIVE: To investigate the treatment of colorectal anastomotic tubular stricture after anterior resection of rectal cancer. METHODS: A retrospective study on 23 cases of anastomotic tubular stricture after anterior resection of rectal cancer from 2008 to 2017 at the Division of Colorectal Surgery, Department of General Surgery of Peking Union Medical College Hospital was performed. The general conditions of the patients, surgical procedures of rectal cancer, perioperative treatment, specific conditions of anastomotic stricture, treatment methods and outcomes were summarized and analyzed...
June 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Ping Wang, Cheng-Zhou Zhang, Guang-Bin Wang, Yang-Yang Li, Xing-Yue Jiang, Fang-Jun Fang, Xiao-Xiao Li, Jia Bian, Xin-Shan Cao, Xiao-Fei Zhong
BACKGROUND: The aim of this study was to evaluate the utility of computed tomography (CT) vascular reconstruction in the localization diagnosis of perigastric mass. METHODS: Fifty-eight patients with pathologically detected perigastric mass underwent abdominal dynamic contrast-enhanced CT. CT vascular reconstructions were produced from arterial phase data using volume rendering (VR), multiplanar reconstruction (MPR), and maximal intensity projection (MIP). Image analysis was focused on the relationship between the mass, perigastric arteries, and the gastric wall...
June 2018: Medicine (Baltimore)
Jeong Hyun Ha, Seong Oh Park, Hak Chang, Ung Sik Jin
INTRODUCTION: In extensive radionecrosis following radiotherapy for breast cancer (BC) treatment, the defect after excision can be reconstructed with a transverse rectus abdominis myocutaneous (TRAM) flap. In this study, we report outcome of free TRAM flap using contralateral internal mammary artery (IMA) as a recipient in comparison with pedicled TRAM. METHODS: We reviewed cases of chest wall radionecrosis following BC treatment during the past 8 years. Radionecrosis involving full-thickness soft tissue with defect sizes greater than 10 × 10 cm were included...
June 26, 2018: Annals of Plastic Surgery
Jennie T Grainger, Yasuko Maeda, Suzanne C Donnelly, Carolynne J Vaizey
Intestinal failure (IF) is a condition characterized by the inability to maintain a state of adequate nutrition, or fluid and electrolyte balance due to an anatomical or a physiological disorder of the gastrointestinal system. IF can be an extremely debilitating condition, significantly affecting the quality of life of those affected. The surgical management of patients with acute and chronic IF requires a specialist team who has the expertise in terms of technical challenges and decision-making. A dedicated IF unit will have the expertise in patient selection for surgery, investigative workup and planning, operative risk assessment with relevant anesthetic expertise, and a multidisciplinary team with support such as nutritional expertise and interventional radiology...
2018: Clinical and Experimental Gastroenterology
Jammula S Srinivas, Prakash Panagatla, Mukunda Reddy Damalacheru
Introduction: Reconstruction of complex abdominal wall defects is both challenging and technically demanding for plastic surgeon. Objectives in abdominal wall reconstruction are consistent and include restoration of abdominal wall integrity, protection of intra abdominal viscera and prevention of herniation. Materials: We conducted a retrospective study on five patients in whom lateral thigh flaps such as anterolateral thigh (ALT) flaps and tensor fascia lata (TFL) myocutaneous flaps as pedicled or free flaps were used for complex abdominal wall Type II defects over a 5- years period between 2007 and 2012...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Yujin Myung, Bomi Choi, Sang Jun Yim, Bo La Yun, Heeyeon Kwon, Chang Sik Pak, Chanyeong Heo, Jae Hoon Jeong
PURPOSE: Studies focusing on the originating patterns of the deep inferior epigastric artery (DIEA) have not been conducted. Here, we analyzed the vascular anatomy of the DIEA with computed tomographic angiography (CTA) to provide assistance during proximal pedicle dissection of a DIEA-based flap. METHODS: We conducted a retrospective study on patients who had undergone breast reconstruction with the transverse rectus abdominis musculocutaneous flap and the deep inferior epigastric perforator flap from March 2006 to October 2016...
June 20, 2018: Surgical and Radiologic Anatomy: SRA
Tal Kaufman, Ben Kaplan, Luba Perry, Yulia Shandalov, Shira Landau, Itay Srugo, Dean Ad-El, Shulamit Levenberg
Autologous muscle flaps are commonly used to reconstruct defects that involve muscle impairment. To maintain viability and functionality of these flaps, they must be properly vascularized and innervated. Tissue-engineered muscles could potentially replace autologous muscle tissue, but still require establishment of sufficient innervation to ensure functionality. In this study, we explored the possibility of innervating engineered muscle grafts transplanted to an abdominal wall defect in mice, by transferring the native femoral nerve to the graft...
June 1, 2018: American Journal of Transplantation
Shozo Yoshida, Akira Onogi, Masamitsu Kuwahara, Tomoko Uchiyama, Hiroshi Kobayashi
We herein report a case of clear cell carcinoma arising from endometriosis in the groin in a 53-year-old woman. The findings of MRI and FDG/PET-CT indicated a malignant tumor, and surgical biopsy confirmed adenocarcinoma of the female genital tract. The tumor including a part of the abdominal rectus muscle and rectus sheath, subcutaneous fat, skin, and the right inguinal ligament was resected en bloc . The defect in the abdominal wall was reconstructed with a fascia lata tensor muscle skin flap. The tumor was composed of clear cell adenocarcinoma arising from extrapelvic endometriosis...
2018: Case Reports in Obstetrics and Gynecology
Julian Braetz, Astrid Becker, Markus Geissen, Axel Larena-Avellaneda, Sonja Schrepfer, Guenter Daum
OBJECTIVE: The main objective of this study was to define a role of sphingosine-1-phosphate receptor 1 (S1PR1) in the arterial injury response of a human artery. The hypotheses were tested that injury induces an expansion of S1PR1-positive cells and that these cells accumulate toward the lumen because they follow the sphingosine-1-phosphate gradient from arterial wall tissue (low) to plasma (high). METHODS: A humanized rat model was used in which denuded human internal mammary artery (IMA) was implanted into the position of the abdominal aorta of immunosuppressed Rowett nude rats...
May 24, 2018: Journal of Vascular Surgery
Matthew A DelMauro, Louis-Joseph Auguste, Peter T Korn
Management of the umbilicus is a common dilemma at the time of abdominoplasty and abdominal wall reconstruction. It is not uncommon for underlying pathologies, such as hernias and surgical scars, to result in a disfigured or obliterated native umbilicus or make the blood supply to the umbilical stalk unreliable. In these scenarios, the umbilicus is often sacrificed. Staged neoumbilical reconstruction may be offered and typically utilizes a small skin flap and full-thickness skin graft (Ann Plast Surg 2009;63:358-360)...
May 17, 2018: Annals of Plastic Surgery
Enrico Coppola Bottazzi, Adele Noviello, Nicola Moles, Antonio Miro, Augusto Striano, Mario Baiamonte, Francesco Esposito, Francesco Crafa
Introduction: Merkel cell carcinomas (MCC) is an aggressive neuroendocrine carcinoma originating from the Merkel cell in the dermo-epidermal junction. Only 10% of MCC occur on the skin of the trunk. Case report: We report a case of Merkel's abdominal carcinomas treated with extensive inguinal lymphadenectomy and reconstruction of the abdominal wall and inguinal canal using prosthesis GORE® BIO-A® . Discussion: Immunohistochemical analysis by tumor-specific markers is crucial for diagnosis and permits differentiation from other tumors of the skin...
May 2018: Journal of Surgical Case Reports
Guangsheng Du, Enlai Jiang, Yuan Qiu, Wensheng Wang, Shuai Wang, Yunbo Li, Ke Peng, Xiang Li, Hua Yang, Weidong Xiao
OBJECTIVE: To explore the feasibility, safety, and preliminary technical experience of single incision plus one port laparoscopic total gastrectomy combined with π-shaped esophagojejunal anastomosis (SILT-π) in the surgical treatment of gastric cancer. METHODS: Clinical data of 5 gastric cancer patients undergoing SILT-π operation at the Department of General Surgery, The Second Affiliated Hospital of the Army Medical University from August to October 2017 were retrospectively analyzed...
May 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
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