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fascial dehiscence

Salvatore Giordano, Patrick B Garvey, Donald P Baumann, Jun Liu, Charles E Butler
BACKGROUND: Previous studies suggest that bridged mesh repair for abdominal wall reconstruction may result in worse outcomes than mesh-reinforced, primary fascial closure, particularly when acellular dermal matrix is used. We compared our outcomes of bridged versus reinforced repair using ADM in abdominal wall reconstruction procedures. METHODS: This retrospective study included 535 consecutive patients at our cancer center who underwent abdominal wall reconstruction either for an incisional hernia or for abdominal wall defects left after excision of malignancies involving the abdominal wall with underlay mesh...
October 31, 2016: Surgery
Benjamin C Powell, Colin B Webb, Joseph A Ewing, Dane E Smith
Elective excision of noninfected pilonidal cysts has historically been plagued by a high rate of complications, such as wound breakdown and recurrence. Debate remains regarding the most effective method of wound closure. We previously reported a small group of patients (n = 17 out of 83 patients) in which a novel technique decreased wound complications and recurrence. The purpose of this article was to build on that prior study by evaluating the utility of the gluteal fascial advancement method to decrease complications over a 10-year period...
July 2016: American Surgeon
A S Bath, P K Patnaik, P S Bhandari
INTRODUCTION: Reconstruction of large abdominal wall defects not amenable to primary closure remains a challenging problem. These defects result from trauma, previous surgery, infection and tumour resection. The primary objectives of abdominal wall reconstructions are to protect abdominal contents and provide functional support. The abdominal wall reconstruction aims at providing basic component parts, i.e. skin, soft tissue and fascia. For large soft tissue defects, pedicled or free flap closure can be used...
April 2007: Medical Journal, Armed Forces India
Thorsten Jentzsch, James Geiger, Clément M L Werner
BACKGROUND: A fascial dehiscence after spinal instrumentation is usually located at the mechanically stressed interscapular thoracic spine and often causes cosmetic impairment and pain. However, therapy options remain barely discussed. Synthetic meshes have been successfully used in the treatment of abdominal hernias. OBJECTIVE: It was hypothesized that synthetic meshes are a successful treatment option for spinal fascial dehiscence. METHODS: This retrospective study of a prospective database investigated all consecutive patients who received a synthetic mesh for a fascial dehiscence of the spine between 2010 and 2014 after prior spinal instrumentation...
June 30, 2016: Journal of Back and Musculoskeletal Rehabilitation
Robert C Johnston, Lauryn Gabby, Tevy Tith, Kristina Eaton, Melissa Westermann, Deborah A Wing
OBJECTIVE: Nearly one-third of all births in the United States in 2013 were by cesarean delivery, with 6% complicated by diabetes. The purpose of this study was to correlate immediate postoperative hyperglycemia with wound morbidity in diabetic women who underwent cesarean delivery. METHODS: This retrospective case-control study was performed at UC Irvine Health and Miller Women's & Children's Hospital Long Beach between 2009 and 2015. Subjects included women with at least Class B diabetes mellitus who underwent cesarean birth...
May 5, 2016: Journal of Maternal-fetal & Neonatal Medicine
Kristian K Jensen, Peter-Martin Krarup, Thomas Scheike, Lars N Jorgensen, Tommie Mynster
BACKGROUND: Laparoscopic surgery for colonic cancer decreases the incidence of postoperative complications and length of hospital stay as compared with open surgery, while the oncologic outcome remains equivalent. It is unknown whether the surgical approach impacts on the long-term rate of incisional hernia. Furthermore, risk factors for incisional hernia formation are not fully elucidated. The aim of this study was to evaluate the long-term effect of elective open versus laparoscopic surgery for colonic cancer on development of incisional hernia...
October 2016: Surgical Endoscopy
Emma L Barber, Benjamin Harris, Paola A Gehrig
BACKGROUND: Intraoperative trainee involvement in hysterectomy is common. However, the effect of intraoperative trainee involvement on perioperative complications depending on surgical approach is unknown. OBJECTIVE: To estimate the effect of intraoperative trainee involvement on perioperative complication after vaginal, laparoscopic, and abdominal hysterectomy for benign disease. METHODS: Patients undergoing laparoscopic, vaginal, or abdominal hysterectomy for benign disease from 2010 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database...
August 2016: American Journal of Obstetrics and Gynecology
Mary R Kwaan, Christopher J Weight, Stacy Jo Carda, Alyssia Mills-Hokanson, Elizabeth Wood, Colleen Rivard-Hunt, Peter A Argenta
BACKGROUND: Prevention of surgical site infections (SSIs) can improve surgical quality through reductions in morbidity and cost. We sought to determine whether the abdominal closure protocol, in isolation, decreases SSI at an academic teaching hospital. METHODS: Adult patients undergoing laparotomy were prospectively randomized to an abdominal closure protocol, which includes unused sterile instruments and equipment at fascial closure, or usual care. A 30-day SSI rates were compared...
June 2016: American Journal of Surgery
Brandon R Bruns, Sarwat A Ahmad, Lindsay OʼMeara, Ronald Tesoriero, Margaret Lauerman, Elena Klyushnenkova, Rosemary Kozar, Thomas M Scalea, Jose J Diaz
BACKGROUND: Damage-control surgery with open abdomen (OA) is described for trauma, but little exists regarding use in the emergency general surgery. This study aimed to better define the following: demographics, indications for surgery and OA, fascial and surgical site complications, and in-hospital/long-term mortality. We hypothesize that older patients will have increased mortality, patients will have protracted stays, they will require specialized postdischarge care, and the indications for OA will be varied...
April 2016: Journal of Trauma and Acute Care Surgery
John A Harvin, Curtis J Wray, Joshua Steward, Ryan A Lawless, Michelle K McNutt, Joseph D Love, Laura J Moore, Charles E Wade, Bryan A Cotton, John B Holcomb
BACKGROUND: Damage control laparotomy (DCL) is performed for physiologically deranged patients. Recent studies suggest overutilization of DCL, which may be associated with potentially iatrogenic complications. METHODS: We conducted a retrospective study of trauma patients over a 2-year period that underwent an emergent laparotomy and received preoperative blood products. The group was divided into definitive laparotomy and DCL. RESULTS: A total of 237 received were included: 78 in definitive laparotomy group, 144 in the DCL group, and 15 who died in the operating room...
July 2016: American Journal of Surgery
Matias Bruzoni, Gary K Steinberg, Sanjeev Dutta
INTRODUCTION: An abundance of angiogenic and immunologic factors makes the omentum an ideal tissue for reconstruction and revascularization of a variety of extraperitoneal wounds and defects. Omental harvesting was historically performed through a large laparotomy and subcutaneous tunneling to the site of disease. Several complications of the open procedure including abdominal wound infection, fascial dehiscence, ventral hernia, and postoperative ileus have been described. The use of laparoscopy to harvest the omentum has the potential to reduce such complications...
April 2016: Journal of Pediatric Surgery
Lindsay O'Meara, Sarwat B Ahmad, Jacob Glaser, Jose J Diaz, Brandon R Bruns
BACKGROUND: Emergency general surgery patients are increasingly being managed with an open abdomen (OA). Factors associated with complications after primary fascial closure (PFC) are unknown. METHODS: Demographic and operative variables for all emergency general surgery patients managed with OA at an academic medical center were prospectively examined from June to December 2013. Primary outcome was complication requiring reoperation. RESULTS: Of 58 patients, 37 managed with OA achieved PFC...
December 2015: American Journal of Surgery
Matias Vested Madsen, Susanne Scheppan, Peter Kissmeyer, Emilie Mørk, Jacob Rosenberg, Mona Ring Gätke
INTRODUCTION: During laparotomy, surgeons frequently experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. This issue is particularly pertinent while closing the fascia and placing the intestines into the abdominal cavity. Establishment of a deep neuromuscular blockade (NMB), defined as a post-tetanic-count (PTC) of 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesised that deep NMB (PTC 0-1) would improve surgical conditions during upper laparotomy as compared to standard NMB with bolus administration...
October 2015: Danish Medical Journal
Alessandro Scalise, Roberto Calamita, Caterina Tartaglione, Marina Pierangeli, Elisa Bolletta, Matteo Gioacchini, Rosaria Gesuita, Giovanni Di Benedetto
Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc...
December 2016: International Wound Journal
Julie L Holihan, Eric P Askenasy, Jacob A Greenberg, Jerrod N Keith, Robert G Martindale, J Scott Roth, Jiandi Mo, Tien C Ko, Lillian S Kao, Mike K Liang
BACKGROUND: Repair of large ventral hernia defects is associated with high rates of surgical site occurrences (SSO), including surgical site infection (SSI), site dehiscence, seroma, hematoma, and site necrosis. Two common operative strategies exist: Component separation (CS) with primary fascial closure and mesh reinforcement (PFC-CS) and bridged repair (mesh spanning the hernia defect). We hypothesized that: (1) ventral hernia repair (VHR) of large defects with bridged repair is associated with more SSOs than is PFC, and (2) anterior CS is associated with more SSOs than is endoscopic, perforator-sparing, or posterior CS...
February 2016: Surgical Infections
D Dondossola, M Cavenago, S Piconi, B Antonelli, E Melada, C Lonati, S Gatti, G Rossi
Although survival after liver transplantation (LT) has progressively improved over the last years, an increased prevalence of clinically relevant infections in LT patients is well documented. In particular, the spread of infections sustained by extensively drug-resistant bacteria (XDR) produced an increase in the incidence of wound infections. Implementation of treatments for these life-threatening events is mandatory. This study describes 2 LT patients in whom XDR wound infection was effectively treated using negative pressure wound treatment (NPWT) combined with targeted local and systemic antibiotic therapy...
September 2015: Transplantation Proceedings
Thorsten Jentzsch, Vinicius Gomes de Lima, Burkhardt Seifert, Kai Sprengel, Clément M L Werner
PURPOSE: While spinal instrumentations are becoming more common, the advantages of elective spinal implant removal remain ambiguous. We hypothesized that elective implant removal of the posterior spine is beneficial. METHODS: A retrospective study evaluated 137 consecutive trauma patients with elective implant removal of the posterior spine. If additional cages were present, they were not removed. Primary outcomes were the change in pre- and post-operative pain, fingertip-floor distance (FFD), and Cobb angles...
March 2016: European Spine Journal
Stephan Duetzmann, Tyler Cole, Christian Senft, Volker Seifert, John Kevin Ratliff, Jon Park
OBJECT: Incisional pain after posterior cervical spine surgery can be severe and very unpleasant to the patient. Ongoing incisional pain is one of the key disadvantages of posterior over anterior surgical approaches to the cervical spine. It prolongs hospital stays and delays return to work. In this study, the hypothesized that incisional pain in the immediate postoperative period is caused partially by tension on the skin as well as on the deep cervical fascia and the fascia overlying the trapezius, which are usually sewn together during closure...
December 2015: Journal of Neurosurgery. Spine
Phillipo L Chalya, Anthony N Massinde, Albert Kihunrwa, Joseph B Mabula
BACKGROUND: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. This study was undertaken to describe our own experiences with abdominal fascial closure following elective midline laparotomy and compare with what is described in literature. METHODS: This was a descriptive prospective study of patients who underwent elective midline laparotomy at Bugando Medical Centre between March 2009 and February 2014...
June 30, 2015: BMC Research Notes
Christian P Meyer, Arturo J Rios Diaz, Deepansh Dalela, Julian Hanske, Daniel Pucheril, Marianne Schmid, Vincent Q Trinh, Jesse D Sammon, Mani Menon, Felix K H Chun, Joachim Noldus, Margit Fisch, Quoc-Dien Trinh
OBJECTIVE: To investigate the incidence and predictors of wound dehiscence in patients undergoing radical cystectomy (RC). PATIENTS AND METHODS: In all, 1 776 patient records with Current Procedural Terminology (CPT) codes for radical cystectomy (RC) were extracted from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) between 2005 and 2012. Stratification was made based on the occurrence of postoperative wound dehiscence, defined as loss of integrity of fascial closure...
June 2016: BJU International
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