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Damage Control Surgery
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
When definitive surgery has been undertaken, it may not be possible to close the abdominal fascia.42–44 As discussed earlier, this is less commonly encountered in current practice; however, if such a situation arises then primary component separation and numerous negative pressure dressing modalities are available management options.
Intestinal transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Loss of domain in the patient with a short bowel with a complex surgical history remains a major technical challenge. Autologous tissue reconstruction, while desirable, is often not possible, and synthetic mesh repairs are accompanied by unacceptable infection rates. Experience with composite abdominal wall transplants remains limited, but there is some favorable experience with the use of avascular donor abdominal fascia; the key to success with the use of fascia appears to be meticulous removal of all fat and muscle and prevention of desiccation of the fascia during the back-table preparation. Our group has had a consistent and high level of success, employing meticulous skin closure alone in cases of limited domain with a large graft, and elective repair of the hernia a year or two later under more controlled conditions.
Incisional Hernias: When Do They Occur?
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Ventral hernias are a long-standing surgical disease and have been described as far back as ancient Egypt. These are weaknesses in the midline abdominal fascia that increase in size over time. Similarly, incisional hernias develop as a failure of the midline fascia to heal after an abdominal surgery and have been prevalent ever since surgeons have been cutting on the abdomen. Weaknesses in the abdominal wall, poor wound healing, obesity, and inadequate fascial bites during closure have all been suggested as contributors to hernia formation. Subsequent increases in intra-abdominal pressures then lead to outpouchings, and abdominal contents begin to fill the empty space. Unchecked, these hernias grow in diameter as continued pressure stretches the fascial defect.
Incisional negative pressure wound therapy does not reduce surgical site infections in abdominal midline incisions: a case control study
Published in Acta Chirurgica Belgica, 2020
Matthias Mehdorn, Stefan Niebisch, Uwe Scheuermann, Ines Gockel, Boris Jansen-Winkeln
Patients received single-shot antibiotics with cefuroxime and metronidazole prior to the incision. At the end of the procedure, the abdominal fascia was closed with continuous sutures of polydioxanon (PDS) loops size 1 (Johnson&Johnson Medical, Norderstedt, Germany) and the skin was closed using staples distanced about 2 cm apart (Medtronic, Meerbusch, Germany). The commercial iNPWT systems were applied according to the manufacturer’s instructions. For the self-made epicutaneous iNPWT system, we replaced the skin protection adhesive drape by stripes of adhesive iNPWT sheets. The staples were then covered by gray foam about the height and width of the commercial device. Finally, the foam was covered with adhesive foil as usual and a negative pressure of 125 mmHg was applied. Both forms of iNPWT were supposed to remain in place for 7 days. The dressing was removed earlier, if it was not tolerated by the patient, showed signs of leakage or suspicious secretion requiring inspection of the wound.
Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Sevgi Kurt Yazar, Merdan Serin, Murat Diyarbakırlıoğlu, Serhat Selami Şirvan, Fatih Irmak, Memet Yazar
In the natural structure of the umbilicus, there is a slight transition from the abdomen to the umbilicus, and there is a continuous contour. However, such a transition cannot be achieved with many umbilicoplasty techniques during abdominoplasty or TRAM/DIEP operations which leads to a steep transition. In our technique, the interdigitating skin flaps enable a natural transition from the abdominal skin to the umbilicus. Craig et al. [1] stated that a small, shallow, and retrusive umbilicus is regarded as being more attractive. In our technique, the fixation of the umbilical stalk to the abdominal fascia, shortens the umbilicus and prevents any protrusion. In addition, since the skin is not resected in the abdominal flap and the umbilicus skin is kept small and planned as a 3-armed star-shaped flap, a small and shallow appearance is obtained. The umbilical stalk is fixated to the fascia of the rectus muscle at the 2, 6, and 10 o’clock positions, and an oval shape is maintained [2].
Donor-site morbidities in 615 patients after breast reconstruction using a free muscle-sparing type I transverse rectus abdominis myocutaneous flap: a single surgeon experience
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Jae-Woo Heo, Seong Oh Park, Ung Sik Jin
The effect of remaining rectus muscle on the donor-site should not be overlooked. But, tension-free closure of anterior rectus sheath is of a parallel importance. There exist various methods of fascia closure. Direct primary closure, onlay or inlay graft using mesh products or acelluar dermal matrix and combination of both are examples. Boehmler et al. compared different techniques of abdominal fascia closure and came to a conclusion that, if feasible, direct closure yielded better outcomes than using adjuvant materials in terms of donor-site morbidity [33]. In this way, besides controlling the muscle-sparing pattern, we also narrowed down the fascia closure pattern to direct primary closure only. To sum up, by means of controlling muscle-sparing and fascia closure pattern, we aimed to verify a direct correlation between primary fascial closure in free muscle-sparing type I TRAM flap on donor-site morbidity.