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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Paediatric umbilical hernias typically close by the age of 4–5 without intervention; however, although complications are rare they must be recognised and acted on immediately. The umbilicus transmits the contents of the umbilical cord via a defect in the linea alba. The umbilical ring usually closes by contraction, the umbilical vein fibroses to become the round ligament of the liver, and attaches to the umbilicus. This provides anchorage to the umbilicus and protects against the formation of a hernia, however, a minority of patients are susceptible to hernia formation if this process does not occur correctly. Important risk factors for umbilical hernia formation include: Low birth weightAfrican ancestryTrisomy 13, 18 and 21Congenital hypothyroidismHurler's syndromeBeckwith-Wiedemann syndrome
Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
The near-universal starting point for laparoscopic access to the peritoneal cavity is the umbilicus. The umbilicus represents remnant scar tissue from involution of umbilical cord structures. As such, use of the umbilicus for trocar placement allows surgeons to “hide” an incision within the folds of a natural scar. The umbilicus also is represented by a single fascial plane that, once crossed with a Veress needle or trocar, allows for efficient entry into the peritoneal space. For children with a persistent natural patency in the center of the umbilicus, incision of the fascia may not even be required.
Soft Tissue Management
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The umbilicus is a central abdominal scar with superior hooding which fixes the abdominal skin to the underlying linea alba and is commonly lost in this patient group. It can either be reconstructed at primary surgery or be subsequently reconstructed as a minor local anaesthetic procedure via a number of strategies once the patient has recovered from repair of the hernia. Although the umbilicus is merely a remnant of scar tissue from intrauterine life, it is a focal point of the abdomen and its absence stigmatises the patient's previous condition. Techniques are varied but essentially of two types, either allowing second intention healing while plicating the abdominal fat to the abdominal wall or performing various local flaps.13
Systematic review and meta-analysis of the inter-recti distance on ultrasound measurement in nulliparas
Published in Journal of Plastic Surgery and Hand Surgery, 2023
As indicated in Table 3, the location of the inter-recti distance measurement by ultrasound was not uniform. With the exception of the umbilicus, the location above and below the umbilicus varies greatly, from 2 to 4.5 cm. Beer measured the inter-recti distance immediately below the xiphoid process, while Lee selected the midpoint between the umbilicus and the xiphoid process to measure the inter-recti distance. With reference to the Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS) (2019) [18], we divided the measurement locations into three areas when pooled the data, namely the umbilical area (umbilical as the center, within 3 cm above and below the umbilicus), epigastric area (3–5 cm above the umbilicus), and infraumbilical area (3–5 cm below the umbilicus). We classified the midpoint between the umbilicus and the xiphoid process as the epigastric area (Table 4). After pooling the data, the umbilical inter-recti distance of the nulliparas was 8.77 mm (6.56–10.99 mm), the distance in the epigastric area was 7.22 mm (2.76–11.68 mm), and that in the infraumbilical area was 4.09 mm (1.55–6.64 mm) (Figure 2).
Randomized Single-Center Study of Effectiveness and Safety of a Resorbable Lysine-Based Urethane Adhesive for a Drain-Free Closure of the Abdominal Donor Site in a DIEP Flap Breast Reconstruction Procedure
Published in Journal of Investigative Surgery, 2022
Sonia Fertsch, Michal Michalak, Christoph Andree, Beatrix Munder, Mazen Hagouan, Tino Schulz, Peter Stambera, Katinka Steammler, Lukas Grueter, Julia Kornetka, Andreas Wolter
The patients were followed up until seroma was resolved and in general for 8 consecutive weeks. Most seroma resolved by week 4 and 2 patients had a seroma until week 5. There was no postoperative bleeding in neither group (Table 4). A wound infection was seen in two patients (7%) from the study group and in two patients (7%) from the control group. The infection was in form of abdominal redness either along the abdominal scar or the umbilicus and was successfully treated with antibiotics. Wound dehiscence occurred in two patients (7%) from the study group and 1 patient (3%) in the control group. All cases of dehiscence were around the umbilicus. In one case a suture stitch was applied to readapt the umbilicus to the skin. In the other two cases the wound healed by secondary intention.
Staged immediate nipple reconstruction with tube flap in secondary autologous breast reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Jiasheng Dong, Tao Wang, Yi Zhang, Hua Xu, Jinguang He
A series of 30 female patients with a previous modified radical mastectomy were recruited in our department between June 2012 and August 2015. Considering the harmful injuries of radiation on the mastectomy skin, patients who received postmastectomy radiation therapy were excluded. Since they had a relatively tight abdomen, a bipedicle DIEP flap was harvested for the secondary unilateral breast reconstruction. Meanwhile, the staged immediate nipple reconstruction was performed with lower mastectomy tube flap. According to the ethical standards of our institutional ethical committee, all patients had signed an informed consent for the use of their data. The age of patient ranged from 35 to 51 years (mean 42 years). The mean body mass index was 23.8 kg m–2 (range, 20.2–26.7). Approximately horizontal postmastectomy scars were left on the chest wall. Nine patients had undergone caesarean operations and vertical scars were seen under the umbilicus.