1
|
Huang Y, Wang P, Hao J, Guo Z, Xu X. The external oblique muscle flap technique for the reconstruction of abdominal wall defects. Asian J Surg 2023; 46:730-737. [PMID: 35794039 DOI: 10.1016/j.asjsur.2022.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Several modifications to the anterior component separation technique (ACST) have been reported to facilitate the closure of abdominal wall defects. In this study, the external oblique (EO) muscle flap for modified ACST during major abdominal wall defect reconstructions has been described. METHODS A retrospective review of consecutive patients undergoing modified ACST was conducted. The clinical data were collected and retrospectively analyzed. RESULTS Among the 36 patients admitted to our hospital from December 2014 to December 2020, 9 cases had rectus abdominis tumors, 1 case had rectus abdominis trauma, and 26 cases had incisional hernias. The average age was 61.17 ± 13.76 years, and the mean BMI was 24.25 ± 3.18 kg/m2. The average width of the defect was 14.33 ± 2.90 cm. Unilateral EO muscle flap technique was used to reconstruct the abdominal wall. 3 cases of surgical site infection (8.3%), 4 cases of grade III or IV seroma (11.1%) and 2 cases of intestinal obstruction (5.5%)were reported postoperatively. Ischemic necrosis of the abdominal EO muscle flap, incision dehiscence, intestinal fistula, or other complications were not observed. 1 case of incisional hernia recurrence (2.8%) was reported. Recurrence of tumors or abdominal wall bulging were not noted during the follow-up period of 32.53 ± 14.21 months. CONCLUTIONS The EO muscle flap technique is associated with low postoperative morbidity and recurrence rate, which approves it a reliable technique for selected groups of patients. Further research are needed to confirm the effectiveness of this technique.
Collapse
Affiliation(s)
- Yonggang Huang
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Ping Wang
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
| | - Jingduo Hao
- Department of General Surgery, People's Hospital of Zhenhai, Ningbo, 315200, PR China
| | - Zicheng Guo
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Xiao Xu
- Department of Hepatobiliary Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
| |
Collapse
|
2
|
Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty. Plast Reconstr Surg 2021; 147:860-863. [PMID: 33710174 DOI: 10.1097/prs.0000000000007768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Abdominoplasty is among the most commonly performed aesthetic operations and is frequently combined with rectus abdominis musculoaponeurotic plication of rectus diastasis and repair of umbilical and ventral hernias. The authors present a spare parts technique to assist in reinforcement of both rectus diastasis plication and hernia repair during abdominoplasty operations using an autodermis onlay reinforcement graft. The graft is harvested from the excess abdominal pannus normally discarded during abdominoplasty and is inset on tension between the bilateral semilunar lines and plicated along a concave "corset" contour. This reduces distracting forces on the hernia and diastasis repairs and further augments abdominal contour. This technique has been performed for 8 years on 82 low-surgical-risk patients, without any noted increase in complications. The corset autodermis external obliqueplasty is a spare parts technique that may reduce recurrence of rectus diastasis and abdominal hernias repaired at the time of abdominoplasty and is an alternative strategy to mesh placement in this risk-averse aesthetic surgery population.
Collapse
|
3
|
Inferior Pedicled De-epithelialized Dermal Flap for Abdominal Wall Support in Recurrent Abdominal Hernias. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
4
|
Dermo-Peritoneal Flap: a Novel, Safe and Effective Technique to Manage Abdominal Defects in Complicated Recurrent Incisional Hernia. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
5
|
Hodgdon I, Cook M, Yoo A, Rajo M, Dooley D, Haydel A, Dogar S, Greiffenstein P, Morrison J, Lau F, Paige J. The Use of Autologous Fenestrated Cutis Grafts in Hernia Repair : Surgical Outcomes and Cost Analysis of 97 Consecutive Patients. Am Surg 2020; 86:819-825. [PMID: 32683916 DOI: 10.1177/0003134820933261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ian Hodgdon
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Michael Cook
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Aran Yoo
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Marco Rajo
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Danielle Dooley
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Adam Haydel
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Shireen Dogar
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Patrick Greiffenstein
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John Morrison
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Frank Lau
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John Paige
- 12258Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
6
|
Bitterman N, Ben-Nun O, Calderon N, Brodsky A, Galis I, Matter I, Sroka G. Use of autologous dermal flap as mesh coverage in the treatment of large abdominal-wall defect in patients following massive weight loss: presentation of a novel surgical technique. Hernia 2020; 24:387-393. [PMID: 32062712 DOI: 10.1007/s10029-020-02127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh. METHOD All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD). RESULTS Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months. CONCLUSION Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible.
Collapse
Affiliation(s)
- N Bitterman
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel.
| | - O Ben-Nun
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - N Calderon
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - A Brodsky
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Galis
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Matter
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - G Sroka
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
7
|
Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias. Case Rep Surg 2018; 2018:9069430. [PMID: 29854546 PMCID: PMC5964430 DOI: 10.1155/2018/9069430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs. Methods A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. “U” figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted. Results No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement. Conclusion Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.
Collapse
|
8
|
Martis G, Rózsahegyi M, Deák J, Damjanovich L. Incarcerated and eventrated abdominal wall hernia reconstruction with autologous double-layer dermal graft in the field of purulent peritonitis-A case report. Int J Surg Case Rep 2016; 30:126-129. [PMID: 28012327 PMCID: PMC5192031 DOI: 10.1016/j.ijscr.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 11/20/2022] Open
Abstract
This is the first applied autologous dermal graft for eventrated hernia in an emergency case. Terminal ileum and ascending colon were perforated into the hernia sac causing dirty operating field. It was impossible to close the 223 cm2 gap with sutures, biological mesh was not available. Specially prepared grafts were applied to reconstruct the gap in a double- layer tension free fashion. No hernia recurrency was observed 8 months after the surgery.
Introduction Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of emergency in septic/dirty environment. Case report A 76-year old female patient (BMI 36.7 kg/m2) was admitted with mechanical bowel obstruction and sepsis caused by a third time recurred, incarcerated and eventrated abdominal wall hernia. During the emergency surgery perforation of the terminal ileum and the ascending colon was detected, along with a feculent peritonitis and extended abdominal wall necrosis. Extended right hemicolectomy and necrectomy of the abdominal wall were performed. The surgery resulted in an abdominal wall defect measuring 223 cm2, for the management of which direct closure was not possible. Using a specific method, an autologous dermal graft was prepared from the redundant skin. The first dermal graft was placed under the abdominal wall with 5 cm overlap, and the second layer was placed onto the first layer with 3 cm overlap in a perforated fashion. The operating time was 250 min. No significant intra-abdominal pressure elevation was measured. No reoperation was performed. On the fifth postoperative day, the patient was mobilised. She was discharged in satisfactory general condition on the 18th postoperative day. There is no recurrent hernia 8 months after the surgery. Discussion Abdominal wall reconstruction was possible in a necrotic, purulent environment by using a de-epithelised autologous double layer dermal graft, without synthetic or biological graft implantation. The advantage of the procedure was cost-effectivity, and the disadvantage was that only in an obese patient is the sufficient quantity of dermal graft available. Conclusion A homogeneous internal and perforated outer dermal graft was suitable for bridging the abdominal gap in the case of an obese, high risk patient. Autologous dermal grafts can be a safe and feasible alternative to biological meshes in emergency abdominal wall surgeries. Evaluation of a case series can be the next cornerstone of the method described above.
Collapse
Affiliation(s)
- Gábor Martis
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary.
| | - Máté Rózsahegyi
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
| | - János Deák
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
| | - László Damjanovich
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
| |
Collapse
|