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The American Surgeon Nov 2023The aim of our study was to determine whether patients with neutropenia (absolute neutrophil count (ANC) ≤1,500 cells/µL) had higher rates of surgical site infection...
The aim of our study was to determine whether patients with neutropenia (absolute neutrophil count (ANC) ≤1,500 cells/µL) had higher rates of surgical site infection after elective abdominal wall reconstruction. This was a case series from a prospective complex abdominal wall reconstruction cohort describing the surgical outcomes of 4 neutropenic patients (ANC ≤1,500 cells/µL) within 48 hours of index operation. Median age was 55 years, 3 patients were female. All patients had liver cirrhosis as a comorbidity: 2 patients as a result of alcohol abuse and 2 patients secondary to cryptogenic and nonalcoholic fatty liver disease, respectively. All patients underwent a posterior component separation with transversus abdominis release and retro-rectus biologic mesh. None of the 4 patients developed a surgical site infection 90 days postoperatively. Complex abdominal wall reconstruction in neutropenic patients could be safe.
Topics: Humans; Female; Middle Aged; Male; Neutropenia; Abdominal Wall; Surgical Wound Infection; Prospective Studies; Surgical Mesh; Aged; Adult; Plastic Surgery Procedures; Abdominoplasty
PubMed: 33847529
DOI: 10.1177/00031348211011086 -
The Kaohsiung Journal of Medical... Nov 2023In order to accurately monitor graft immunology, we have developed a method for performing intestine and abdominal wall transplantation heterotopically in miniature...
In order to accurately monitor graft immunology, we have developed a method for performing intestine and abdominal wall transplantation heterotopically in miniature swine. The procedure consisted of simultaneous segmental terminal ileum and full-thickness abdominal wall transplantation in Lanyu miniature swine, with the intestinal and the abdominal wall grafts being placed on the recipient's bilateral rear flank. Five transplantations were technically successful. One animal died on the first post-transplant day due to anesthesia-related issues, three abdominal wall and four intestinal grafts survived, while one abdominal wall graft failed due to vascular thrombosis. Acute cellular rejection (ACR) of the intestinal graft could occur preceding, simultaneously with or following ACR of the abdominal wall graft. Our experimental model demonstrates the technical feasibility of heterotopic intestine and abdominal wall transplantation in miniature swine without grafting in gastrointestinal continuity. This model could be suitable for further studies of graft immunology.
Topics: Swine; Animals; Swine, Miniature; Abdominal Wall; Intestines; Ileum; Graft Rejection
PubMed: 37573495
DOI: 10.1002/kjm2.12742 -
The Surgical Clinics of North America Oct 2023A wide array of mesh choices is available for abdominal wall reconstruction, making mesh selection confusing. Understanding mesh properties can make mesh choice simpler.... (Review)
Review
A wide array of mesh choices is available for abdominal wall reconstruction, making mesh selection confusing. Understanding mesh properties can make mesh choice simpler. Each mesh has characteristics that determine its durability, ability to clear an infection, and optimal position of placement in the abdominal wall. For clean retromuscular hernia repairs, we prefer bare, heavy weight, permanent synthetic mesh. For contaminated retromuscular abdominal wall reconstruction cases, such as parastomal hernia repairs, we typically use bare, medium weight, permanent synthetic mesh. Biologic and biosynthetic meshes also have acceptable wound event and hernia recurrence rates when used in contaminated cases.
Topics: Humans; Abdominal Wall; Biocompatible Materials; Surgical Mesh; Herniorrhaphy; Prostheses and Implants
PubMed: 37709387
DOI: 10.1016/j.suc.2023.04.010 -
Journal of Abdominal Wall Surgery : JAWS 2023Incisional hernia prevention has become an important concept for surgeons operating on the abdominal wall. Several techniques have been proposed to help decrease... (Review)
Review
Incisional hernia prevention has become an important concept for surgeons operating on the abdominal wall. Several techniques have been proposed to help decrease incisional hernia formation with suture closure of the abdominal wall being one of the cornerstones. Technical details that have been reported to decrease incisional hernia rates include achieving a 4:1 Suture to Wound length ratio and the use of a small bites technique. Despite evidence to support many of these techniques there appears to be a gap in practice patterns amongst practicing surgeons. Introducing and promoting these principles in surgical residency may help to close this gap. This paper reviews our experience with surgical training for abdominal wall closures at our institution. Programs and projects related to abdominal wall closure were reviewed from our institution from 2010-Present. Type of project, intervention, and impact on education was evaluated and summarized. Seven projects were identified relating to surgical training and abdominal wall closure. Three projects dealt with skills training using an abdominal wall simulation model and related to suturing techniques. Two projects were clinical studies focused on suture to wound length ratios and improving outcomes with this variable in a residency training program. Two projects dealt with models relating to abdominal wall closure and education. Implementation of educational programs in surgical residency programs can lead to improvements in technique and knowledge around abdominal wall closure and help in research endeavors.
PubMed: 38312420
DOI: 10.3389/jaws.2023.12159 -
The Surgical Clinics of North America Oct 2023Robotic abdominal wall reconstruction is becoming an accepted technique to approach complex hernias in a minimally invasive fashion. There remain a deficit of... (Review)
Review
Robotic abdominal wall reconstruction is becoming an accepted technique to approach complex hernias in a minimally invasive fashion. There remain a deficit of high-quality data to suggest significant clinical benefit but current randomized trials are ongoing. Robotic surgery can be applied to a range of abdominal wall defects safely and with positive outcomes which are at least equivocal to open abdominal wall techniques.
Topics: Humans; Abdominal Wall; Robotics; Robotic Surgical Procedures
PubMed: 37709400
DOI: 10.1016/j.suc.2023.04.007 -
Cureus Oct 2023Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral... (Review)
Review
Congenital abdominal wall abnormalities in infants present an interesting and difficult management problem for surgeons. Congenital malformations of the ventral abdominal wall can be diagnosed by their distinctive anatomical presentations. Among them, omphalocele, gastroschisis and umbilical cord hernias are the most frequently observed clinically detected abdominal wall anomalies. Omphalocele refers to the herniation of abdominal contents through a defect in the abdominal wall at the umbilicus with or without the presence of a sac. This article gives an insight into the embryology, risk factors, treatment, investigations and complications of omphalocele, a common congenital abdominal wall defect. There is minimal proof that environmental factors contribute to the development of omphalocele. However, there is a considerable amount of evidence which points to the importance of genetic or familial risk factors. Newborns and infants with prenatal diagnoses are the most frequently presenting patients with omphalocele to paediatric surgeons. This article describes the problems and the steps of management for handling each circumstance, as well as any further complications. Omphalocele and gastroschisis are frequently described together in many research papers. However, it's crucial to consider that they are two different conditions which vary in anatomy, pathology and associated conditions which account for the difference in their treatments and noticeably varied outcomes. Additionally, there is evidence that each has a different set of factors associated with risk for occurrence. There are no known etiologic causes that cause these abnormalities to develop. The size of the baby, the extent of the lesion, and any other disorders all affect how individuals with these congenital abdominal wall anomalies are treated.
PubMed: 38021990
DOI: 10.7759/cureus.47638 -
Neuromodulation : Journal of the... Oct 2023This study aimed to investigate the correlation between the vertebral level of paddle placement and abdominal wall stimulation (AWS) after differential target...
OBJECTIVES
This study aimed to investigate the correlation between the vertebral level of paddle placement and abdominal wall stimulation (AWS) after differential target multiplexed spinal cord stimulation (SCS) to improve the safety and effectiveness of SCS for patients with chronic pain, particularly those with low back pain (LBP).
MATERIALS AND METHODS
The Correlation Between Abdominal Wall Stimulation and Spinal Cord Stimulator Tip Location study was a nonrandomized clinical trial that included 24 patients with SCS for persistent spinal pain syndrome (PSPS) type 2 (trial ID: NCT05565469). The intervention involved increasing stimulation amplitude to a maximum tolerable value and obtaining numerical rating scores for AWS. The primary outcome measure was the association between AWS, the neurostimulator tip, and conus medullaris location, whereas the secondary outcome was the pre-postinterventional difference in proportion of patients experiencing AWS. Patient demographics and postoperative imaging were assessed. Statistical analyses involved descriptive statistics, a descriptive logistic regression, and a McNemar test.
RESULTS
The results of the study showed that seven (29%) of the 24 patients experienced AWS either previously or during interventional stimulation. However, there was no significant correlation found between AWS and the location of the neurostimulator tip or conus medullaris, and there was no difference in the pre-postinterventional proportion of patients experiencing AWS.
CONCLUSIONS
The study concludes that a relatively high proportion of patients who received SCS for PSPS type 2 experienced or previously experienced AWS. There was no significant correlation found between the location of the neurostimulator tip and the occurrence of AWS. This suggests that AWS may not be solely dependent on the stimulation itself and emphasizes the need to consider other factors. Nonetheless, this study provides important insights into the occurrence of AWS in patients receiving SCS for PSPS type 2 and highlights the need for further research in this area.
CLINICAL TRIAL REGISTRATION
The Clinicaltrials.gov registration number for the study is NCT05565469.
PubMed: 37632515
DOI: 10.1016/j.neurom.2023.07.004 -
Abdominal Radiology (New York) Jun 2024
Review
Topics: Endometriosis; Humans; Female; Abdominal Wall; Diagnosis, Differential
PubMed: 38492002
DOI: 10.1007/s00261-024-04284-x -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2023To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and... (Review)
Review
OBJECTIVE
To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice.
METHODS
The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed.
RESULTS
This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications.
CONCLUSION
Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Topics: Animals; Abdominal Wall; Vascularized Composite Allotransplantation; Transplantation, Homologous; Skin Transplantation; Hematopoietic Stem Cell Transplantation
PubMed: 37460189
DOI: 10.7507/1002-1892.202302077