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BMJ Case Reports Apr 2017A 54-year-old man presented with a productive cough, chest pain, fever and weight loss. Initial analysis revealed a palpable chest wall mass and consolidation in the...
A 54-year-old man presented with a productive cough, chest pain, fever and weight loss. Initial analysis revealed a palpable chest wall mass and consolidation in the left lower lobe and pleural abnormalities on imaging. At that point no infectious cause or malignancy was identified. Microbiological analysis of a needle biopsy from a newly developed abdominal wall mass revealed growth of The patient was successfully treated with antibiotic therapy for 1 year. is a Gram-negative coccobacillus and is part of the normal oral flora. It is capable of causing infections in humans including periodontitis, soft tissue abscesses and systemic invasive infections, most commonly endocarditis.
Topics: Abdominal Wall; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Humans; Male; Middle Aged; Pasteurellaceae Infections; Pneumonia, Bacterial; Thorax; Treatment Outcome
PubMed: 28432161
DOI: 10.1136/bcr-2016-217377 -
Muscle patterning in mouse and human abdominal wall development and omphalocele specimens of humans.Anatomical Record (Hoboken, N.J. : 2007) Dec 2012Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around... (Comparative Study)
Comparative Study
Human omphalocele is a congenital defect of the abdominal wall in which the secondary abdominal wall structures (muscle and connective tissue) in an area centered around the umbilicus are replaced by a translucent membranous layer of tissue. Histological examination of omphalocele development and moreover the staging of normal human abdominal wall development has never been described. We hypothesized that omphalocele is the result of an arrest in the secondary abdominal wall development and predicted that we would observe delays in myoblast maturation and an arrest in secondary abdominal wall development. To look for evidence in support of our hypothesis, we performed a histological analysis of normal human abdominal wall development and compared this to mouse. We also conducted the first histological analysis of two human specimens with omphalocele. In these two omphalocele specimens, secondary abdominal wall development appears to have undergone an arrest around Carnegie Stage 19. In both specimens disruptions in the unidirectional orientation of myofibers were observed in the external and internal obliques, and rectus abdominis but not in the transversus abdominis. These latter findings support a model of normal abdominal wall development in which positional information instructs the orientation of myoblasts as they organize into individual muscle groups.
Topics: Abdominal Muscles; Abdominal Wall; Animals; Body Patterning; Gestational Age; Hernia, Umbilical; Humans; Mice; Muscle Development; Myoblasts, Skeletal; Rectus Abdominis
PubMed: 22976993
DOI: 10.1002/ar.22556 -
Scientific Reports Oct 2023This study investigates the mechanical behavior of the Physiomesh/Securestrap system, a hernia repair system used for IPOM procedures associated with high failure rates....
This study investigates the mechanical behavior of the Physiomesh/Securestrap system, a hernia repair system used for IPOM procedures associated with high failure rates. The study involved conducting mechanical experiments and numerical simulations to investigate the mechanical behavior of the Physiomesh/Securestrap system under pressure load. Uniaxial tension tests were conducted to determine the elasticity modulus of the Physiomesh in various directions and the strength of the mesh-tissue-staple junction. Ex-vivo experiments on porcine abdominal wall models were performed to observe the system's behavior under simulated intra-abdominal pressure load. Numerical simulations using finite element analysis were employed to support the experimental findings. The results reveal nonlinearity, anisotropy, and non-homogeneity in the mechanical properties of the Physiomesh, with stress concentration observed in the polydioxanone (PDO) stripe. The mesh-tissue junction exhibited inadequate fixation strength, leading to staple pull-out or breakage. The ex-vivo models demonstrated failure under higher pressure loads. Numerical simulations supported these findings, revealing the reaction forces exceeding the experimentally determined strength of the mesh-tissue-staple junction. The implications of this study extend beyond the specific case of the Physiomesh/Securestrap system, providing insights into the mechanics of implant-tissue systems. By considering biomechanical factors, researchers and clinicians can make informed decisions to develop improved implants that mimic the mechanics of a healthy abdominal wall. This knowledge can contribute to better surgical outcomes and reduce complications in abdominal hernia repair and to avoid similar failures in future.
Topics: Animals; Swine; Abdominal Wall; Hernia, Abdominal; Causality; Herniorrhaphy; Elastic Modulus; Biomechanical Phenomena
PubMed: 37845369
DOI: 10.1038/s41598-023-44940-8 -
Langenbeck's Archives of Surgery Aug 2022One of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was...
PURPOSE
One of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction.
METHODS
Twenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT).
RESULTS
The mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia.
CONCLUSION
Vertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.
Topics: Abdomen; Abdominal Wall; Abdominal Wound Closure Techniques; Fascia; Fasciotomy; Humans; Negative-Pressure Wound Therapy; Surgical Mesh; Traction
PubMed: 35147749
DOI: 10.1007/s00423-021-02424-1 -
Revista Do Colegio Brasileiro de... 2013The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of... (Review)
Review
The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of patients left with an open abdomen (or peritoneostomy). Gigantic hernias are among the dreaded consequences of damage control and the impossibility of closing the abdomen during the initial hospital admission. To minimize this sequela, the literature has proposed many different strategies. In order to explore this topic, the "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT -TACS) conducted a literature review and critically appraised the most relevant articles on the topic. No commercially available systems for the closure of peritoneostomies were analyzed, except for negative pressure therapy. Three relevant and recently published studies on the sequential closure of the abdominal wall (with mesh or sutures) plus negative pressure therapy were appraised. For this appraisal 2 retrospective and one prospective study were included. The EBT-TACS meeting was attended by representatives of 6 Universities and following recommendations were generated: (1) the association of negative pressure therapy and continuous fascia traction with mesh or suture and adjusted periodically appears to be a viable surgical strategy to treat peritoneostomies. (2) the primary dynamic abdominal closure with sutures or mesh appears to be more efficient and economically sound than leaving the patient with a gigantic hernia to undergo complex repair at a later date. New studies including larger number of patients classified according to their different presentations and diseases are needed to better define the best surgical treatment for patients with peritoneostomies.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Fascia; Humans; Negative-Pressure Wound Therapy; Practice Guidelines as Topic; Prospective Studies; Retrospective Studies; Sutures; Traction
PubMed: 23538547
DOI: 10.1590/s0100-69912013000100017 -
World Journal of Surgery Oct 2017Abdominal wall reconstruction is a rapidly evolving area of surgical interest. Due to the increase in prevalence and size of ventral hernias and the high recurrence...
Abdominal wall reconstruction is a rapidly evolving area of surgical interest. Due to the increase in prevalence and size of ventral hernias and the high recurrence rates, the academic community has become motivated to find the best reconstruction techniques. Whilst interrogating the abdominal wall reconstruction literature, we discovered an inconsistency in hernia nomenclature that must be addressed. The terms used to describe the anatomical planes of mesh implantation 'inlay', 'sublay' and 'underlay' are misinterpreted throughout. We describe the misinterpretation of these terms and give evidence of where it exists in the literature. We give three critical arguments of why these misinterpretations hinder advances in abdominal wall reconstruction research. The correct definitions of the anatomical planes, and their respective terms, are described and illustrated. Clearly defined nomenclature is required as academic surgeons strive to improve abdominal wall reconstruction outcomes and lower complication rates.
Topics: Abdominal Wall; Consensus; Hernia, Ventral; Herniorrhaphy; Humans; Recurrence; Surgical Mesh; Terminology as Topic
PubMed: 28462438
DOI: 10.1007/s00268-017-4037-0 -
Annals of Surgery Jan 2007The purpose of this study is to measure abdominal wall myopathic histologic and mechanical changes during incisional herniation and its effect on incisional hernia...
OBJECTIVE
The purpose of this study is to measure abdominal wall myopathic histologic and mechanical changes during incisional herniation and its effect on incisional hernia repairs.
SUMMARY BACKGROUND DATA
Unloaded skeletal muscles undergo characteristic atrophic changes, including change in fiber type composition, decreased cross-sectional area, and pathologic fibrosis. We hypothesize that these atrophic changes decrease muscle elastic properties and may contribute to the high laparotomy wound failure rate observed following incisional hernia repair.
METHODS
A rat model of chronic incisional hernia formation was used. Failing midline laparotomy incisions developed into incisional hernias. Controls were uninjured and sham laparotomy (healed) groups. Internal oblique muscles were harvested for fiber typing, measurement of cross-sectional area, collagen deposition, and mechanical analysis. Mesh hernia repairs were performed on a second group of rats with chronic incisional hernias or acute anterior abdominal wall myofascial defects.
RESULTS
The hernia group developed lateral abdominal wall shortening and oblique muscle atrophy. This was associated with a change in the distribution of oblique muscle fiber types, decreased cross-sectional area, and pathologic fibrosis consistent with myopathic disuse atrophy. These muscles exhibited significant decreased extensibility and increased stiffness. The healed (sham) laparotomy group expressed an intermediate phenotype between the uninjured and hernia groups. Recurrent hernia formation was most frequent in the chronic hernia model, and hernia repairs mechanically disrupted at a lower force compared with nonherniated abdominal walls.
CONCLUSIONS
The internal oblique muscles of the abdominal wall express a pattern of changes consistent with those seen in chronically unloaded skeletal muscles. The internal oblique muscles become fibrotic during herniation, reducing abdominal wall compliance and increasing the transfer of load forces to the midline wound at the time of hernia repair.
Topics: Abdominal Muscles; Abdominal Wall; Animals; Compliance; Disease Models, Animal; Fibrosis; Hernia, Ventral; Laparotomy; Male; Muscular Atrophy; Rats; Rats, Sprague-Dawley
PubMed: 17197977
DOI: 10.1097/01.sla.0000251267.11012.85 -
JSLS : Journal of the Society of... 2019The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The...
BACKGROUND AND OBJECTIVE
The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars.
METHODS
Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation.
RESULTS
Greater deformations and forces occurred in nonbladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical.
CONCLUSION
The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.
Topics: Abdominal Wall; Animals; Equipment Design; Laparoscopy; Models, Animal; Swine
PubMed: 31097906
DOI: 10.4293/JSLS.2019.00002 -
Scientific Reports Mar 2022An ostomy is a surgical procedure by which an artificial opening in the abdominal wall, known as a stoma, is created. We assess the effects of stoma location on the...
An ostomy is a surgical procedure by which an artificial opening in the abdominal wall, known as a stoma, is created. We assess the effects of stoma location on the abdominal wall mechanics. We perform three-dimensional finite element simulations on an anatomy model which was generated on the basis of medical images. Our simulation methodology is entirely based on open source software. We consider seventeen different locations for the stoma incision (trephine) and we simulate the mechanical response of the abdominal wall when an intraabdominal pressure as high as 20 kPa is applied. We focus on factors related to the risk of parastomal hernia development such as the deformation experienced by the abdominal wall, the stress levels supported by its tissues and the corresponding level of trephine enlargement. No significant dependence was found between stoma location and the levels of abdominal wall deformations or stress supported by tissues, except for the case with a stoma located on the linea alba. Trephine perimeter and area respectively increased by as much as [Formula: see text] and [Formula: see text]. The level of trephine deformation depends on stoma location with considerably higher trephine enlargements found in stomas laterally located with respect to the rectus abdominis muscle.
Topics: Abdominal Wall; Biomechanical Phenomena; Humans; Incisional Hernia; Rectus Abdominis; Surgical Stomas
PubMed: 35241748
DOI: 10.1038/s41598-022-07555-z -
Fertility and Sterility Oct 2008To report a case of clear cell carcinoma in abdominal wall endometriosis after cesarean section. (Review)
Review
OBJECTIVE
To report a case of clear cell carcinoma in abdominal wall endometriosis after cesarean section.
DESIGN
Case report.
SETTING
A French oncology center.
PATIENT(S)
A 38-year-old woman who developed a 10-cm mass in the abdominal wall muscles, 13 years after a cesarean section.
INTERVENTION(S)
Abdominal wall resection and chemotherapy.
MAIN OUTCOME MEASURE(S)
Clinical outcome.
RESULT(S)
The diagnosis of clear cell carcinoma in abdominal wall endometriosis was confirmed, and wide surgical excision with abdominal wall reconstruction was performed after three courses of chemotherapy.
CONCLUSION(S)
The malignant transformation of abdominal wall endometrioma has not been clearly elucidated, owing to its rarity. However, the eventuality should always be considered, and the prognosis improved through wide surgical excision.
Topics: Abdominal Neoplasms; Abdominal Wall; Adult; Cell Transformation, Neoplastic; Endometriosis; Female; Humans; Sarcoma, Clear Cell
PubMed: 18082734
DOI: 10.1016/j.fertnstert.2007.08.080