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PubMed2004

Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction.

Ventral hernia repair often includes the use of structural prosthetic materials, such as polypropylene mesh, that can induce dense abdominal adhesions to peritoneal structures. AlloDerm (LifeCell Corp., Branchburg, N.J.), a commercially available decellularized human dermal analogue with its native basement membrane components intact, is gradually revascularized and replaced with autologous tissue after implantation. The authors hypothesized that AlloDerm integrated with polypropylene mesh would reduce adhesions and provide a biodegradable scaffold to generate an autologous vascularized tissue layer separating the abdominal viscera from the mesh. Ventral hernia defects (3 x 1 cm) in 19 guinea pigs were repaired using an inlay technique with polypropylene mesh alone (n = 6) or with composite implants constructed by integrating polypropylene mesh and AlloDerm with its basement membrane surface oriented toward (polypropylene/AlloIn, n = 7) or away from (polypropylene/ AlloOut, n = 6) the peritoneal cavity. At 4 weeks, the authors determined the amount of mesh implant surface area covered by adhesions, the strength of the adhesions [graded from 0 (none) to 3], and the incidence of bowel adhesions. Histologic analyses were performed on full-thickness tissue sections from the repair sites. The mean surface areas affected by adhesions and mean adhesion strength were significantly lower in the polypropylene/AlloIn (area, 12.4 percent; mean grade, 1.0) and polypropylene/AlloOut (area, 9.5 percent; mean grade, 0.5) groups than in the polypropylene group (area, 79.5 percent; mean grade, 2.9); there were no such differences between the polypropylene/AlloIn and polypropylene/AlloOut groups. The bowel was adherent to 67 percent of polypropylene repairs and 0 percent of the composite mesh repairs. The AlloDerm was remodeled to form a vascularized tissue layer beneath the mesh in composite repairs, unlike the significantly thinner, dense scar layer that formed in the polypropylene repairs. Immunohistochemical labeling for factor VIII showed neovascularization throughout the AlloDerm. The AlloDerm thus functioned as a biodegradable tissue scaffold, guiding the formation of a thick, well-vascularized tissue layer separating the polypropylene mesh from intraperitoneal structures. This significantly reduced both the amount of surface area covered by adhesions and adhesion strength. Basement membrane orientation had no effect. Composite mesh implants composed of structural prosthetic materials integrated with AlloDerm may have useful clinical applications for abdominal wall reconstruction by reducing adhesions and providing a vascularized tissue layer to separate and protect the peritoneal structures from polypropylene mesh fibers.

Abdominal Wall↗
PubMed1997

Lower extremity salvage after radical resection of malignant tumors in the groin and lower abdominal wall.

BACKGROUND: Resection of a large malignant tumor in the groin often leaves a substantial soft-tissue defect that makes wound closure difficult. Nevertheless, palliation and lower extremity salvage is frequently possible if the tumor is widely excised and the wound closed with well-vascularized tissue; however, few data are available on patients undergoing such procedures. STUDY DESIGN: We retrospectively examined our experience with limb salvage in 25 patients undergoing radical groin resection for metastatic or recurrent malignant tumors between April 1, 1991 and April 8, 1996. RESULTS: Defect size ranged from 15 to 735 cm2 (mean, 238.5 cm2). Tumor resection included part of the abdominal wall in 14 patients and the femoral vessels in 5 patients. Defects were most commonly repaired with a vertical rectus abdominis myocutaneous flap (56%). Mean hospital stay was 10.4 days, and mean followup was 15.5 months. Although the complication rate was 68%, the limb salvage rate was 100%, and normal ambulation was achieved in 88% of patients. The most frequent complications were chronic lymphedema (42%) and seroma (29%). There was one perioperative death (4%). CONCLUSIONS: Functional limb salvage after radical resection of the groin and lower abdominal wall is very successful, has an acceptable morbidity rate, does not prolong hospital stay, and contributes significantly to the patient's quality of life. Chronic lymphedema is a frequent complication after this treatment but can be managed successfully with conservative techniques.

Abdominal Muscles↗
PubMed1988

S-100 protein and neuron-specific enolase in amniotic fluid as markers of abdominal wall and neural tube defects in the fetus.

The aim of this study was to determine whether there is increased leakage of neuron-specific enolase (NSE) and S-100 protein into amniotic fluid in pregnancies with neural tube defects, since both these proteins are produced by neural tissue, and to compare the value of these substances for detecting such defects with that of the more conventional techniques of alpha-fetoprotein (AFP) and acetylcholinesterase (AChE) gel electrophoresis. Amniotic samples from 25 mid-pregnancies (15-17 weeks' gestation) with neural tube defects (14 with open spina bifida and 11 with anencephaly) and from seven mid-pregnancies with abdominal wall defects were compared with a control material consisting of 80 amniotic fluid samples from 80 consecutive mid-pregnancy amniocenteses, with normal karyotypes and AFP concentrations. All of the above cases of abnormalities were primarily detected through increased AFP levels in the amniotic fluid. Amniotic fluid samples from 13 pregnancies with fetuses with autosomal chromosomal abnormalities and seven amniotic fluid samples contaminated with blood were also included in the investigation. It is concluded from the results that the conventional AFP assay combined with AChE gel electrophoresis is the best method for screening amniotic fluid for neural tube defects and defects of the abdominal wall. Neither NSE nor S-100 assay alone proved to be superior for the detection of these cases in mid-trimester amniotic fluid. The S-100 assay, however, could give additional information in cases where AChE gel electrophoresis is not decisive; for example, in samples contaminated with blood.

Abdominal Muscles↗
PubMed2004

[Clinical characteristics of abdominal wall endometrioma and its recurrence-related factors].

OBJECTIVE: To analyze the clinical characteristics, and treatment, recurrence-related factors of abdominal wall endometriomas (AWE). METHODS: Fifty-seven cases of AWE treated at Peking Union Medical College Hospital from 1983 to 2002 were reviewed. RESULTS: The incidence of AWE was 1.04% (57/5478) in patients with endometriosis after surgical treatment. It was 0.046% in patients undergoing cesarean section in the same period. Of 57 cases with AWE, 56 had low-abdominal operation previously and one was primary umbilicus endometrioma. Fifty-five cases of AWE were secondary to cesarean section. The latent period of AWE was positively correlated to patient's age at onset (P < 0.001). Fifty-five cases received surgical treatment while 2 were given medical treatment. Follow-up duration was 1.1 - 235 months. Five cases recurred and one was transformed to malignancy. The recurrence was correlated to the size and depth of the lesions. CONCLUSIONS: AWE could be diagnosed prior to operation according to its typical clinical manifestations. Ultrasonic examination may be valuable for the diagnosis of atypical cases. Surgical treatment is effective. A complete excision with clear margin is very important to prevent recurrence.

Abdominal Wall↗
PubMed1998

Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall.

OBJECTIVE: To develop a new mesh for hernia repair that is adapted to the physiological forces. DESIGN: Animal experiment. SETTING: Surgical Department of the RWTH-Aachen. ANIMALS: Wistar rats MAIN OUTCOME MEASURES: Textile analysis, tensile strength, bending stiffness, histology and morphometry. RESULTS: After textile analysis of commercially available meshes in clinical use we defined the physiological forces and constructed a new mesh (Soft Hernia Mesh, SHM) based on a combination of non-absorbable polypropylene and absorbable polyglactin 910. The amount of non-absorbable material could be reduced to < 30% compared with Marlex while still guaranteeing the necessary pulling force of 16 N/cm. Improvements of the hosiery structure improved the symmetrical distribution of the retaining forces in all directions. Compared with the considerable restriction of the abdominal wall mobility by Prolene (polypropylene) and Mersilene (polyester) meshes there was no increase in the bending stiffness after the implantation of the new mesh. Histological examination showed a pronounced reduction of the inflammatory reaction in the tissues, and the collagen bundles were orientated merely around the mesh filaments instead of forming a scar plate that completely embedded the mesh. CONCLUSION: Different meshes caused specific histological reactions with changes of their mechanical properties after implantation in rodents. A new mesh with a reduced amount of polypropylene showed both less inflammation and less restriction in the mobility of the abdominal wall though it exceeded the required tensile strength of 16 N/cm.

Abdominal Muscles↗
PubMed1988

Con A non-reactive fractions of human amniotic fluid alpha-fetoprotein in prenatal diagnosis of fetal neural tube defects and fetal abdominal wall defects. Predictive values, sensitivity, and specificity, and comparison to acetylcholinesterase and ultrasound scanning.

During a 6-year period 19,647 consecutively received amniotic fluid samples were analyzed for the alpha-fetoprotein (AFP) concentration. In samples with an AFP concentration above the 95% upper normal limit the fraction of AFP non-reactive with concanavalin A (con A) was determined by crossed affinity immunoelectrophoresis. Of 436 samples from normal pregnancies with a moderate elevation of AFP (between the 95% limit and 2.5 times the median) the con A fraction was normal in 92 to 98% of the cases, depending on the gestational age. At significantly elevated AFP concentrations (above 2.5 times the median), the fractions were normal in 78% of the 50 cases with a normal outcome. In 80 of 89 cases of fetal malformations, abnormally low fractions were found, and in all 19 cases of abdominal wall defects and congenital nephrosis the fractions were low. No significant difference was found in the sensitivity for detection of fetal malformations by con A analysis compared to quantitative analysis for acetylcholinesterase (AChE). However, significantly more false positive results were found in normal pregnancies for the con A analysis compared to the AChE analysis. Both analyses performed significantly better than ultrasound scanning in terms of sensitivity. It is concluded that AChE is the test of choice in prenatal diagnosis of fetal neural tube defects. However, a sensitivity of 1.00 and a predictive value of a negative test of 1.00 were found for the con A analysis for fetal abdominal wall defects. The AchE analysis performed less well in this context.

Abdominal Muscles↗
PubMed2001

Iatrogenic implantation of malignant meningioma to the abdominal wall.

We report a case of malignant meningioma that occurred in the abdominal operation scar of a 71-year-old woman. This tumor was a 13 x 8 cm gray-tan soft tumor, consisting of multiple nodules. Histologically, tumor cells proliferated in the subcutaneous tissue, displaying mostly a storiform pattern and a focal whorl formation with high mitotic figures. The immunohistochemical positivity for epithelial membrane antigen and negativity for CD34 enabled us to differentiate this tumor from a dermatofibroma protuberance or hemangiopericytoma. The patient had a history of operation for a recurrent orbital lesion of a malignant meningioma that initially developed in the frontal skull base. The present case probably resulted from iatrogenic transplantation of the orbital malignant meningioma to the lower abdominal wall, which had served as a donor site for adipose tissue used to pack the orbital defect.

Abdominal Muscles↗
PubMed1997

[Endometriosis of the abdominal wall. Clinical case and review of literature].

The authors report a clinical case of endometriosis the abdomen rectum muscle, in woman 28 years old, after a cesarean section delivery. On the basis of literature on the topic, the following are taken into consideration, the incidence, the pathogenesis, the clinical characteristics of this kind of pathology and the aspects which might facilitate the diagnostic approach and correct therapeutic to be given or follow. Parietal endometriosis is an extremely rare disease with incidence in feminine population of 0.03-1%. The pathogenesis is still ill-known. Lack of the classical symptoms and the unusual site can make diagnosis difficult. Pathognomonics but not always present are the presence of tumescence palpable of the abdominal wall near or proximity of preceding surgical scar, the cyclic character of painful symptomatology, the augmentation of volume and the bleeding in period menstrual or premenstrual. The ultrasonography, the computerized axial tomography, the nuclear magnetic resonance can facilitate the preoperative diagnosis but they do not always furnish reports of certainty. The aspirate-needle in ultrasonography control can furnish one of orientation diagnosis. The diagnosis of certainty is founded on the histologic examination after biopsy or excision. The treatment of the abdominal wall endometriosis is surgically essential. The excision of tumescence, easy usually, it is the only means to obtain the definitive recovery. The medical therapy postoperative is adjuvant in the treatment of unrecognized pelvic centres of endometriosis.

Adult↗
PubMed1980

Ultrasonography of the abdominal wall in the diagnosis of spigelian hernia.

Gray scale ultrasonography of the abdominal wall was used in the evaluation of patients suspected to have spigelian hernia. This diagnostic technique was found to be accurate in displaying defects in the spigelian fascia. Application of this technique to patients with mild abdominal tenderness may result in the detection of more cases of spigelian hernia and also prevent unnecessary exploration in patients in whom the sonogram is normal.

Abdominal Muscles↗
PubMed1994

[Esthetic effects of surgery in hernia of the anterior abdominal wall in children].

The cosmetic effect of operative interventions for the anterior abdominal wall hernia, vaginal process of peritoneum anomalies in 558 patients aged from 7 to 27 years was studied. The 15-year follow-up was available. Poor cosmetic results appropriateness were determined, the advantages of the sutureless abdominal wound closure were examined, an operative accesses for the umbilical hernia and the hernia of linea alba treatment were proposed.

Adolescent↗
PubMed2006

Acellular dermal matrix in the management of high-risk abdominal wall defects.

BACKGROUND: Ventral hernia repair in the face of a contaminated field or with questionable skin coverage requires either complex abdominal wall flaps or a staged repair. The development of biologic prostheses has altered the approach to these difficult clinical problems. METHODS: The study population consisted of human acellular dermal matrix (HADM) implantation into wounds considered high risk, defined as either infected or with poor skin coverage. Patient demographics, preoperative risk factors and infection data, postoperative wound complications, and long-term results were collected. RESULTS: Twenty-nine patients were identified in whom ADM was implanted into high-risk hernia defects. Forty-five percent developed a postoperative wound occurrence, with 31% requiring the wound to be either treated open or with a percutaneous drain. Ninety-six percent went on to heal without event. The follow-up evaluation averaged 182 days. Eighty-nine percent were repaired successfully with one surgery. Three recurrences have been identified. CONCLUSIONS: The use of ADM allowed for successful primary closure in 90% of patients with intermediate- to long-term follow-up evaluation. A postoperative wound occurrence rate of 45% shows the use of this material in resisting infection. ADM can be used in ventral hernia repair in high-risk wounds with a high degree of success.

Abdominal Wall↗
PubMed1994

[Reconstruction of the lower abdominal wall after extensive full-thickness excision].

The reconstruction of major inferior abdominal wall defects is a rare but difficult problem. We present five consecutive cases of reconstruction following major excision for the treatment of tumors (3 cases) and radionecrosis (2 cases). The immediate reconstruction was performed by fasciomyocutaneous flaps of the thigh, pedicled on the tensor fascia lata (4 cases) or the rectus femoris (1 case). The functional results of the abdominal reconstruction are good. The sequelae of the donor site are mainly aesthetic; the function of the thigh is not affected by the harvest. These two flaps are very reliable. The rectus femoris flap has muscle throughout the extent of the flap and may be preferred in contaminated wounds or postradiation ulcers. It also allows the midline to be reached more easily.

Abdominal Muscles↗
PubMed1998

Cryptorchidism in boys with congenital abdominal wall defects.

Cryptorchidism (CPT) has been suggested to be common in boys with congenital abdominal wall defects (CAWD). It has been hypothesized that the low intra-abdominal pressure in both omphalocele (OMP) and gastroschisis (GS) and brain malformations in patients with OMP contribute to the high incidence of CPT. To determine the incidence of CPT in boys with OMP and GS and to assess the relationship of CPT to the size of the AWD, prematurity, and concomitant anomalies, the hospital records and autopsy reports of 113 boys with CAWD (OMP n = 75; GS n = 38) were reviewed. Twelve (16.0%) boys with OMP had undescended testes; 5 (41.0%) of those had bilateral and 4 (23.5%) intraabdominal undescended testes. The occurrence of CPT in OMP patients did not correlate with the size of the AWD, birth weight, or gestational age. However, congenital cardiac anomalies and cleft lip and palate were significantly more common (P < 0.05) among those with CPT. Two (5.0%) boys with GS, both of whom were born prematurely, had unilateral CPT. In patients with OMP, the incidence of CPT was significantly higher than that of healthy children. There was a correlation between CPT and congenital midline defects such as cardiac anomalies and cleft lip and palate. In patients with GS, the incidence of CPT only slightly exceeded that of normal children and may have been related to prematurity.

Abdominal Muscles↗