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Traumatic intermuscular hernia in the anterior abdominal wall.

Traumatic ventral herniae are uncommon. The authors present a patient with traumatic intermuscular hernia in the anterior abdominal wall. Early recognition and differentiation from haematoma is important. In this case, the overlying intact muscle layer masked the classical clinical signs. The incision should be adequate and all internal organs carefully examined. Primary repair is usually possible.

Abdominal Muscles↗

Midline abdominal wall closure: a new prophylactic mesh concept.

BACKGROUND: Despite intense research efforts, incisional hernias continue to be a problem in patients who undergo laparotomy. This study was designed to reinforce the midline laparotomy closure by including a new prosthetic design between the edges of the surgical wound. STUDY DESIGN: A midline incision was made in New Zealand white rabbits and closed by inserting a polypropylene strip, T-shaped in cross-section, between the incisional borders. The T was placed upside down such that the horizontal arm of the T, whose surface is coated with extra-low pore size expanded polytetrafluoroethylene, made contact with the visceral peritoneum. The mesh was secured by a mass polypropylene 3/0 running suture. Surgery outcomes in these animals were compared with those in which the surgical wound was closed by simple suture and with control, nonoperated animals. RESULTS: The T-mesh induced an increased amount of scar tissue at the midline, where neoformed recipient tissue appeared around the polypropylene mesh filaments. The expanded polytetrafluoroethylene lamina became appropriately mesothelialized. Compared with the simple suture, the T-mesh provided a significant gain in biomechanical strength at postoperative week 6 (43.99+/-4.17 Newtons and 56.96+/-10.94 Newtons, respectively, p < 0.05). At 6 months, the strength of the reinforced wound even surpassed, although not significantly, that of the control intact abdominal wall (82.25+/-7.60 Newtons versus 79.55+/-11.46 Newtons). Data were expressed as mean +/- standard deviation. CONCLUSIONS: The use of a nonabsorbable biomaterial for midline laparotomy closure significantly improves its biomechanical resistance. Used in high-risk patients or even prophylactically, this technique could reduce the incidence of incisional hernia.

Abdominal Wall↗

Subcutaneous adipose tissue blood flow varies between superior and inferior levels of the anterior abdominal wall.

OBJECTIVE: Blood flow regulation is thought to mediate the metabolic functions of adipose tissue. Different depots, and even different layers within the subcutaneous adipose tissue, may vary in metabolic activity and blood flow. Therefore, we investigated if any differences in subcutaneous adipose tissue blood flow (ATBF) exist at different locations of the anterior abdominal wall. METHODS: ATBF was measured 8-10 cm above or below the umbilicus, at 8-10 cm (both sides) from the midline, in 18 healthy subjects (BMI range 18-33 kg/m(2)). Measurements of ATBF were performed using (133)xenon washout, during a stable baseline period and after ingestion of 75 g of glucose. RESULTS: At baseline, ATBF was greater at the upper level compared to the lower level (4.4+/-0.3 vs 3.8+/-0.2 ml min(-1) 100 g tissue(-1), P=0.005), but was not different between the right and the left sides at either level. ATBF increased in response to oral glucose at all sites. The mean increase at the superior level was also greater than the inferior level (3.5+/-0.7 vs 2.2+/-0.6 ml min(-1) 100 g tissue(-1), P=0.001). CONCLUSIONS: Even at a constant depth and with only 16-20 cm difference between sites, there are significant differences in function of the same adipose depot. These findings have physiological and methodological implications for in vivo metabolic studies of human adipose tissue.

Abdominal Wall↗

[Prosthesis used in the surgery of the abdominal wall. Focus on a comparative experimental protocol: difficulties and limits].

During many years the use of prosthesis for abdominal wall repair was not accepted by all surgeons. Now the laparoscopic repair has brought some surgeons to do it nearly systematically and industry proposes new materials. To allow comparing new materials the authors have developed an experimental proceeding of which they analyse technical difficulties and limits.

Abdominal Muscles↗

Composite prostheses for the repair of abdominal wall defects: effect of the structure of the adhesion barrier component.

The component of a composite prosthesis, which makes contact with the visceral peritoneum, can be reabsorbable or non-reabsorbable, and laminar or reticular. This study was designed to determine whether the composition of this second, barrier component could improve its behavior at this interface. Abdominal wall defects in rabbits were repaired using a polypropylene prosthesis (PP), or the composites Sepramesh (PP + h) or Vicryl (PP + v). Fourteen days after surgery, the implants were evaluated by light and scanning electron microscopy, and immunohistochemistry. Prosthetic areas occupied by adhesions (PP: 71.08 +/- 5.09, PP + h: 18.55 +/- 4.96, P + v: 69.69 +/- 16.81%), neoperitoneal thickness (PP: 256.17 +/- 21.68, PP + h: 83.11 +/- 19.63, PP + v:213.72 +/- 35.90 microm) and macrophage counts (PP: 8.73 +/- 1.16, PP + h: 27.33 +/- 4.13, PP + v: 31.24 +/- 3.08%) showed significant differences (P < 0.05). The tested biomaterials induced an optimal recipient tissue infiltration. Least adhesion formation was observed on the PP + h implants. This suggests that the second component, although reabsorbable, should be smooth in structure.

Abdominal Wall↗

Abdominal wall endometrioma in a laparoscopic trocar tract: a case report.

Extrapelvic endometriosis often presents as an atypical, painful abdominal mass often referred to the surgeon for diagnosis and treatment. The majority of extrapelvic endometriosis is found in surgical scars. We present a patient with an abdominal wall endometrioma that occurred in a laparoscopy trocar tract. To our knowledge, this is the first such case reported in the surgery or gynecology literature. With the increasing use of laparoscopy for gynecologic and general surgery procedures, this problem will likely become more common. The general surgeon should know how to diagnose and treat endometriomas arising in laparoscopic trocar tracts.

Abdominal Muscles↗

[Seringueira's latex membrane (Hevea brasiliensis) with and without polylysine 0.1% and marlex mesh for the reconstruction of iatrogenics abdominal wall defects in rats].

PURPOSE: To compare seringueira latex membrane implant, with and without polylysine at 0.1% and marlex mesh on the repair of iatrogenic abdominal defects in rats. METHODS: A circular segment block of approximate three centimeters of diameter was sectioned out of the ventral abdominal muscle wall of 31 Wistar rats. The skin was preserved. The animals were divided into three experimental groups: only latex, latex and polylysine at 0.1%, and marlex mesh. Some rats underwent euthanasia at five and some at 120 days after surgery. Fragments of abdominal wall were collected and submitted at histopathologic analysis. RESULTS: The main alterations observed in groups treated with the latex membrane with and without polylysine were dehiscence (21 animals) and evisceration (two animals). The elimination of implant occurred at an average of 13.8 days. These animals presented fiber conjunctive tissue formation, similar to that observed in the group which received the marlex mesh. Other alterations noted were viscera-parietal adherences in all evaluated groups. CONCLUSION: The seringueira' s latex membrane, with or without polylysine 0.1%, when used on the reconstruction of abdominal defects in rats is eliminated at 13.8 days after its implantation, leaving a fiber base of reparation, similar to that observed after marlex mesh implantation.

Abdominal Wall↗

[Diagnosis and the surgical treatment of tumors of the anterior abdominal wall].

In 1015 patients with various diseases of soft tissues the pathological process was localized in the anterior abdominal wall in 64 patients (6,3%): desmoids were found in 41 patients, sarcomas -- in 12, benign tumors -- in 5 and non-tumor diseases -- in 6 patients. Dissection of the tumor must be performed not less than 2 -- 3 cm further than the pulpated borders. When plasty with local tissues is not possible, it is expedient to employ synthetic (terylene) prostheses.

Abdominal Muscles↗

Systemic juvenile xanthogranulomatosis imitating a malignant abdominal wall tumor with lung metastases.

Juvenile xanthogranulomatosis (JXG) is a rare benign condition, which usually presents with characteristic skin lesions and can be diagnosed clinically. However, systemic JXG may involve a wide range of extracutaneous sites and may pose a diagnostic dilemma for the clinician, radiologist, and pathologist. In particular it may simulate malignancy. Here, we report a case of systemic JXG within the abdominal wall musculature and lungs, which imitated a sarcoma with pulmonary metastases on computerized tomography. To the best of our knowledge, this is the first such reported case. In particular, systemic disease presenting without skin lesions is unusual.

Abdominal Neoplasms↗