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PubMed1983

[Pre- and postnatal diagnosis of abdominal wall defects (omphalocele and gastroschisis). Case reports].

Whereas the omphalocele develops from a malformation of the mesoderm during the embryonal period, the gastroschisis appears to be the result of an intrauterine vascular occlusion; defined as disruption. Definite signs of malformations are seen in omphalocele. In our patient population observed during a three year period, eight cases of abdominal wall defects were seen, four of which with Wiedemann-Beckwith syndrome and one with trisomy 18, two with an isolated omphalocele and one with a gastroschisis. The concomitance of genetic malformation syndromes implies the necessity of intrauterine diagnosis evaluation. In proven cases of chromosomopathies and signs of omphalocele in ultrasound an interruption of pregnancy may be indicated. Similarly with very unfavourable prognosis such as Edwards syndrome, a post partum operative intervention is not necessary. This decision however can only be reached through interdisciplinary consultation between the pediatrician, pediatric surgeon, midwife and parents.

Abdominal Muscles↗
PubMed1997

[Complications and abdominal wall sequelae in pedicle TRAM breast reconstruction].

The doubts concerning silicon implants since 1991 have led to the development of autologous tissue reconstruction and especially pedicle rectus abdominis flap (TRAM). The good cosmetic results obtained on the reconstructed breast also promoted the development of this technique. However, the complications and donor site sequelae must not be underestimated. The abdominal wall is considerably modified in terms of muscle strength and residual scars. It can be the site of complications such as herniae and scar necrosis. In order to more accurately assess these risks, the authors studied a series of 251 TRAM breast reconstructions performed at the Institut Gustave-Roussy between 1982 and 1992. The rate of herniae requiring reoperating decreased considerably with improvement of the technique, falling from 10% to less than 2% in the most recent cases, with a mean rate of 7% for the overall series. Infraumbilical scar necrosis was not exceptional, but the incidence appeared to decline with the surgeon's experience (about 5%). This depended on the patient's clinical context, especially a history of smoking. The strength of contraction of the upper segment of the muscle was significantly decreased and the cosmetic results of the abdominal scar were not always favourable as they were considered to be satisfactory in only 70% of cases. This study demonstrates the importance of not underestimating the sequelae of donor site scars, which must be taken into account when evaluating the results of the technique.

Abdominal Muscles↗
PubMed1996

The anterior abdominal wall in laparoscopic procedures and limitations of laparoscopic simulators.

BACKGROUND: Maneuvers involving two-handed techniques such as intracorporeal suturing and knot-tying during laparoscopy are intrinsically more difficult than ones performed during open surgery. METHODS: The use of simulators to practice and teach specialized techniques is established. However, simulators vary greatly, and few, as yet, represent the abdominal wall well. RESULTS: This study has shown that the working angle between instruments during laparoscopic cholecystectomy is 78 degrees, and this can be increased to 117 degrees by moving the instruments laterally. In contrast, the working angle in four trainers assessed was never greater than 77 degrees. CONCLUSIONS: This suggests that some maneuvers may be more difficult in trainers than at surgery. This has implications for training and the further development of more realistic simulators.

Abdominal Muscles↗
PubMed1995

Integration of biomaterials implanted into abdominal wall: process of scar formation and macrophage response.

The behaviour of two biomaterials polytetrafluoroethylene (PTFE) and polypropylene (PL) has been studied, focussing especially on the macrophage response to the implant, as well as on certain aspects of the process of scar formation. A total of 24 animals (white New Zealand rabbits) received prostheses implanted into the anterior abdominal wall in such a way as to involve every layer over an area of 7 cm x 5 cm. The interfaces formed with the visceral peritoneum, subcutaneous tissue layer and the recipient muscle-aponeurotic tissue were assessed. The techniques employed were light microscopy, scanning electron microscopy and immunohistochemical methods, the latter using a monoclonal antibody specific for rabbit macrophages (RAM-11). From the results obtained, it can be seen that: (a) the structure of PL allows its total integration with the reparative tissue, while PTFE becomes encapsulated, on both the subcutaneous and the peritoneal aspects, by orderly connective tissue; (b) the macrophage response, determined on the basis of the presence of labelled macrophages, shows a similar pattern in both biomaterials; and (c) angiogenesis is very intense in the PL mesh, whereas the PTFE prosthesis undergoes almost no vascular colonization.

Abdominal Muscles↗
PubMed2001

Use of composite prostheses in the repair of defects in the abdominal wall: prosthetic behaviour at the peritoneum.

OBJECTIVE: To compare the behaviour of two composite biomaterials in rabbit peritoneum. DESIGN: Animal study. SETTING: Faculty of Medicine, University of Alcalá, Spain. ANIMALS: 14 white New Zealand white rabbits divided into 2 groups of 7 each. INTERVENTIONS: Defects (7 x 5 cm) involving all the layers of the abdominal wall were created and repaired using Parietex Composite or Vypro prostheses. Fourteen days after implantation, prosthetic specimens were examined by microscopy, and morphometric and biomechanical analysis. MAIN OUTCOME MEASURES: Infection, healing, development of adhesions, and histological appearance of the interface. RESULTS: Firm adhesions were detected after the implant of Vypro while adhesion were loose in the Parietex group. The mean (SD) prosthetic surface area covered by adhesions was significantly greater in the Vypro group 22.3 (2.8) compared with 0.2 (0.02), p <0.01). The neoperitoneum formed after the implant of Parietex was well-organised and homogeneous and covered by a typical mesothelium, while in the Vypro it was disorganised, with a rough texture composed of prosthetic filaments and nodes. The neoperitonum was thicker in the Parietex group 154.0 (5.4) compared with 50.8 (2.3), p <0.05) while higher biomechanical resistance values were recorded in the Vypro group 30.4 (1.9) compared with 15.0 (2.73), p <0.05). CONCLUSIONS: While both biomaterials integrated well with tissue, Parietex behaved better at the peritoneal interface.

Animals↗
PubMed1979

[A case of relapsing mesenchymatous tumour of the abdominal wall with metastases (author's transl)].

It is classical to consider desmoid tumours as an entity with only a local prognosis, conditioned by the frequency of relapses. In this respect, they are different from other mesenchymatous tumours, fibrosarcomas in particular which have a poorer prognosis. The authors report the case of a 23 years old man with a tumour of the abdominal wall, which in the early stages resembled a desmoid tumour, but the development of metastases suggested a sarcoma. This observation seems to make doubtful the distinction between desmoid tumour and fibrosarcoma, and thus the prognosis of tumours with a desmoid appearance. Under these conditions, this term should only be used for descriptive purposes and has no prognostic value.

Abdominal Muscles↗
PubMed1994

[Morphology and healing of skin repair in abdominal wall defects. An animal experiment study].

UNLABELLED: The aim of the experimental study was to investigate morphology and wound healing following the skin plasty ("Kutisplastik") technique originally introduced by Loewe [11] and Rehn [17] under different conditions. We wanted to clarify the mechanism and development of revascularisation. RESULTS: The familiar phases of wound healing take the usual course after a skin plasty. In the exsudative reaction the cutis is covered with fibrin fibres. This leads to the development of granulation tissue. The cellular reaction takes place in two parts: first comes the ingrowth of capillary bundles and vessels in the collagen network of corium; revascularization is complete within 14 days after the operation. This is followed by the immigration of granulocytes and macrophages into the graft. The release of enzymes leads to the lysis of epidermal structures, cutaneous appendages and ultimately to collagen fibres of corium. There is also proliferation from fibroblasts. Genesis from new collagen fibres is then observed as scar tissue. The skin plasty technique involves turning the epidermal side of the graft to the peritoneum and suturing it under the highest tension possible to the surrounding healthy fascia. This course of healing is seen only with such high-tension suturing. Experimental nontension suturing has led to failure of skin plasty for abdominal wall defects.

Abdominal Muscles↗
PubMed1997

[Imaging of abdominal wall eventration: role and value of x-ray computed tomography].

The role of imaging in preoperative investigation of incisional hernia was studied in a series of 332 operated patients. CT scan (220 patients) remains the reference investigation. Magnetic resonance imaging (8 patients) does not provide any supplementary information at the present time. The classical features of median and lateral incisional hernia are described and the importance of evaluation of the elasticity and strength of the abdominal wall is stressed. In the authors' experience, this evaluation has implications for pre- and intraoperative strategy.

Abdominal Muscles↗
PubMed1994

Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall.

One of the major problems associated with the radial forearm free flap is donor site morbidity. Traditionally the defect is repaired using a split-thickness skin graft which gives poor coverage of the underlying structures, is unsightly, and in the long term may result in marked scarring. There is also morbidity associated with the skin graft donor site. We describe an alternative technique for closure of the donor site using full-thickness skin from the anterior abdominal wall. We believe this technique reduces not only donor site morbidity but also morbidity at the graft site.

Abdominal Muscles↗
PubMed1995

Spilled gallstones--complications of abdominal-wall abscesses. Case report and review of the literature.

Laparoscopic cholecystectomy has become the preferred method for removal of the diseased gallbladder. While its morbidity and mortality rates are lower than those of the open technique, it does have associated complications which may cause significant morbidity. The morbidity associated with spilled gallstones is not well studied and little can be found in the literature on this subject. We encountered a patient who developed abscesses within the abdominal wall following laparoscopic cholecystectomy. We recommend that spilled gallstones be removed when possible and that surgeons be aware of this possible complication.

Abdominal Abscess↗
PubMed1991

Psychosocial adjustment and physical growth in children with imperforate anus or abdominal wall defects.

Pediatric surgeons have the unique responsibility of performing surgical procedures that will enable their patients to function normally throughout a lifetime. Good anatomic results may not ensure that this goal will be achieved. Using a battery of psychological testing instruments, we evaluated the academic achievement and psychosocial status of 56 children (mean age, 10.6 years) with imperforate anus (IA) and abdominal wall defects (AWDs). Physical growth was assessed by measurement of standard anthropometric parameters, and a parent questionnaire was used to define clinical status. As a group, the children presented with average intellectual ability. Achievement in both reading and math was in the normal range. In 12.5% of the children a reading learning disability was noted and 10.7% had a disability in math. On the basis of parental assessments, 25% of the children demonstrated externalizing behavior disorders (eg, conduct problems) and 29% displayed internalizing symptomatology (eg. withdrawal, anxiety). Social competency deficits were described in 23% of the children. Data obtained from the teachers were consistent with the parental assessments. No major differences between the IA and AWD patients in academic achievement, psychosocial status, or physical growth were discovered. Routine screening of these children for learning disabilities and behavior problems is recommended.

Abdominal Muscles↗