OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
ObjectiveTo discuss the clinical characteristics, treatment and prevention of abdominal wall endometriosis (AWE).
MethodsA retrospective analysis of 295 cases of AWE from February 2007 to August 2011 in our hospital was performed.
ResultsAll of the patients had abdominal operations before and 99% of them had a history of caesarean section. The mean age of the patients was (31.55±4.52) years old. The average size of the mass was (2.66±1.12) cm, significantly larger than the estimation of ultrasonography before operation which was (1.91±0.83) cm (P<0.001). No relapse was discovered five months to three years after the operation.
ConclusionIt is easy to diagnose abdominal wall endometriosis through medical history, clinical characteristics, physical signs and ultrasonic assessment. The prevention of AWE is very important. Operation is still the best treatment for AWE.
Objective To evaluate the outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. Methods From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm×7 cm to 25 cm×17 cm. Results The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. Conclusion It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.
Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
Objective To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. Methods The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.
Acute respiratory distress syndrome following plastic operation of the abdominal wall with the purpose to reduce over-weight of the body in 3 case was reported. They all recovered following effective and appropriate treatment. The criteria for the diagnosis of ARDS were diseussed and the method of treatment was introduced and the importance of early diagnosis was emphasized.
35 cases of abdominal adiposity weretreated by fat extraction technique combinedwith partial resection of abdonminal adiposetissue and skin. The average total amount ofextracted fat tissue was 3186ml, and theweight of resected skin and fat was 0. 84kg.The abdominal circumference at the highestprojected point was reduced 13cm postopera-tively compared with the preoperative. Goodhealings were achieved in all cases with anexception of partial necrosis at the tip of theflap.
OBJECTIVE To repair the huge incisional hernia of abdominal wall, a new surgical method was introduced. METHODS Eight cases of huge ventral incisional hernia, developed in 3 months to 12 months after operation, were treated in this new method with the defects ranged from 8 cm x 4 cm to 12 cm x 6 cm. RESULTS They were followed up for 6 months to 18 months after operation. The clinical results showed that all of the 8 cases recovered satisfactorily without recurrence. CONCLUSION The new method was recommendable for its advantages of easier manipulation, shortened time, no tissue reaction and less tissue trauma from operation.
Objective To summarize the therapeutic experiences of abdominal wall bulge repair with compound patch intraperitoneal placement. Methods From October 2005 to October 2008, intraperitoneal onlay mesh with compound patch applied in 7 patients with abdominal wall bulge, whose clinical data were analyzed retrospectively. Results All the procedures were performed successfully, including 5 open operation and 2 laparoscopic repair. The mean operation time was 85 min (ranged 68 to 130 min). After operation, 1 seroma formation and 1 hemorrhage in the thoracic cavity developed and were cured with the conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged 8 to 16 d). There was no recurrence, infection, or prolonged pain during 1－4 years follow-up. Conclusion Abdominal wall bulge is caused by the weakness of abdominal wall muscle, and the intraperitoneal onlay mesh repair with compound patch is an appropriate therapy.
