Recent studies have suggested that pressure overload hypertrophy (POH) alters the viscoelastic properties of individual cardiocytes when studied in isolation. However, whether these changes in cardiocyte properties contribute causally to changes in the material properties of the cardiac muscle as a whole is unknown. Accordingly, a selective, isolated, acute change in cardiocyte constitutive properties was imposed in an in vitro system capable of measuring the resultant effect on the material properties of the composite cardiac muscle. POH caused an increase in both myocardial elastic stiffness, from 20.5 ± 1.3 to 28.4 ± 1.8, and viscous damping, from 15.2 ± 1.1 to 19.8 ± 1.5 s (normal vs. POH, P < 0.05), respectively. Recent studies have shown that cardiocyte constitutive properties could be acutely altered by depolymerizing the microtubules with colchicine. Colchicine caused a significant decrease in the viscous damping in POH muscles (19.8 ± 1.5 s at baseline vs. 14.7 ± 1.3 s after colchicine, P < 0.05). Therefore, myocardial material properties can be altered by selectively changing the constitutive properties of one element within this muscle tissue, the cardiocyte. Changes in the constitutive properties of the cardiocytes themselves contribute to the abnormalities in myocardial stiffness and viscosity that develop during POH.
term repair, can be diffi cult as many comorbidities persist.General surgeons and plastic and reconstructive surgeons should communicate the anatomic and physiologic obstacles they foresee after history and examination of the patient to maximize repair success and decrease recurrence. This effective communication between the operating surgeons and review of CT-scans can help formulate successful fl ight plans for surgery.The more time spent in the pre-operative preparation and in the fl ight planning stage, the more optimized the patient is for success even in the face of previous radiation, comorbidities, or encountered post-operative obstacles.
Background: Abdominal wall reconstruction of ventral hernias can be challenging. Patients have undergone successful treatment of cancer or other intra-abdominal processes and have worked hard to get back to a “normal” life. Successful repair of abdominal wall hernias can be difficult as many comorbidities persist. Previous radiation, ongoing smoking, or overall protein malnutrition may affect wound healing and overall outcome. Surgical teams need to communicate to maximize repair success and decrease recurrence. Purpose: To create a systematic approach from our current method of abdominal wall reconstruction that facilitates communication between general surgeons and plastic and reconstructive surgeons for optimizing hernia repair outcomes. Methods: A retrospective chart review was done on patients who underwent abdominal wall reconstruction of ventral hernias and recurrent hernias with component separation and placement of strattice acellular dermal matrix or synthetic mesh over a 10 year period. Pre-op imaging consisted of an abdominal/pelvic CT-scan. A surgical flight plan was created to determine a plane of Strattice insertion and abdominal wall exposure. Pre/post-operative CT-scans were compared as well as before and after photographs. Patient satisfaction was assessed subjectively in follow-up appointments. Results: The most commonly encountered clinical scenarios were placed into a pictorial essay and a step by step approach to abdominal wall reconstruction was then created. Strattice or synthetic mesh were placed using a “load-sharing” principle and restoration of a dynamic abdominal wall was associated with high patient satisfaction, a more functional repair, and a lower incidence of recurrence. Conclusions: Successful repair of primary and recurrent abdominal wall hernias requires communication between general surgeons and plastic & reconstructive surgeons. Incision placement is important for adequate exposure and the ability to place transfascial sutures. T-junction skin breakdown and seroma formation can be minimized by maintaining blood supply and minimizing dead space. High protein nutritional stores are important for expeditious healing.
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