Abdominal wall bulging after thoracic surgery, an underdiagnosed wound complication

Timmermans, Lucas; Klitsie, Pieter J.; Maat, Alexander P.W.M.; Goede, Barry de; Kleinrensink, Gert Jan; Lange, Johan F.

doi:10.1007/s10029-012-0971-9

Cited by 22 publications

(14 citation statements)

References 29 publications

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“…Two cases did not recover after more than a 1-year follow-up, and were considered a permanent nerve injury. [2][3][4] Longterm follow-up was lost in one case. Total pleurectomy was performed additionally in two patients who did not recover neurologically.…”

Section: Discussionmentioning

confidence: 99%

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Paralysis of the Rectus Abdominis Muscle after a Video-Assisted Thoracoscopic Surgery

Cho

Sim

Kim

et al. 2018

ATCS

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The rectus abdominis muscle is innervated by intercostal nerves T7-T12, and most thoracotomies are performed through the fourth to sixth intercostal spaces, so direct nerve damage to the rectus abdominis seems unlikely. However, at least one trocar is inserted below the seventh intercostal space in most multi-port video-assisted thoracoscopic surgeries (VATSs), and injury of the seventh or lower intercostal nerve with related paralysis of the rectus abdominis is possible, albeit rare. Only two cases of rectus abdominis paralysis caused by after VATSs have been reported, and these cases were not permanent injuries. This is the first report of permanent paralysis of the rectus abdominis after VATSs.

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Section: Discussionmentioning

confidence: 99%

“…1,2) In particular, paralysis of the rectus abdominis after video-assisted thoracoscopic surgery (VATS) has been reported in only two cases worldwide. 3,4) Paralysis of the rectus abdominis can theoretically occur in the thoracic surgery area, including VATS.…”

Section: Introductionmentioning

confidence: 99%

Paralysis of the Rectus Abdominis Muscle after a Video-Assisted Thoracoscopic Surgery

Cho

Sim

Kim

et al. 2018

ATCS

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“…[1][2][3] In rare cases, hard physical exercise and violent coughing with rib fracture can also cause herniation. [4][5][6][7][8] Commonly, an intercostal hernia consists of prolapse of the abdominal/thoracic contents, sacs containing atrophied intercostal/ oblique/diaphragm muscle, and defects of the intercostal space and diaphragm.…”

Section: Discussionmentioning

confidence: 99%

“…These various causes can lead to intercostal/diaphragmatic muscle defects, intercostal/diaphragmatic nerve injuries, fractures of the ribs or costal cartilage, and/or costotransverse joint dislocations. 3,4 These derangements ultimately disrupt the integrity of the thoracic cage, and the resulting negative thoracic pressure draws the abdominal content out of the damaged thoracic cage. Development of herniation tends to the left flank, and the hernia content is commonly the small or large intestine.…”

Section: Discussionmentioning

confidence: 99%

“…In reviewing the 4 known cases, we conjecture some of the following to be factors of lower incisional intercostal hernia: cicatrization of intercostal muscle, paralysis of thoracic muscle caused by intercostal nerve injury, costal cartilage not repaired after the operation, dislocation of the costotransverse joint, and additional abdominal pressure caused by obesity. 3,4 We believe that the surgical procedure of nephrectomy easily tends to provoke the aforesaid triggers that can lead to intercostal hernia, although incisional intercostal hernia after nephrectomy indeed seldom develops. Surgeons and urologists must therefore take great care in the performance of nephrectomy, being aware of the potential for intercostal hernia to occur from anatomic derangements created during nephrectomy.…”

Section: -11mentioning

confidence: 99%

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Incisional Intercostal Hernia With Prolapse of the Colon After Right Partial Nephrectomy

Yamamoto

Kurashima

Chie

et al. 2013

International Surgery

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A 75-year-old woman with a history of myocardial infarction, gallstones, and right renal cancer was referred to our department because of right flank pain. She had a surgical scar on the right abdomen between the 10th and 11th ribs; computed tomography demonstrated intercostal herniation of the colon. Recognizing the possibility of adhesions of the hernia and colon, we used a median skin incision and patched a polyester mesh coated with absorbent collagen. The patient had an uneventful postoperative course, with no pain for 6 months postoperatively. Transdiaphragmatic intercostal hernias with abdominal contents commonly develop after trauma or thoracic surgery. Incisional intercostal hernias seldom develop after nephrectomy; the present case is only the fourth report. We conjecture that a costochondral incision can induce subluxation of the costotransverse joint, intercostal nerve injury, and atrophy of the intercostal and abdominal oblique muscles. Surgeons must therefore recognize the potential, albeit rare, for intercostal hernia after nephrectomy.

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A comparison study of deep muscle sparing transverse rectus abdominis musculocutaneous flap for breast reconstruction

et al. 2019

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Background: Breast reconstruction by deep inferior epigastric perforator flap (DIEP) involves only little rectus abdominis muscle sacrifice. However, the operative procedure may get complicated. We propose here a novel method involving two adjacent perforators and requiring the addition of only the superficial muscle to the flap. This novel technique, termed "deep muscle sparing transverse rectus abdominis musculocutaneous flap (DMS-TRAM)," was compared to DIEP and MS-TRAM groups.Methods: The subjects were 70 patients. The indication of DMS-TRAM was the distance between two perforators penetrating the deep fascia was <3 cm, and the two perforators ran through the superficial layer of the muscle until they became confluent. All patients were evaluated by contrasting computed tomography. The data of age, body mass index, flap volume, operative time, blood loss, laterality, immediate reconstruction, prior radiation, smoking, re-exploration, total flap necrosis, partial fat necrosis, and abdominal bulging were compared. Ultimately, DMS-TRAM was applied in 20 subjects (28.6%), DIEP in 31 (44.3%), and MS-TRAM in 19 (27.1%). Results:The volume of blood loss in the DIEP group was significantly higher than that in the DMS-TRAM group (328 ± 182 vs 454 ± 217 mL, p = 0.02), the other factors did not significantly influence. The rate of fat necrosis in DIEP tended to be high (10.0% vs 22.6%, p = 0.22). Conclusions:Because DMS-TRAM could preserve the deep muscle and penetrating side of intercostal nerve, it could be performed less sacrifice and there were few bleeding and partial necrosis at the same level as MS-TRAM. DMS-TRAM was effective in the applied cases.

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Abdominal wall bulging after thoracic surgery, an underdiagnosed wound complication

Abstract: Abdominal wall paralysis is an underdiagnosed complication after thoracic surgery. The amount of stress on the intercostal nerves could be reduced with less invasive techniques such as the VATS technique.

Cited by 22 publications

References 29 publications

Paralysis of the Rectus Abdominis Muscle after a Video-Assisted Thoracoscopic Surgery

Paralysis of the Rectus Abdominis Muscle after a Video-Assisted Thoracoscopic Surgery

Incisional Intercostal Hernia With Prolapse of the Colon After Right Partial Nephrectomy

A comparison study of deep muscle sparing transverse rectus abdominis musculocutaneous flap for breast reconstruction

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