Closure of Chronic Abdominal Wall Defects: A Long-term Evaluation of the Components Separation Method

Girotto, John A.; Ko, Marcia G.; Redett, Rick; Muehlberger, Thomas; Talamini, Mark A.; Chang, Bernard

doi:10.1097/00000637-199904000-00007

Cited by 103 publications

(36 citation statements)

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“…Many studies have shown that this operation is safe and effective for reconstructing complex abdominal wall defects, with recurrence rates of approximately 10%. [13][14][15][16][17][18] Among our patients, 5 (17%) had postoperative complications, which were all easily treated, and only 1 hernia (3%) recurred.…”

Section: Commentmentioning

confidence: 99%

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

et al. 2007

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Section: Commentmentioning

confidence: 99%

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

et al. 2007

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“…221 This technique has been reported to suffer from considerable wound-related complications 222 which have been reduced by endoscopic-assisted 223 and periumbilical perforating vessel-preserving techniques. 224,225 Decisions regarding these techniques can be informed by intra-operative monitoring including intra-vesical pressure measurement.…”

Section: Delayed Abdominal Wall Reconstructionmentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…Esta gran laxitud permite resecciones agresivas y al mismo tiempo seguras, pues ofrecen un cierre sin tensión. También, plicaturas efectivas que evitan en muchos casos la necesidad de aplicar mallas como complemento a la reconstrucción de la continencia abdominal (9,10). En estos pacientes la pérdida de grasa intra-abdominal constituye una gran ventaja por la disminución de la tensión a que es sometida la pared abdominal como continente de las vísceras abdominales.…”

Section: Pacientes Con Grandes Adelgazamientosunclassified

Abdominoplastia multifuncional en ancla: nuestra experiencia y nueva sistemática de abordaje en el paciente sin adelgazamiento

Vidal

Soto

Estefanía

et al. 2010

Cir. plást. iberolatinoam.

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ResumenLa dermolipectomía multifuncional en ancla es una técnica efectiva en el tratamiento del contorno corporal en pacientes que han sufrido grandes pérdidas de peso.En la actualidad, en el sistema público de salud español, no es infrecuente que el cirujano plástico deba abordar pacientes en los que no ha habido adelgazamiento alguno y que más allá del contorno corporal, requieren una reparación de la pared abdominal. Los procedimientos reconstructivos de la pared abdominal no están reñidos con un abordaje simultáneo del contorno corporal para una mejora funcional y de la calidad de vida del paciente.Exponemos nuestra experiencia con este conocido patrón de dermolipectomía en 32 casos, en los que mostramos el abordaje hecho en 3 pacientes con ausencia o fracaso en el adelgazamiento. El gran volumen intrabdominal, graso y visceral, de estos pacientes sin adelgazamiento, conlleva que puedan presentar complicaciones por alteración en la relación continente-contenido abdominal tras grandes dermolipectomías; las más frecuentes son dehiscencia de sutura, necrosis de los colgajos, alteraciones respiratorias o cierre a tensión que en último término puede desencadenar un síndrome compartimental intrabdominal.La adaptación y fisioterapia respiratoria preoperatoria del enfermo, el diseño de colgajos suprapúbicos que eviten el cierre a tensión en el punto de unión de las suturas, el no despegamiento de los colgajos y la estimación de la presión intrabdominal intraoperatoria, permiten ampliar la indicación de este patrón de dermolipectomía a pacientes en los que no ha habido adelgazamiento. Código numérico 53-5311 AbstractMultifunctional anchor dermolipectomy has been a proved effective technique in the treatment of body contouring in patients who have suffered great loss of weight.Currently, in Spanish public health system, are not uncommon for the plastic surgeon patients who have not lost enough weight, and beyond any body contour procedure require repair of the abdominal wall. As other authors describe, reconstructive procedures of the abdominal wall can be practised with a simultaneous approach of body contour, resulting in a patients´ functional improvement and better quality of life.We present our experience with this dermolipectomy pattern in 32 cases and we show our managing of 3 patients with no weight loss.The large intrabdominal volume, visceral and fatty in these patients without weight loss, involves complications that may result in alterations of the container-contained relationship after major abdominal surgery. The most common ones are suture dehiscence, flap necrosis, respiratory failure or stress closure that ultimately may result in an intra-abdominal compartimental syndrome.Respiratory fisiotherapy and preoperative chest physiotherapy, suprapubic flap design to prevent the closure stress or non-stripping of the flaps and the measure of the stimative intraoperative intra-abdominal pressure can extend indication of this abdominoplasty pattern in patients in which there has been no thinning. Key wordsAbd...

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Closure of Chronic Abdominal Wall Defects: A Long-term Evaluation of the Components Separation Method

Cited by 103 publications

References 0 publications

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Abdominoplastia multifuncional en ancla: nuestra experiencia y nueva sistemática de abordaje en el paciente sin adelgazamiento

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