Periumbilical Rectus Abdominis Perforator Preservation Significantly Reduces Superficial Wound Complications in “Separation of Parts” Hernia Repairs

Saulis, Alexandrina S.; Dumanian, Gregory A.

doi:10.1097/00006534-200206000-00017

Cited by 30 publications

(39 citation statements)

References 9 publications

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“…After dissociation, a rectus abdominis flap could close a large midline defect, making it potentially part of a successful surgical intervention after mesh removal. According to existing literature, when using this method, also called component separation method, the hernia relapse rate is low (Saulis and Dumanian, 2002;Kim and Kim, 2011;Krpata et al, 2012;Espinosa-de-los-Monteros et al, 2013;Morris and LeBlanc, 2013;Wang and Singh, 2013). Even with the low relapse rate, this method is not appropriate for all types of repair after mesh removal (e.g., if the defect is too large or serious scar hyperplasia has made dissociation nearly impossible).…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect

Fd¹,

Jy²,

Yao³

et al. 2015

Genet. Mol. Res.

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Section: Discussionmentioning

confidence: 99%

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect

Fd¹,

Jy²,

Yao³

et al. 2015

Genet. Mol. Res.

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“…6 A fluorescence perfusography study from Germany on effects of abdominoplasty on abdominal wall perfusion showed significant impairment of vascular supply of the so-called zone 1 in all patients. 16 Saulis et al 17 have reported a significant reduction of postoperative wound complications in midline ventral hernia repairs by preservation of peri-umbilical rectus abdominis perforator vessels. Selective dissection and preservation of one perforator vessel from the inferior epigastric artery has been described in a patient with no risk factors undergoing aesthetic abdominoplasty.…”

Section: Discussionmentioning

confidence: 99%

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

et al. 2007

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Background: The number of patients after gastric bypass being referred to plastic surgery units for secondary plastic surgery procedures is increasing. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars in the upper abdomen. Often a limited abdominoplasty of the low transverse type with limited undermining only up to the level of the umbilicus is performed in order not to compromise blood supply in the zone between the old transverse and the new transverse scar.Method: We propose a new, modified and safe surgical technique to perform a complete abdominoplasty with wide undermining up to the xiphoid process in patients with preexisting transverse subcostal scars after gastric bypass surgery, by selectively dissecting and preserving one to three periumbilical abdominal wall perforator vessels to secure flap blood supply. Vessel tunnelling through the rectus sheath and muscle and ligation of the cephalad branch of the perforator provide sufficient flap mobility without perforator tension or traction. Flap undermining is performed around these perforator vessels. To match dissected flap perforators with blood-flow, we performed postoperative color-flow duplex scanning.Results: We treated two patients according to this new technique. In both cases the postoperative course was uneventful and a good aesthetic result was achieved.Conclusion: We conclude from our experience that with this perforator-sparing abdominoplasty technique, safe and complete abdominoplasty can be performed with no additional risk of complications and that a good cosmetic result can be achieved in patients after open gastric bypass surgery.

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“…По всей видимости, техника сепарации компонентов передней брюшной стенки за-нимает сегодня ключевое направление в ле-чении БГПБС [17]. Базисным вариантом раз-деления компонентов брюшной стенки явля-ется операция по Ramirez.…”

Section: результаты и их обсуждениеunclassified

“…Так, недостатками операции Ramirez являются большая раневая поверхность в зоне сепара-ции подкожного лоскута, что ассоциировано с риском формирования некрозов кожи в сред-нем сегменте брюшной стенки (пересекаются перфорантные сосуды в области пупка), а также лежит в основе длительной экссудации и формирования жидкостных скоплений [8]. Предложен вариант, сохраняющий перфори-рующие сосуды в околопупочной области [17]. Кроме того передняя сепарация может быть выполнена эндоскопически [9].…”

Section: результаты и их обсуждениеunclassified

Comparative Evluation of the Influence of Different Methods of the Abdominal Wall Separation at Increasing Abdominal Cavity Volume

Shapoval'yants¹,

Mikhalev²,

Mikhaleva³

et al. 2017

JAH

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Целью исследования явилось изучение влияния различных методов сепарации передней брюшной стенки на степень увеличения объема брюшной полости (ОБП). Было изучено влияние задней сепарации по Novitsky, передней -по Ramirez с мобилизацией задней стенки влагалища прямой мышцы живота (R+МЗСПМ) на увеличение ОБП. Исследование проведено на аутопсийном материале 30 нефиксирован-ных трупов. Работа проведена в трех сериях исследований. В первой части исследования на 10 трупах были изучены результаты операции по Novitsky, во второй -по Ramirez, в третей -R+МЗСПМЖ. Определяли ОБП до и после операций и отмечали степень его увеличения после каждой операции. При операции по Ramirez исходный ОБП в среднем составил 3.2±0.2 л. После выполнения операции ОБП увеличился до 4.06±0.2 л (на 27.8±2.6%). При операции по Novitsky исходный ОБП в среднем составил 3.1±0.1 л, после операции -3.9±0.1 л, (увеличился на 24.2±1.7%). При операции Ramirez + МЗСПМ исходный ОБП в сред-нем был равен 3.1±0.08 л, после операции -4.7±0.22 л, с увеличением на 49.8±4.5%. Исследование вы-явило различное влияние трех видов сепараций передней брюшной стенки на увеличение ОБП. К наи-большему увеличению ОБП (на 49.8±4.6%) приводит операция Ramirez+МЗСПМ, в меньшей степени -операция по Ramirez (на 27.8±2.7%), наименьшим эффектом (увеличение на 24.2±1.7%) обладает сепара-ция по Novitsky. The aim of the study was to investigate the effect of different methods of anterior abdominal wall separation on the increasion of the abdominal cavity volume (ACV). The effect of Novitsky posterior separation (Transversus Abdominis Release -TAR), Ramirez anterior separation and Ramirez anterior separation with the mobilization of posterior wall rectus sheath (R+MPRS) on increase ACV was studied. The study was conducted on autopsy materials of 30 non-fixed corpses. In the first part of investigation the results of Novitsky operation have been studied (n=10), in the second part -of Ramirez operation (n=10) and in the third part -R+MPRS (n=10). The ACV have been determined before and after surgery and the degree of it's increasion after each operation have been counted. In Ramiraz's separation the average of ACV before the operation was 3.2±0.2 L, after the operation -4.06±0.2 L with an average increasion in volume of 27.8±2.6%. In Novitsky operation the average of ACV before the operation was 3.1±0.1 L, after the operation -3.9±0.1 L, with an average increasion of 24.2±1.7%. In Ramiraz + MPRS the average of ACV before the operation was 3.1±0.08 L, after the operation -4.7±0.22 L with an average increasion of 49.8±4.6%. The study revealed different effects of the three types seperation of the abdominal wall on increasion the ACV. The operation of Ramiraz+ MPRS has the greatest effect on the increasion the ACV (49.8±4.6).

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Periumbilical Rectus Abdominis Perforator Preservation Significantly Reduces Superficial Wound Complications in “Separation of Parts” Hernia Repairs

Cited by 30 publications

References 9 publications

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

Comparative Evluation of the Influence of Different Methods of the Abdominal Wall Separation at Increasing Abdominal Cavity Volume

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