Progressive fascial wound failure impairs subsequent abdominal wall repairs: A new animal model of incisional hernia formation

DuBay, Derek A.; Wang, Xue; Adamson, Belinda; Kuzon, William M.; Dennis, Robert G.; Franz, Michael

doi:10.1016/j.surg.2004.12.016

Cited by 43 publications

(36 citation statements)

References 16 publications

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“…This hypothesis is now tested in at least one animal model where intentional mechanical laparotomy wound failure lead to pathological wound fibroblast function in vivo and in vitro. 10 It is possible that a subset of incisional hernia patients expresses a defect in extra-cellular matrix and or wound repair function. It is hard to resolve that mechanism with the fact that the majority of surgical patients have no history of a wound healing defect (making them surgical candidates) and also do not express a defect at the primary surgical site (GI tract, vascular system, solid organs etc.).…”

mentioning

confidence: 99%

The Biology of Hernia Formation

Franz

2008

Surgical Clinics of North America

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165

112

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mentioning

confidence: 99%

The Biology of Hernia Formation

Franz

2008

Surgical Clinics of North America

Self Cite

165

112

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“…Postoperative wound dehiscence rates range between 0.024% to 11% and different factors are defined in etiology (16)(17)(18)(19)(20). One of the important reasons for these differences is inclusion of patients with appendectomy and inguinal hernia repair in large series resulting in a heterogenous group of patients.…”

Section: Discussionmentioning

confidence: 99%

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Yılmaz

Akıncı

Doğan

et al. 2013

UCD

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Objective: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. Material and Methods:The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis.Results: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Conclusion:Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.Key Words: Abdominal surgery, wound dehiscence, incisional hernia, sinus formation, chronic incisional pain INTRODUCTIONWound dehiscence after laparotomy can manifest with different presentations varying from simple skin detachment to evisceration and eventration, leading to an increase in surgical mortality and morbidity, as well as increase in length of hospital stay and loss of work force.Anterior abdominal wall incision hernia that can be seen in the long term is also one of the common surgical complications. Known as postoperative hernia or incisional hernia, it is thought to result from insufficient closure of the fascia and/or poor healing. Factors causing chronic or prolonged postoperative intra-abdominal pressure increase and those affecting wound healing contribute to its development. The incidence of incisional hernias vary from 2% to 20% in different sources, and in addition to pain and impairment in quality of life it may also cause significant complications (1, 2). It has been reported that incarceration may occur in a rate of 15%, ...

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“…A brief review of five years on electronic data base of biomedical literature (Medline and Pubmed) showed thirty seven reports with rats, nineteen with rabbits, five with pigs or mini pigs, three with guinea-pigs, three with dogs, two with mice and no one with sheep or goats. Except for reports of one research group 16,17,[20][21][22] in rats and another one in rabbits 18 , almost all studies on wound healing and scar formation, using or not the different types of mesh, are based on the promotion of an acute full-thickness abdominal wall defect that is immediately repaired by a mesh and/or a surgical technique.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in rats the defect might be only a middle line incision closed with absorbable suture 16,17,[20][21][22] or fullthickness defect range of one squared centimeter 7 up to resections of 1.5 x 2.5 cm 8,23 , 2x2 cm 24 or 2x3 cm 6,25 . In guinea pigs the size was reported as 3x1 cm 26 and in pigs as 10x10 cm 13 , 12x4 cm 12 or 5 cm of diameter 14 .…”

Section: Discussionmentioning

confidence: 99%

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Animal model of chronic abdominal hernia in rabbit

Silva

Fagundes

Seidel³

et al. 2009

Acta Cir. Bras.

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Purpose: To create a feasible animal model of hernia that should be reliable to test the different types of mesh and/or surgical technique. Methods: Thirty six male New Zealand albino rabbits were submitted to surgical procedure to provoke a standard hole in the abdominal wall. A metallic frame measuring 3 cm length and 1 cm width was allocated longitudinally on the umbilicus scar and the comprehensive three squared centimeters area was resected. A continuous 4.0 polyamide was performed to closure the subcutaneous and skin. Results: During three weeks a score of signals/symptoms was performed to evaluate the wound and clinical conditions. No death or severe complications occurred. In the 3rd week the hernia ring and visceral adhesions were evaluated. Soft omental adherences were present in the hernial sac in all animals. The area of hernia ring ranged from 32.1±5.5 to 35.6±3.1 squared centimeter and the maximum was 39 cm 2 and the minimum was 30 cm 2 . The model results in protrusion which was similar to a human incisional hernia with hernia sac, visceral adhesions and fibrous healing ring. Conclusion: The model was more reliable to test further techniques or mesh on hernia repair. Key words: Hernia, Ventral. Hernia, Abdominal. Wound Healing. Animal Experimentation. Rabbits. RESUMO Objetivo:Criação de um modelo animal de hérnia que seja confiável para testar as diferentes técnicas e tipos de telas. Métodos: Trinta e seis coelhos foram submetidos a procedimento operatório que provocou uma falha na parede abdominal. Uma moldura metálica com 3 cm de comprimento e 1 cm de largura foi colocada longitudinalmente sobre a cicatriz umbilical e ressecada uma área de 3cm 2 . Uma sutura contínua de poliamida 4.0 fechou a tela subcutânea e pele. Resultados: durante três semanas o escore de sinais e sintomas foi coletado para avaliar as condições clínicas e da ferida operatória. Não ocorreram óbitos ou complicações graves. Na terceira semana o anel herniário e aderências peritoneais foram avaliadas. Aderências frouxas estavam presentes no saco herniário em todos os animais. A área do anel herniário variou de 32.1±5.5 a 35.6±3.1 cm 2 , com um máximo de 39 cm 2 e um mínimo de 30 cm 2 . O modelo resultou numa protrusão de vísceras semelhante ao que ocorre em hérnia incisional de humanos. Conclusão: O modelo é factível para testar técnicas operatórias ou telas na reconstrução de hérnias incisionais.

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Progressive fascial wound failure impairs subsequent abdominal wall repairs: A new animal model of incisional hernia formation

Cited by 43 publications

References 16 publications

The Biology of Hernia Formation

The Biology of Hernia Formation

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Animal model of chronic abdominal hernia in rabbit

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