Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been p...Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.展开更多
Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is perf...Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.展开更多
Lateral abdominal wall(LAW)defects are defined as hernias,bulges,or surgical wounds that occur within the anatomic region bounded by the linea semilunaris,costal margin,iliac crest,and paraspinous musculature.Reconstr...Lateral abdominal wall(LAW)defects are defined as hernias,bulges,or surgical wounds that occur within the anatomic region bounded by the linea semilunaris,costal margin,iliac crest,and paraspinous musculature.Reconstruction of the LAW is complicated by the relatively complex anatomy,asymmetric biomechanical forces on the repair,and progressive nature of concomitant denervation injuries.Furthermore,the relative rarity and varied nature of these defects have complicated comparative analysis and the development of consensus regarding optimal surgical management.Although mesh reinforcement of LAW defects is a universal component of available repair techniques,significant variation exists regarding mesh material selection,anatomic plane utilization,and extent of mesh reinforcement.Special consideration must be given to extirpative defects that extend beyond the aforementioned boundaries of the LAW.In this review,we outline the incidence of LAW defects,pertinent risk factors,common history and physical examination findings,supplementary diagnostic modalities,defect classification systems,surgical indications,and available repair techniques.The outcomes data in this review are presented to help guide surgical management and optimize outcomes for affected patients.展开更多
文摘Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.
文摘Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.
文摘Lateral abdominal wall(LAW)defects are defined as hernias,bulges,or surgical wounds that occur within the anatomic region bounded by the linea semilunaris,costal margin,iliac crest,and paraspinous musculature.Reconstruction of the LAW is complicated by the relatively complex anatomy,asymmetric biomechanical forces on the repair,and progressive nature of concomitant denervation injuries.Furthermore,the relative rarity and varied nature of these defects have complicated comparative analysis and the development of consensus regarding optimal surgical management.Although mesh reinforcement of LAW defects is a universal component of available repair techniques,significant variation exists regarding mesh material selection,anatomic plane utilization,and extent of mesh reinforcement.Special consideration must be given to extirpative defects that extend beyond the aforementioned boundaries of the LAW.In this review,we outline the incidence of LAW defects,pertinent risk factors,common history and physical examination findings,supplementary diagnostic modalities,defect classification systems,surgical indications,and available repair techniques.The outcomes data in this review are presented to help guide surgical management and optimize outcomes for affected patients.
