BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and tech...BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and technology.Surgical techniques,primarily involving the use of mesh to cover the abdominal wall gap,are widely used as a standard intervention strategy.AIM To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix[ReGeneraTing Agent(RGTA)],adipose tissue micrografts(ATM),and platelet rich plasma(PRP)as regenerative agents.METHODS Regenerative agents such as RGTA,ATM,and PRP are gaining popularity.ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells.RGTAs are heparan sulfate(HS)mimetics that replace degraded HSs in damaged tissue,enhancing the quality and speed of repair.PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production.An acellular dermal matrix is a biological implant free of cellular or antigenic components,making it an excellent material for reconstructive surgery.Polyglactin is a synthetic,absorbable mesh that loses 50%of its strength after fourteen days,providing initial support for new tissue regeneration before being completely absorbed.RESULTS Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus.They will be divided into sixteen groups,each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments.A collagenelastin matrix will be used to join the aponeurosis edges,with an absorbable polyglactin mesh anchored over it.Samples will be taken for macroscopic,histological,and immunohistochemical evaluation of tissue regeneration.CONCLUSION Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall,potentially reducing the frequency and complications of incisional hernias.This approach could offer a more economical and efficient treatment option compared to current costly methods.展开更多
BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fist...BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.展开更多
BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure...BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.展开更多
BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,i...BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,including debridement,tensionreduced closure(TRC),and reconstruction with mesh and a free musculocutaneous flap.During a 3-year follow-up,the patient recovered well without hernia or other problems.CONCLUSION TRC is a practical approach for the temporary closure of LAWD,particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.展开更多
Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdomina...Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdominal wall defect after malignant tumors resection(10 × 10 cm-32 cm×32 cm) were reviewed. The defectcontributed:Ⅰ region, 2 cases; twin-Ⅱ region, 2; Ⅲ region, 2; Ⅰ and Ⅱ region of one side, 1 and total abdominal wall,one case, The tissue flaps of transposition included: gracilis myocutaneous flaps, 4; retus abdominal myocutaneous flaps, 2; external abdominal obligue musculo-fascia flaps, 2; latissimus dorsi muscle, tensor fasciae latae muscle and retus femoris muscle flaps each, 1. One patient used MycroMesh also. Results In the course of peroperation, the incisions of 8 cases healed in first time; total tissue flaps survived and all pateints started exercise left the bed in 3 weeks. All 8 patients were followed up average of 2 years and 5 months: the success rate of reconstruction展开更多
Effective antibacterial property and long-term mechanical support are essential for the repair of complex ab-dominal wall defects associated with infection.However,clinically available repair materials often fail to m...Effective antibacterial property and long-term mechanical support are essential for the repair of complex ab-dominal wall defects associated with infection.However,clinically available repair materials often fail to meet these requirements,resulting in high surgical failure rate and complications.In this study,an asymmetric porous composite hydrogel patch(cCS/PVA@BAC)with antibacterial,anti-adhesion,pro-healing,and durable mechan-ical support properties is designed for the efficient repair of contaminated abdominal wall defects.By stepwise phase-conversion and soaking method,robust and stable polyvinyl alcohol hydrogel(PVAH)is integrated with the biocompatible multicomponent hydrogel made of chitosan and carboxymethyl chitosan(cCS),and benza-lkonium chloride(BAC)is loaded to enhance the antibacterial property.The cCS layer of cCS/PVA@BAC has an extracellular matrix-like porous structure,which can promote fibroblasts adhesion and wound healing.In contrast,the PVAH layer on the other side with a smooth and dense structure,which can reduce fibroblasts adhesion and prevent visceral adhesion.In addition,the composite hydrogel patch has good anti-swelling and anti-deformation properties as well as stable mechanical strength,thus can withstand high intraperitoneal pres-sure in the wet internal microenvironment.The loaded BAC can efficiently kill bacteria and improve the local inflammatory microenvironment.With these advantages,cCS/PVA@BAC can significantly reduce inflammation,promote tissue remodeling,and accelerate the healing of contaminated abdominal wall defects in the rat model.These findings suggest a potential use of multifunctional hydrogel patch as an ideal material for effective repair of contaminated soft tissue defects.展开更多
BACKGROUND After parietal peritoneum excision with an underlying superficial layer of muscle tissue in rats,there is failed vasculature,and finally,increased adhesion formation.We hypothesized that unlike nitric oxide...BACKGROUND After parietal peritoneum excision with an underlying superficial layer of muscle tissue in rats,there is failed vasculature,and finally,increased adhesion formation.We hypothesized that unlike nitric oxide(NO)-agents,L-NAME and/or L-arginine,the application of the stable gastric pentadecapeptide BPC 157 with its most recent vascular effects(“vascular recruitment”)means attenuated bowel adhesion formation and NO-and malondialdehyde(MDA)-tissue values.AIM To focused on the bowel adhesion and the therapy with the BPC 157,its most and application of NO-agents.METHODS Along with defect creation,medication was(1)during surgery,once,at 1 min after defect creation as an abdominal bath(1 mL/rat),BPC 157(10μg/kg,10 ng/kg,1 mL/rat),an equivolume of saline,L-NAME(5 mg/kg),L-arginine(200 mg/kg)alone and/or combined.Alternatively,medication was(2)intraperitoneally once daily,first application at 30 min after surgery,last application 24 h before assessment at d 7 or d 14.As a postponed therapy to preexisting adhesion(3),BPC 157(10μg/kg,10 ng/kg intraperitoneally,1 mL/rat)was given once daily since d 7.RESULTSThe recovery effect of the BPC 157 regimens goes with the presence of abundant vascular vessels in and near the defect,which occurs rapidly.Lastly,also applied as post-treatment,BPC 157 creates attenuated adhesions,minimal or no adhesion.Contrarily,NO-agents have diverse initial and final effects:The initial weakening of blood vessel disappearance and finally,severe worsening of adhesions(LNAME)vs the initial weakening of blood vessel disappearance and finally,attenuation of adhesions formation(L-arginine),which counteract each other response given together.Importantly,BPC 157 maintains its beneficial effect also when given with NO-agents(L-NAME+BC 157;L-arginine+BPC 157;L-NAME+L-arginine+BPC 157).Finally,with respect to the increased NO-and MDAvalues-adhesion tissue formation relation,unlike diverse effect of the NO-agents,the BPC 157 application effect regularly combines decrease on the increased NOand MDA-values and the beneficial outcome(less adhesion formation).CONCLUSION BPC 157 therapy can be suited for the realization of the peritoneal defect healing with minimal or no adhesion formation.展开更多
Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appen...Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.展开更多
We present a 2,440 g male neonate born by caesarian section at 38 weeks of gestational age.Baby had been diagnosed with giant exomphalos during prenatal scans.Due to the giant size of the exomphalos with liver being s...We present a 2,440 g male neonate born by caesarian section at 38 weeks of gestational age.Baby had been diagnosed with giant exomphalos during prenatal scans.Due to the giant size of the exomphalos with liver being sac content to more than 50%and severe degree of abdominovisceral disproportion,the decision was made to adopt a staged-treatment approach.We created an external silo supplemented with DuoDERM compression dressings and adjusted it over three weekly sessions.The exomphalos was completely reduced,and the patient underwent delayed primary closure A modified single-layer abdominal wall repair was carried out uneventfully.The post-operative period was uncomplicated and at follow-up 4 years later the patient had no incisional hernia and is thriving well.展开更多
文摘BACKGROUND Incisional hernias are a common complication of previous surgeries and remain a persistent issue in clinical practice,posing a significant burden on healthcare systems despite advances in education and technology.Surgical techniques,primarily involving the use of mesh to cover the abdominal wall gap,are widely used as a standard intervention strategy.AIM To examine the regeneration of the aponeurosis defect in the anterior abdominal wall in rats using regenerative mimetic factors of the extracellular matrix[ReGeneraTing Agent(RGTA)],adipose tissue micrografts(ATM),and platelet rich plasma(PRP)as regenerative agents.METHODS Regenerative agents such as RGTA,ATM,and PRP are gaining popularity.ATM involves autologous adipose tissue cells with mesenchymal stem cell markers and a high percentage of stromal vascular fraction cells.RGTAs are heparan sulfate(HS)mimetics that replace degraded HSs in damaged tissue,enhancing the quality and speed of repair.PRP is a concentrated plasma preparation containing seven fundamental proteins responsible for tissue production.An acellular dermal matrix is a biological implant free of cellular or antigenic components,making it an excellent material for reconstructive surgery.Polyglactin is a synthetic,absorbable mesh that loses 50%of its strength after fourteen days,providing initial support for new tissue regeneration before being completely absorbed.RESULTS Rats will undergo a laparotomy with a precise 2 cm by 2 cm excision of the anterior abdominal wall fascia below the umbilicus.They will be divided into sixteen groups,each receiving different combinations of regenerative factor injections into the denervated area in both non-contaminated and contaminated environments.A collagenelastin matrix will be used to join the aponeurosis edges,with an absorbable polyglactin mesh anchored over it.Samples will be taken for macroscopic,histological,and immunohistochemical evaluation of tissue regeneration.CONCLUSION Our study aims to demonstrate how these factors promote cell proliferation and healing of the denervated anterior abdominal wall,potentially reducing the frequency and complications of incisional hernias.This approach could offer a more economical and efficient treatment option compared to current costly methods.
基金Supported by Youth Project of Anhui Provincial Health Commission T,No.AHWJ2023A30225.
文摘BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.
文摘BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.
文摘BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,including debridement,tensionreduced closure(TRC),and reconstruction with mesh and a free musculocutaneous flap.During a 3-year follow-up,the patient recovered well without hernia or other problems.CONCLUSION TRC is a practical approach for the temporary closure of LAWD,particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.
文摘Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdominal wall defect after malignant tumors resection(10 × 10 cm-32 cm×32 cm) were reviewed. The defectcontributed:Ⅰ region, 2 cases; twin-Ⅱ region, 2; Ⅲ region, 2; Ⅰ and Ⅱ region of one side, 1 and total abdominal wall,one case, The tissue flaps of transposition included: gracilis myocutaneous flaps, 4; retus abdominal myocutaneous flaps, 2; external abdominal obligue musculo-fascia flaps, 2; latissimus dorsi muscle, tensor fasciae latae muscle and retus femoris muscle flaps each, 1. One patient used MycroMesh also. Results In the course of peroperation, the incisions of 8 cases healed in first time; total tissue flaps survived and all pateints started exercise left the bed in 3 weeks. All 8 patients were followed up average of 2 years and 5 months: the success rate of reconstruction
基金supported by the projects of the National Key R&D Program of China(2021YFC2101700)National Natural Science Foundation of China(52372057,22371312)+4 种基金Guangdong Major Project of Basic and Applied Basic Research(2023B0303000025)Sun Yat-sen University Clinical Research 5010 Program(2017008)Medical Scientific and Technical Foundation of Guangdong Province(A2023085)Fundamental Research Funds for the Central Universities,Sun Yat-sen University(23yxqntd002)Guangdong Basic Research Center of Excellence for Functional Molecular Engineering.
文摘Effective antibacterial property and long-term mechanical support are essential for the repair of complex ab-dominal wall defects associated with infection.However,clinically available repair materials often fail to meet these requirements,resulting in high surgical failure rate and complications.In this study,an asymmetric porous composite hydrogel patch(cCS/PVA@BAC)with antibacterial,anti-adhesion,pro-healing,and durable mechan-ical support properties is designed for the efficient repair of contaminated abdominal wall defects.By stepwise phase-conversion and soaking method,robust and stable polyvinyl alcohol hydrogel(PVAH)is integrated with the biocompatible multicomponent hydrogel made of chitosan and carboxymethyl chitosan(cCS),and benza-lkonium chloride(BAC)is loaded to enhance the antibacterial property.The cCS layer of cCS/PVA@BAC has an extracellular matrix-like porous structure,which can promote fibroblasts adhesion and wound healing.In contrast,the PVAH layer on the other side with a smooth and dense structure,which can reduce fibroblasts adhesion and prevent visceral adhesion.In addition,the composite hydrogel patch has good anti-swelling and anti-deformation properties as well as stable mechanical strength,thus can withstand high intraperitoneal pres-sure in the wet internal microenvironment.The loaded BAC can efficiently kill bacteria and improve the local inflammatory microenvironment.With these advantages,cCS/PVA@BAC can significantly reduce inflammation,promote tissue remodeling,and accelerate the healing of contaminated abdominal wall defects in the rat model.These findings suggest a potential use of multifunctional hydrogel patch as an ideal material for effective repair of contaminated soft tissue defects.
文摘BACKGROUND After parietal peritoneum excision with an underlying superficial layer of muscle tissue in rats,there is failed vasculature,and finally,increased adhesion formation.We hypothesized that unlike nitric oxide(NO)-agents,L-NAME and/or L-arginine,the application of the stable gastric pentadecapeptide BPC 157 with its most recent vascular effects(“vascular recruitment”)means attenuated bowel adhesion formation and NO-and malondialdehyde(MDA)-tissue values.AIM To focused on the bowel adhesion and the therapy with the BPC 157,its most and application of NO-agents.METHODS Along with defect creation,medication was(1)during surgery,once,at 1 min after defect creation as an abdominal bath(1 mL/rat),BPC 157(10μg/kg,10 ng/kg,1 mL/rat),an equivolume of saline,L-NAME(5 mg/kg),L-arginine(200 mg/kg)alone and/or combined.Alternatively,medication was(2)intraperitoneally once daily,first application at 30 min after surgery,last application 24 h before assessment at d 7 or d 14.As a postponed therapy to preexisting adhesion(3),BPC 157(10μg/kg,10 ng/kg intraperitoneally,1 mL/rat)was given once daily since d 7.RESULTSThe recovery effect of the BPC 157 regimens goes with the presence of abundant vascular vessels in and near the defect,which occurs rapidly.Lastly,also applied as post-treatment,BPC 157 creates attenuated adhesions,minimal or no adhesion.Contrarily,NO-agents have diverse initial and final effects:The initial weakening of blood vessel disappearance and finally,severe worsening of adhesions(LNAME)vs the initial weakening of blood vessel disappearance and finally,attenuation of adhesions formation(L-arginine),which counteract each other response given together.Importantly,BPC 157 maintains its beneficial effect also when given with NO-agents(L-NAME+BC 157;L-arginine+BPC 157;L-NAME+L-arginine+BPC 157).Finally,with respect to the increased NO-and MDAvalues-adhesion tissue formation relation,unlike diverse effect of the NO-agents,the BPC 157 application effect regularly combines decrease on the increased NOand MDA-values and the beneficial outcome(less adhesion formation).CONCLUSION BPC 157 therapy can be suited for the realization of the peritoneal defect healing with minimal or no adhesion formation.
文摘Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.
文摘We present a 2,440 g male neonate born by caesarian section at 38 weeks of gestational age.Baby had been diagnosed with giant exomphalos during prenatal scans.Due to the giant size of the exomphalos with liver being sac content to more than 50%and severe degree of abdominovisceral disproportion,the decision was made to adopt a staged-treatment approach.We created an external silo supplemented with DuoDERM compression dressings and adjusted it over three weekly sessions.The exomphalos was completely reduced,and the patient underwent delayed primary closure A modified single-layer abdominal wall repair was carried out uneventfully.The post-operative period was uncomplicated and at follow-up 4 years later the patient had no incisional hernia and is thriving well.
