RESUMEN
BACKGROUND: Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement. METHODS: All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study. RESULTS: 105 patients (52 male, 53 female; mean age 59.2 years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36 months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36 months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma. CONCLUSIONS: These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.
Asunto(s)
Pared Abdominal/cirugía , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Poliésteres , Mallas Quirúrgicas , Abdominoplastia/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Herniorrafia/instrumentación , Herniorrafia/métodos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Reoperación , Seroma/etiología , Mallas Quirúrgicas/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufï¬cient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES: With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS: This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
Asunto(s)
Abdominoplastia/normas , Consenso , Hernia Ventral/cirugía , Herniorrafia/normas , Guías de Práctica Clínica como Asunto , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Adulto , China , Hernia Ventral/diagnóstico , Herniorrafia/instrumentación , Herniorrafia/métodos , Humanos , Índice de Severidad de la Enfermedad , Cirujanos/normas , Colgajos Quirúrgicos/trasplante , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
SUMMARY: Ventral hernias have numerous causes, ranging from sequelae of surgical procedures to congenital deformities. Patients suffering from these hernias experience a reduced quality of life through pain, associated complications, and physical disfigurement. Therefore, it is important to provide these patients with a steadfast repair that restores functionality and native anatomy. To do this, techniques and materials for abdominal wall reconstruction have advanced throughout the decades, leading to durable surgical repairs. At the cornerstone of this lies the use of mesh. When providing abdominal wall reconstruction, a surgeon must make many decisions with regard to mesh use. Along with the type of mesh and plane of placement of mesh, a surgeon must decide on the method of mesh fixation. Fixation of mesh provides an equal distribution of tension and a more robust tissue-mesh interface, which promotes integration. There exist numerous modalities for mesh fixation, each with its own benefits and drawbacks. This Special Topic article aims to compare and contrast methods of mesh fixation in terms of strength of fixation, clinical outcomes, and cost-effectiveness. Methods included in this review are suture, tack, fibrin glue, mesh strip, and self-adhering modes of fixation.
Asunto(s)
Abdominoplastia/métodos , Hernia Ventral/cirugía , Herniorrafia/métodos , Complicaciones Posoperatorias/prevención & control , Mallas Quirúrgicas , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Adhesivo de Tejido de Fibrina , Hernia Ventral/complicaciones , Hernia Ventral/psicología , Herniorrafia/efectos adversos , Herniorrafia/instrumentación , Humanos , Complicaciones Posoperatorias/etiología , Calidad de Vida , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact™ vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia. MATERIAL AND METHODS: Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints. RESULTS: Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien-Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference. CONCLUSION: LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.
Asunto(s)
Abdominoplastia/efectos adversos , Pérdida de Sangre Quirúrgica/prevención & control , Electrocoagulación/instrumentación , Hemostasis Quirúrgica/instrumentación , Obesidad/cirugía , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Adulto , Transfusión Sanguínea , Disección/instrumentación , Disección/métodos , Electrocoagulación/métodos , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Reoperación , Estudios Retrospectivos , Pérdida de PesoRESUMEN
Post-bariatric patients undergoing abdominoplasty have a relatively high risk of complications due to residual obesity and major comorbidities. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcomes. This retrospective randomised clinical study evaluated the effect of low-thermal plasma dissection device (PEAK [pulsed electron avalanche knife] PlasmaBlade) in comparison with conventional electrosurgery. A total of 52 post-bariatric patients undergoing abdominoplasty were randomised to PEAK PlasmaBlade (n = 26) and to monopolar electrosurgery (n = 26). Wounds of 20 patients per group were examined histologically for acute thermal injury depth. In PEAK PlasmaBlade incisions, acute thermal damage was significantly reduced compared with standard of care (40% vs 75%; P = .035). Also, acute thermal injury depth from PEAK PlasmaBlade was less than that from electrosurgery (2780 µm vs 4090 µm). Significantly less total complication rate (30.8% vs 69.2%; P = .012) was found by PEAK PlasmaBlade compared with electrosurgery. Moreover, the PEAK PlasmaBlade showed less than half as many wound healing problems (19.2% vs 46.2%; P = .075), far fewer secondary bleeding (7.7% vs 30.8%; P = .075), and no seroma compared with four seroma with the standard of care (0% vs 15.4%; P = .11). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric abdominoplasty, because it demonstrated significantly less tissue damage, less total complication rate, and fewer postoperative seroma resulting in faster wound healing.
Asunto(s)
Abdominoplastia/instrumentación , Electrocirugia , Ablación por Radiofrecuencia/instrumentación , Adulto , Cirugía Bariátrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Seroma/etiología , Cicatrización de HeridasRESUMEN
PURPOSE: Hernia repair for large and complex hernias presents challenges related to the availability of larger mesh sizes. When sizes beyond those manufactured are required, multiple meshes (MM) may be sutured to create a larger graft. With the availability of large polypropylene mesh up to 50 × 50 cm (LM), abdominal wall reconstruction (AWR) may be accomplished with a single mesh. This study evaluates clinical and economic outcomes following AWR with component separation utilizing MM and LM. METHODS: A retrospective study was performed with review of health records and cost accounting data. Patients that underwent AWR with LM were case matched 1:1 with patients undergoing MM repair based upon comorbidities, defect size and wound class. RESULTS: Twenty-four patients underwent AWR with LM. Twenty patients (10F, 10 M) who underwent AWR with LM were matched with 20 MM AWR (11F, 9 M). Age, BMI, ASA 3 + , never smoker, diabetes, and hernia characteristics were similar between LM and MM. Operative cost ($4295 vs $3669, p = 0.127), operative time (259 min vs 243 min, p = 0.817), length of stay (5.5 vs 6.2, p = 0.484), wound complication (30% vs 20%, p = 0.716), infected seroma (5% vs 5%, p = 1), and readmission (5% vs 15%, p = 0.605) were similar between LM and MM, respectively. CONCLUSIONS: This is the first report of patients undergoing AWR with a large 50 × 50 cm prolene mesh. In this small cohort, clinical outcomes were similar between those undergoing repair with multiple sutured mesh sheets and a single large mesh.
Asunto(s)
Pared Abdominal/cirugía , Abdominoplastia/instrumentación , Hernia Ventral , Herniorrafia , Mallas Quirúrgicas/normas , Abdominoplastia/efectos adversos , Abdominoplastia/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Hernia Ventral/diagnóstico , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Herniorrafia/economía , Herniorrafia/instrumentación , Herniorrafia/métodos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Polipropilenos/uso terapéutico , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: Incisional hernia is the most common complication following abdominal surgery. While mesh repair is common, none of the current meshes mimic the physiology of the abdominal wall. This study compares suture only repair with polypropylene mesh and a prototype of a novel implant (poly-epsilon-caprolactone nanofibers) and their influence on the physiology of an abdominal wall in an animal model. METHODS: 27 Chinchilla rabbits were divided into six groups based on the type of the implant. Midline abdominal incision was repaired using one of the compared materials with suture alone serving as the control. 6 weeks post-surgery animals were killed and their explanted abdominal wall subjected to biomechanical testing. RESULTS: Both-hysteresis and maximum strength curves showed high elasticity and strength in groups where the novel implant was used. Polypropylene mesh proved as stiff and fragile compared to other groups. CONCLUSION: Poly-epsilon-caprolactone nanofiber scaffold is able to improve the dynamic properties of healing fascia with no loss of maximum tensile strength when compared to polypropylene mesh in an animal model.
Asunto(s)
Abdominoplastia/instrumentación , Hernia Abdominal , Herniorrafia/instrumentación , Hernia Incisional , Nanofibras/uso terapéutico , Polipropilenos/uso terapéutico , Mallas Quirúrgicas , Abdominoplastia/métodos , Animales , Modelos Animales de Enfermedad , Elasticidad , Hernia Abdominal/etiología , Hernia Abdominal/cirugía , Herniorrafia/métodos , Hernia Incisional/etiología , Hernia Incisional/cirugía , Ensayo de Materiales , Conejos , Resistencia a la TracciónRESUMEN
The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.
Asunto(s)
Abdominoplastia/métodos , Diástasis Muscular/cirugía , Complicaciones del Embarazo/cirugía , Técnicas de Sutura/instrumentación , Suturas , Pared Abdominal/cirugía , Abdominoplastia/instrumentación , Femenino , Humanos , Embarazo , Recto del Abdomen/lesiones , Recto del Abdomen/cirugíaRESUMEN
BACKGROUND: Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty. OBJECTIVES: To present an effective and safe technique that can address large umbilical herniae during abdominoplasty. METHODS: A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee. RESULTS: At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes). CONCLUSIONS: We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.
Asunto(s)
Abdominoplastia/métodos , Hernia Umbilical/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Músculos Abdominales/cirugía , Abdominoplastia/instrumentación , Adulto , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Herniorrafia/instrumentación , Humanos , Laparoscopía/instrumentación , Estudios Prospectivos , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
PURPOSE: Abdominal wall defects caused by neoplasms with large extended resection defects remain a challenging problem. Autologous flaps, meshes, and component separation techniques are effective in reconstructing these defects. We retrospectively reviewed and assessed the success of reconstruction using tensor fascia lata flap with or without meshes. METHODS: 18 patients with abdominal wall neoplasms were identified during the period from 2007 to 2016. A retrospective review of office charts and hospital records was performed. RESULTS: A total of 18 patients received corresponding treatment according to the degree of defects, with a mean age of 53.89 ± 14.56 years old, a mean body mass index (BMI) of 22.89 ± 4.09 kg/m2, and a mean American Society of Anesthesiologist (ASA) score of 2.18 ± 0.75. Operative details included the mean defect size (303.44 ± 175.67 cm2), the mean mesh size (265.92 ± 227.99 cm2), and the mean operative time (382.33 ± 180.38 min). Postoperative wound complications were identified in 7 (39%) patients, including incisional infection, edema and thrombus. Neoplasm recurrence was observed in 2 (13%) primary neoplasms patients. No hernias were present in any patient. CONCLUSIONS: Abdominal wall defects caused by neoplasms should be repaired by autologous flaps combined with or without mesh reinforcement. Most type I defects should be primary sutured; type II or III defects should be repaired well by flaps, with or without mesh; if the incision is infected or contaminated, biological mesh or flaps are the best choice.
Asunto(s)
Neoplasias Abdominales , Pared Abdominal/cirugía , Abdominoplastia , Recurrencia Local de Neoplasia , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Neoplasias Abdominales/epidemiología , Neoplasias Abdominales/patología , Neoplasias Abdominales/cirugía , Pared Abdominal/patología , Técnicas de Cierre de Herida Abdominal , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Adulto , Anciano , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Prótesis e Implantes , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Colgajos Quirúrgicos , Mallas QuirúrgicasRESUMEN
INTRODUCTION: Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. METHODS: A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. RESULTS: The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. CONCLUSION: The routine use of biologic and biosynthetic meshes cannot be recommended.
Asunto(s)
Pared Abdominal/cirugía , Abdominoplastia , Materiales Biocompatibles , Productos Biológicos , Hernia Abdominal/cirugía , Herniorrafia , Complicaciones Posoperatorias , Mallas Quirúrgicas , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Materiales Biocompatibles/efectos adversos , Materiales Biocompatibles/uso terapéutico , Productos Biológicos/efectos adversos , Productos Biológicos/uso terapéutico , Consenso , Herniorrafia/efectos adversos , Herniorrafia/instrumentación , Herniorrafia/métodos , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: Abdominoplasty is the most frequently performed surgical procedure for body contour; in our experience, we have observed some patients with prominent bulging that is difficult to treat and that presents results that are unsatisfactory or have recurrences to conventional treatments. This leads us to carry out an analysis of the elements responsible for the containment and abdominal format. We determined that it may be due to an inability of an important sagging aponeurotic muscle of primary origin to support the abdomen and could be caused by predisposing factors. For these specific cases, we developed a treatment proposing the use of a mesh. METHODS: We present these cases over a period of 24 years. Fourteen patients were treated with primary and secondary abdominoplasties. The abdominal wall reinforcement was performed by placing polypropylene mesh at the sub-muscular plane, fixed with U-stitches on the fascia transversalis, seeking to strengthen the muscle and the fascia transversalis. RESULTS: The results were satisfactory after long-term observation, gaining resolution of the abdominal bulges. Only two complications occurred; the presence of localized chronic pain and the appearance of umbilical fistula. DISCUSSION: We emphasize the importance of avoiding unnecessary interventions in patients with marked bulging, associated with inability of abdominal restraint. We only consider its indications in patients with conventional recurrence treatment, also identifying the predisposing factors, the knowledge of the abdominal anatomy, the muscular dynamics of the abdomen and understanding its indication in these specific cases of difficult treatment. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Músculos Abdominales/cirugía , Abdominoplastia/instrumentación , Abdominoplastia/métodos , Mallas Quirúrgicas , Pared Abdominal/cirugía , Adulto , Anciano , Aponeurosis , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Cavidad Abdominal/cirugía , Abdominoplastia/métodos , Cirugía Bariátrica/métodos , Movimiento y Levantamiento de Pacientes/métodos , Procedimientos de Cirugía Plástica/métodos , Abdominoplastia/instrumentación , Aire , Cirugía Bariátrica/instrumentación , Humanos , Movimiento y Levantamiento de Pacientes/instrumentación , Procedimientos de Cirugía Plástica/instrumentaciónRESUMEN
BACKGROUND: The retro-rectus placement of a prosthesis for reinforcement of a hernia repair is a powerful surgical maneuver and results in reduced hernia recurrence rates in the absence of ventral hernia. Fascial reinforcement theoretically should improve columnar support to the spine and enhance athletic activity. The purpose of this study was to demonstrate the long-term efficacy of the restoration of the cylindrical lumbar abdominal myofascial complex as an adjunct to cosmetic abdominoplasty. OBJECTIVES: A retrospective evaluation of retro-rectus inlay prosthesis during cosmetic abdominoplasty was undertaken to subjectively assess aesthetic and functional benefits. METHODS: Six patients with severe anterior fascial laxity presenting for abdominoplasty underwent prosthetic augmentation of the posterior rectus sheath. The prosthesis was measured and contoured to provide structural support to the rectus sheath and linea Alba and to restore normal anatomic features to these structures. All procedures were performed via a traditional low abdominal curvilinear incision for optimum cosmesis. RESULTS: All 6 patients had long-term follow up, ranging from 13 to 40 months. All patients reported improved core strength and relief of back pain. All patients were pleased with the cosmetic results. CONCLUSIONS: Retro-rectus prosthetic augmentation for cosmetic abdominoplasty is effective in restoring anatomic relationships and can be used to improve core strength and to enhance aesthetic objectives. LEVEL OF EVIDENCE: 4.
Asunto(s)
Abdominoplastia/métodos , Hernia Ventral/cirugía , Implantación de Prótesis/métodos , Recto del Abdomen/cirugía , Pared Abdominal/cirugía , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Adulto , Anciano , Dolor de Espalda/etiología , Dolor de Espalda/cirugía , Estética , Femenino , Estudios de Seguimiento , Humanos , Satisfacción del Paciente , Diseño de Prótesis , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Recurrencia , Estudios Retrospectivos , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
Background: Plication of the anterior rectus sheath is the most commonly used technique for repair of diastasis recti, but is also a time-consuming procedure. Objectives: The aim of this study was to compare the efficacy and time required to repair diastasis recti using different plication techniques. Methods: Thirty women with similar abdominal deformities, who had had at least one pregnancy, were randomized into three groups to undergo abdominoplasty. Plication of the anterior rectus sheath was performed in two layers with 2-0 monofilament nylon suture (control group) or in a single layer with either a continuous 2-0 monofilament nylon suture (group I) or using a continuous barbed suture (group II). Operative time was recorded. All patients underwent ultrasound examination preoperatively and at 3 weeks and 6 months postoperatively to monitor for diastasis recurrence. The force required to bring the anterior rectus sheath to the midline was measured at the supraumbilical and infraumbilical levels. Results: Patient age ranged from 26 to 50 years and body mass index from 20.56 to 29.17 kg/m2. A significant difference in mean operative time was found between the control and study groups (control group, 35 min:22 s; group I, 14 min:22 s; group II, 15 min:23 s; P < 0.001). Three patients in group II had recurrence of diastasis. There were no significant within- and between-group differences in tensile force on the aponeurosis. Conclusions: Plication of the anterior rectus sheath in a single-layer with a continuous suture showed to be an efficient and rapid technique for repair of diastasis recti.
Asunto(s)
Abdominoplastia/métodos , Tempo Operativo , Recto del Abdomen/cirugía , Técnicas de Sutura , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Adulto , Brasil , Diseño de Equipo , Femenino , Humanos , Persona de Mediana Edad , Contracción Muscular , Fuerza Muscular , Recuperación de la Función , Recto del Abdomen/diagnóstico por imagen , Recto del Abdomen/fisiopatología , Recurrencia , Técnicas de Sutura/efectos adversos , Técnicas de Sutura/instrumentación , Suturas , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Flujo de TrabajoRESUMEN
Background: With seroma formation being the most common complication of abdominoplasty, multiple surgical strategies have been proposed to lower the seroma rate, yet their effectiveness is unclear. Objectives: The objective of this systematic review and meta-analysis was to comprehensively summarize and quantify the effects of preventive surgical measures for seroma in patients undergoing abdominoplasty. Methods: A predetermined protocol was used. An electronic search in MEDLINE, Scopus, the Cochrane Library, and CENTRAL electronic databases was conducted from inception to June 2016. This search was supplemented by a review of reference lists of potentially eligible studies and a manual search of key journals in the field of plastic surgery. Eligible studies were prospective controlled studies, which investigated prevention of seroma formation and reported on seroma rate. Secondary outcomes were rate of hematoma, wound dehiscence, infection, reoperation and hospital readmission, time to drain removal, total drain output, and length of hospital stay. Results: The meta-analysis included nine studies with 664 abdominoplasty patients. Seroma rate was 7.5% in the prevention group and 19.5% in the control group with the odds ratio (95% confidence interval) being 0.26 (0.10-0.67), P = .006, favoring the prevention group. Similar results were also revealed for infection rate, time to drain removal, and length of hospital stay. Subgroup analysis showed that preservation of Scarpa's fascia, tissue adhesives and, possibly, progressive tension sutures reduce, independently, seroma formation. Conclusions: This meta-analysis provides strong evidence that the use of certain preventive measures during abdominoplasty, compared to conventional procedure, reduces seroma formation.
Asunto(s)
Abdominoplastia/métodos , Complicaciones Posoperatorias/prevención & control , Seroma/prevención & control , Pared Abdominal/anatomía & histología , Pared Abdominal/cirugía , Abdominoplastia/efectos adversos , Abdominoplastia/instrumentación , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Oportunidad Relativa , Readmisión del Paciente/estadística & datos numéricos , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Seroma/etiología , Técnicas de Sutura , Adhesivos Tisulares/uso terapéuticoRESUMEN
The method of the implant fixation for prophylaxis of complications after alloplasty of complex abdominal wall defects was proposed. Taking into account physico-mechan- ical parameters of implant, degree of anisotropy, in accordance to mechanical and morphological characteristics of the abdominal wall musculo-aponeurotic structures, it is possible to individualize the choice maximally, to plan the alloplasty kind, and to determine the method of optimal surgical treatment objectively.
Asunto(s)
Pared Abdominal/cirugía , Abdominoplastia/métodos , Mallas Quirúrgicas , Pared Abdominal/patología , Abdominoplastia/instrumentación , Anciano , Anisotropía , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polipropilenos , Medicina de Precisión , Estudios Retrospectivos , Estrés MecánicoRESUMEN
UNLABELLED: Body contouring by means of minimally invasive procedures is a growing trend. Current approaches to body contouring often involve a combination of surgical techniques (eg, laser-assisted liposuction) and a series of noninvasive device-based treatments aimed at accelerating recovery and improving aesthetic outcomes. In this case study, we describe a 38-year-old woman who presented with an abdominal-wall mass that resembled a tumor when assessed with magnetic resonance imaging. Twenty-six months before presenting to our office, the patient had undergone laser lipolysis and a series of treatments with a device that delivered dual-wavelength laser energy and vacuum-assisted massage. To address the patient's concerns, we removed the mass and performed abdominal dermolipectomy. No postoperative complications occurred, and the patient was highly satisfied with the aesthetic outcome. The results of histologic studies indicated that the mass was pseudocystic and fluid-filled, surrounded by a fibrous capsule, and characterized as a foreign-body granuloma. Further analysis is warranted regarding the safety of laser lipolysis without aspiration combined with a device delivering dual-wavelength laser energy and vacuum-assisted massage. LEVEL OF EVIDENCE: 5 Risk.
Asunto(s)
Abdominoplastia/instrumentación , Granuloma de Cuerpo Extraño/etiología , Terapia por Láser/instrumentación , Rayos Láser , Lipectomía/instrumentación , Masaje/instrumentación , Abdominoplastia/efectos adversos , Abdominoplastia/métodos , Adulto , Femenino , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/cirugía , Humanos , Terapia por Láser/efectos adversos , Lipectomía/efectos adversos , Imagen por Resonancia Magnética , Masaje/efectos adversos , VacioRESUMEN
Este artigo descreve a adaptação de um mandril de micro-punch - normalmente empregado em transplantes capilares - para uso em marcações intraoperatórias. O mandril foi usado como cabo para manuseio de palitos de dente esterilizados nas demarcações de procedimentos cirúrgicos diversos, como abdominoplastias, mamoplastias e ritidoplastias. O emprego deste instrumento oferece um meio confortável, acessível, preciso e de baixo custo para todos os tipos de marcações cirúrgicas em cirurgia plástica, sendo mais barato e eficiente do que canetas demarcatórias descartáveis.
This article describes the adaptation of a micro-punch mandrel, which is usually used in hair transplants, in intraoperative markings. The mandrel was used as a wire for sterile toothpick handling in different surgical marking procedures, such as those in abdominoplasties, mammoplasties, and rhytidectomies. The use of this instrument offers a comfortable, affordable, precise, and low-cost tool for all types of surgical marking performed in plastic surgery. It is cheaper and more efficient than disposable pens.