ABSTRACT
AIM: To define the optimal treatment of postoperative ventral hernias. MATERIAL AND METHODS: It was performed microscopic examination of intraoperative specimens which were obtained from 40 patients with medium, large and giant hernia. The aim was to reveal ultrastructural changes and morphological features which are associated with abdominal wall weakness in case of postoperative ventral hernia. There were 28 (70%) cases of primary postoperative hernia and 12 (30%) cases of recurrent and multiple-recurrent hernia. In 4 patients polypropylene mesh implants were implanted prior to recurrence. Tissue specimens were obtained from the top of herniation, hernial ring and in 6 cm from the hernial ring. RESULTS AND DISCUSSION: Electron microscopy showed that postoperative ventral hernias are accompanied by ultrastructural destructive changes in cells of the skin, aponeurosis and muscles that indicates on morphofunctional failure of abdominal wall tissues. Swelling and degradation of collagen, fibroblasts vacuolization, capillary sludge of erythrocytes, development of vacuum zones with the fragments of altered collagen fibrils, red blood cells and mast cells are morphological signs of micronecrosis followed by abdominal wall weakness and postoperative ventral hernias. CONCLUSION: Postoperative ventral hernias are associated with morphological and functional failure of abdominal wall due to tissue destructive changes. Therefore, this obviously defective tissue can not be used per se and especially with tension. Mesh implants should be applied.
Subject(s)
Abdominal Wall/pathology , Hernia, Ventral/pathology , Incisional Hernia/pathology , Abdominal Wall/surgery , Biocompatible Materials , Hernia, Ventral/etiology , Humans , Incisional Hernia/etiology , Microscopy, Electron , Polypropylenes , Recurrence , Surgical MeshABSTRACT
The article analyses the 17-year (1993-2009 yy) experience of surgical treatment of desmoid fibroma and sarcoma of the thoracic and abdominal wall. 46 operations were analyzed. The radical excision according to the principles of surgical oncology remains the mainstay in the treatment of such patients. The combined technique with the use of polymeric implantates allows to cover large wall defects, thus extending the operability borders and being one of the main factors of the better treatment prognosis.
Subject(s)
Abdominal Neoplasms/pathology , Fibromatosis, Aggressive , Neoplasm Recurrence, Local , Plastic Surgery Procedures , Sarcoma , Thoracic Neoplasms/pathology , Abdominal Neoplasms/physiopathology , Abdominal Neoplasms/surgery , Abdominal Wall/pathology , Adult , Female , Fibromatosis, Aggressive/pathology , Fibromatosis, Aggressive/physiopathology , Fibromatosis, Aggressive/surgery , Humans , Male , Polymers/therapeutic use , Prostheses and Implants , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Sarcoma/pathology , Sarcoma/physiopathology , Sarcoma/surgery , Severity of Illness Index , Survival Analysis , Thoracic Neoplasms/physiopathology , Thoracic Neoplasms/surgery , Thoracic Wall/pathology , Treatment OutcomeABSTRACT
On the basis of investigations performed a classification is made systematizing postlactational involution according to different parameters and degree. It facilitates objectivization of indications to different correcting operative interventions on mammary glands with postlactational involution and choice of the optimum complex of surgical measures for correction of the mammary gland. It allows prognosis of its contour and esthetic results.
