Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview.

Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.

ARAapp: filling gaps in the ecological knowledge of spiders using an automated and dynamic approach to analyze systematically collected community data.

The ARAMOB data repository compiles meticulously curated spider community datasets from systematical collections, ensuring a high standard of data quality. These datasets are enriched with crucial methodological data that enable the datasets to be aligned in time and space, facilitating data synthesis across studies, respectively, collections. To streamline the analysis of these datasets in a species-specific context, a suite of tailored ecological analysis tools named ARAapp has been developed. By harnessing the capabilities of ARAapp, users can systematically evaluate the spider species data housed within the ARAMOB repository, elucidating intricate relationships with a range of parameters such as vertical stratification, habitat occurrence, ecological niche parameters (moisture and shading) and phenological patterns. Database URL: ARAapp is available at  www.aramob.de/en.

Cumulative Incidence of SARS-CoV-2 in Healthcare Workers at a General Hospital in Germany during the Pandemic-A Longitudinal Analysis.

Health workers (HW) are at increased risk for SARS-CoV-2 infection. In order to monitor the infection dynamic on the basis of contact with patients, HW at the St. Antonius Hospital (SAH) were tested four times in one year by PCR and serology. The cumulative incidence of infection in HW was calculated. Swab and blood tests were simultaneously performed between April 2020 and April 2021. Risk factors and demographic information were assessed at the beginning of the study. The response rate was above 75% in all rounds of testing. The study comprised 1506 HW, 165 (10.6%) of which tested positive for SARS-CoV-2 infection. Working in an ICU or on wards with patient contact were risk factors (OR 4.4, 95% CI 1.73-13.6 and OR 2.9, 95% CI 1.27-8.49). At the end of the study, the majority of HW (810 of 1363 (59.4%)) had been vaccinated at least once. A total of 29.1% of unvaccinated HW and 5.3% of vaccinated HW showed an immune response typical for natural SARS-CoV-2 infection. Of the 73 HW who provided information on the course of the disease, 31.5% reported that their quality of life continued to be impaired. The cumulative incidence of infection was low in these HW, which may be attributed to vaccination and good hygiene. Nevertheless, a work-related infection risk was identified, highlighting the need to improve protection against infection. A high risk of developing long COVID was found after the infection has subsided. Special rehabilitation programs should be provided and HW should be compensated for reduced work capacity in the case that rehabilitation fails or takes a long time.

[Prevalence of SARS-CoV-2 in employees of a general hospital in Northrhine-Westphalia, Germany]. / Prävalenz von SARS-CoV-2 bei Mitarbeitern eines Krankenhauses der Regel-/Schwerpunktversorgung in Nordrhein-Westfalen.

BACKGROUND: We assessed the prevalence of SARS-CoV-2 in the staff of a general hospital in North-Rhine-Westphalia in a cross-sectional study. METHOD: Employees (n = 1363) were offered a nasopharyngeal swab and serology for SARS-CoV-2. Additionally, employees completed a questionnaire about preexisting conditions, contacts with SARS-CoV-2-positive individuals and COVID-19-specific symptoms. RESULTS: 1212 employees participated. 19 of 1363 (1.4 %) employees tested positive by PCR (3 within and 16 before the study). 40 (3.3 %) and 105 (8.6 %) had IgG and IgA, respectively, 32 (2.6 %) both IgG and IgA. Overall, 47 employees tested positive. In this group, most frequently reported symptoms were headache (56 %), fatigue (49 %), sore throat (49 %), and cough (46 %); fever was reported by 33 %. SARS-CoV-2-positive employees reported more frequently contact with COVID-19 cases (60.5 % vs. 37.3 %, p = 0.006). Employees testing positive only for IgA reported less symptoms. CONCLUSION: Between 27.04. and 20.05.2020, 3.9 % of the employees working in a general hospital were tested positive for SARS-CoV-2. This proportion was lower than expected; possible explanations are the low level of endemic infection and the extensive, uniform in-house preventative measures.

Secondary "Hybrid Reconstruction" Concept with Silicone Implants After Autologous Breast Reconstruction - Is It Safe and Reasonable?

BACKGROUND The use of autologous tissue for breast reconstructive surgery following mastectomy has become routine and allows for excellent symmetry and aesthetic results. However, in some cases, the amount of tissue available from the utilized flaps is not enough to achieve the desired outcome. The use of autologous fat grafting, as well as other techniques, has been described to deal with such problems. However, though well-established, these techniques may also fail to achieve the desired results. The aim of this study was to highlight the opportunity to improve aesthetic results using a secondary prosthesis underneath the previously used free flap and to examine whether this is a safe and reasonable procedure. MATERIAL AND METHODS In our study we included patients with unsatisfied aesthetic results after free flap procedures (DIEP, S-GAP, TMG, and FCI) between 2011 and 2018. In each case described, a secondary prosthesis was placed underneath the original flap in order to improve symmetry, shape and projection. Patient age, indication for surgery, adjuvant therapy, complications and outcomes have been registered. A 12-point scale was established to analyze patient satisfaction and aesthetic outcome. RESULTS Overall "operative success" was achieved in all 13 patients (14 flaps) evaluated. At 12 months after reconstruction, all aesthetic scores collected were between good and excellent. In contrast to other studies, we chose a secondary approach for the flap augmentation and we used the epipectoral pocket for the placement of the implant. In our series, low rates of early and late post-operative complications were observed, with a high overall rate of satisfaction. CONCLUSIONS The demonstrated "Hybrid Breast Reconstruction" approach, using an implant underneath a free flap autologous breast reconstruction, provided a safe and reliable option to optimize breast reconstruction outcomes.

[Importance of ST arthroplasty in the treatment of STT osteoarthritis and concomitant basal thumb osteoarthritis]. / Stellenwert der ST-Arthroplastik in der Therapie der STT-Arthrose bei gleichzeitiger Rhizarthrose.

BACKGROUND: Basal thumb osteoarthritis is one of the most prevalent forms of osteoarthritis worldwide and is frequently associated with osteoarthritis of the STT joint. The surgical gold standard comprises various modifications of arthroplasty resection. A retrospective study compared the postoperative results of Lundborg's resection-suspension-arthroplasty, modified by Wulle, with and without additional ST arthroplasty. PATIENTS AND METHODS: In this study, 50 patients with symptomatic basal thumb osteoarthritis (stages III and IV) were examined. Twenty-one of them were treated with conventional resection-suspension-arthroplasty (RSA) and 29 patients were treated with the same technique and additional ST arthroplasty (RSA-plus). The analysis included an assessment of the Thumb Disability Examination (TDX) score, the Kapandji Thumb Opposition score, the Visual Analogue Scale (VAS) pain score as well as grip force, key pinch force, two-point and three-point pinch force. RESULTS: In both groups, the duration of the operation was comparable. The overall TDX score was 15.9 ±â€…19.5 in the RSA-plus group and 20.8 ±â€…24.3 in the RSA group (p > 0.05). A marginally significant difference was noted for the Kapandji score, which was 9.5 ±â€…1.1 in the RSA-plus group and 8.9 ±â€…1.6 in the RSA group (p = 0.08). There was no significant difference between both groups for grip strength (RSA-plus: 48.3 ±â€…21 kPa, RSA: 55.2 ±â€…24.9 kPa (p > 0.05)), key pinch force (RSA-plus: 32.6 ±â€…15 kPa, RSA: 37.3 ±â€…15.4 kPa (p > 0.05)), two-point pinch force (RSA-plus: 30.6 ±â€…12.9 kPa, RSA: 34.8 ±â€…12.4 kPa (p > 0.05)) and three-point pinch force (RSA-plus: 36.2 ±â€…14.2 kPa, RSA: 42 ±â€…13.6 kPa (p > 0.05)). Both groups demonstrated insignificant differences in pain intensity at rest (RSA-plus: 0.4 ±â€…1.3, RSA: 1 ±â€…2.1 (p > 0.05)), during movement (RSA-plus: 0.7 ±â€…1.8, RSA: 1.6 ±â€…2.7 (p > 0.05)) and under stress (RSA-plus: 1.6 ±â€…2.5, RSA: 2.9 ±â€…3.4 (p > 0.05)). CONCLUSION: The followed-up patient groups demonstrated no significant differences in the examined variables. This leads us to the conclusion that there are no disadvantages associated with performing ST arthroplasty in addition to conventional RSA. In fact, based on the collected data, we suggest that ST arthroplasty should be more widely indicated in the context of RSA.

Size matters--The phototoxicity of TiO2 nanomaterials.

Under solar radiation several titanium dioxide nanoparticles (nano-TiO2) are known to be phototoxic for daphnids. We investigated the influence of primary particle size (10, 25, and 220 nm) and ionic strength (IS) of the test medium on the acute phototoxicity of anatase TiO2 particles to Daphnia magna. The intermediate sized particles (25 nm) showed the highest phototoxicity followed by the 10 nm and 220 nm sized particles (median effective concentrations (EC50): 0.53, 1.28, 3.88 mg/L). Photoactivity was specified by differentiating free OH radicals (therephthalic acid method) and on the other hand surface adsorbed, as well as free OH, electron holes, and O2(-) (electron paramagnetic resonance spectroscopy, EPR). We show that the formation of free OH radicals increased with a decrease in primary particle size (terephthalic acid method), whereas the total measured ROS content was highest at an intermediate particle size of 25 nm, which consequently revealed the highest photoxicity. The photoactivities of the 10 and 220 nm particles as measured by EPR were comparable. We suggest that phototoxicity depends additionally on the particle-daphnia interaction area, which explains the higher photoxicity of the 10 nm particles compared to the 220 nm particles. Thus, phototoxicity is a function of the generation of different ROS and the particle-daphnia interaction area, both depending on particle size. Phototoxicity of the 10 nm and 25 nm sized nanoparticles decreased as IS of the test medium increased (EC50: 2.9 and 1.1 mg/L). In conformity with the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory we suggest that the precipitation of nano-TiO2 was more pronounced in high than in low IS medium, causing a lower phototoxicity. In summary, primary particle size and IS of the medium were identified as factors influencing phototoxicity of anatase nano-TiO2 to D. magna.

Is there a Rationale for Autologous Breast Reconstruction in Older Patients? A Retrospective Single Center Analysis of Quality of life, Complications and Comorbidities after DIEP or ms-TRAM Flap Using the BREAST-Q.

Autologous breast reconstruction with the deep inferior epigastric perforator (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap is a common method in the majority of patients after mastectomy. Because of an increased perioperative risk profile the benefit in older patients is questionable. To assess the postoperative quality of life and peri- and post-operative complications of older compared to younger patients is the aim of this retrospective study. In a retrospective analysis 39 older (i.e. >60 years) and 140 younger patients (i.e. <60 years) with autologous breast reconstruction in the Department of Plastic Surgery at the University Hospital of Erlangen-Nuernberg were surveyed at least 6 month postoperative using the BREAST-Q questionnaire. Correlations were generated between comorbidities and complications. Significant differences were observed regarding hospitalization, pre-existing diseases and the choice of DIEP versus ms-TRAM flaps. Parameters such as major and minor complications, bulging or hernia and risk factors (e.g. smoking or obesity) showed no significant differences. The results of the questionnaire parameters showed no significant difference between both groups, revealing high satisfaction with the aesthetic result and an improvement in quality of life independent of age. Autologous breast reconstruction after mastectomy generates a gain in quality of life and shows a good to excellent overall satisfaction in older as well as younger patients. Despite a longer hospitalization and a different risk profile there were no significant differences regarding minor and major complications in the postoperative course. Hence autologous breast reconstruction for older patients is justified and should be taken into consideration.

Lumpectomy versus mastopexy--a post-surgery patient survey.

BACKGROUND: In oncoplastic surgery, post-surgical subjective outcome evaluation is usually performed for patients with breast-conserving surgery and patients with mastectomy. This study attempts to broaden the spectrum by comparing mastopexy (MP) and lumpectomy (BCS). Evaluating this aspect is important, since performing a mastopexy along with tumor removal offers a chance for simultaneous breast enhancement, thus possibly offering a more beneficial subjective outcome. Both procedures were used to remove single-locus tumors. A total of 143 patients, 71 of which answered a questionnaire regarding post-surgical body image, were evaluated. RESULTS: Post-surgical patient evaluation showed the following results: A "very satisfactory" or "satisfactory" outcome was achieved in 87% of BCS cases and 86% of MP cases. No significant difference was established here (p=0.48). Evaluation of overall cosmetic outcome, scar tissue formation, shape and size of the breast and overall quality of life were answered positively in both groups. Regarding the remaining superficial scar tissue, patients answered as being satisfied with the result in 85% of BCS cases and 79% of MP cases. A significant difference was established between the very satisfied (77% BCS/44% MP) and satisfied (8% BCS/35% MP) group (p=0.013). Post-surgical swelling, nipple sensitivity and overall quality of life did not differ significantly. CONCLUSION: Simple lumpectomy, i.e. classic BCS, leads to less scar tissue and involves a shorter surgical procedure, both of which may be considered as arguments for performing BCS. Scar tissue formation was more positively evaluated in the BCS group, where 77% of patients were "very satisfied" and 8% "satisfied". The other evaluated parameters did not differ significantly. MP may be offered as an option when simultaneous breast enhancement is desired at little cost to post-surgical patient satisfaction.

Comparison between distally based peroneus brevis and sural flaps for reconstruction of foot, ankle and distal lower leg: an analysis of donor-site morbidity and clinical outcome.

BACKGROUND: Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. We aimed to compare functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs). METHODS: Between 2003 and 2006, 52 patients (24 DSFs and 28 PBFs) were included. For increased reliability, all extended sural flaps were delayed for 3-15 days. At the end of the follow-up period (minimum 12 months), patients were asked to fill out a modified foot and ankle score (Foot and Ankle Outcome Score (FAOS)) questionnaire. In addition, a chart review and a physical examination were performed. RESULTS: Total hospital stay and total number of operations were significantly lower in the PBF group. Minor flap necrosis (<10%) was observed in 21% of the DSF and 7% of the PBF group, and partial (>10%) or total flap loss occurred in one and three patients from the DSF group, respectively. Patient satisfaction, FAOS results and range of motion were comparable in both groups. Defect aetiology and patient age did not influence surgical outcome. CONCLUSION: Donor-site morbidity and functional outcome after DSF and PBF are comparable. A higher rate of complications was observed in the DSF group. Based on our findings, the PBF is recommended as first-line procedure for reconstruction of small- to medium-sized defects at the distal tibia, fibula, ankle and heel. The sural flap might be chosen for extended skin defects especially when a larger arc of rotation is required.

Double pedicled perforator flap to close flank defects: an alternative for closure of a large lumbar defect after basalioma excision--a case report and review of the literature.

Large defects following resection of skin cancers are sometimes a challenge for the reconstructive surgeon. Although skin grafts are considered as the first choice for reconstruction of large skin defects at the trunk region, pedicled or free flaps provide sometimes a superior functional and aesthetic outcome. Perforator flaps represent a valuable option for these patients. The progress in understanding the perforator vessel system of the body facilitated the development of a plethora of novel pedicled flaps which could be transferred over long distances with minimal donor site morbidity. We present a patient suffering from a large exulcerated basalioma at the lumbar region. The skin defect after excision was reconstructed using a novel concept based on 2 independent pedicled perforator flaps, a lumbar artery perforator, and a lateral intercostal artery perforator.

Aesthetic correction of tuberous breast deformity: lessons learned with a single-stage procedure.

Tuberous breast deformity is a pathologic condition of the breast affecting teenage women. The aberration of breast shape in tuberous breast deformity consisting of a constricting ring at the breast base, breast tissue deficiency, and herniation of breast tissue into the nipple-areola-complex with areola enlargement and additional asymmetry makes the surgical correction challenging. In the present study, 15 patients were operated using a surgical procedure, which addresses all aspects of the deformity at a one-stage operation. The described technique results in a periareolar scar only, and the use of tissue expanders or skin flaps is unnecessary. Minor periareolar scar revision surgery was necessary in eight of 15 patients (53%) because of hypertrophic or expanded scarring. In two patients, implant dislocation occurred and therefore surgical revision was necessary. In all cases, an excellent final aesthetic result with a high patient satisfaction was achieved.

Intrapulmonary and cutaneous siliconomas after silent silicone breast implant failure.

Since the implementation and use of silicone implants in breast surgery the risks are published and discussed. Especially, the incidence of late silicone implant rupture and its potential risk to induce local siliconomas are still under discussion and not sufficiently evaluated. So far literature data offer no information of intrapulmonal or peripheral located cutaneous siliconomas because of systemic migration of silicone after breast augmentation. In light of silicones checkered history, and given the large and growing number of women who choose to undergo breast augmentation surgery each year, the presented clinical findings in our study are likely to be of interest to medical professionals, producers, and consumers alike. We present six female patients with an average age of 55 (+/-5) years with bilateral rupture of silicone implants after breast augmentation for aesthetic reasons. The average time after operation was 18 (+/-6) years. In five patients, we identified peripheral located cutaneous siliconomas and one patient suffered from an intrapulmonal siliconoma. The diagnosis of bilateral rupture of the silicone implants was performed preoperatively by MRI-scans. All five peripheral cutaneous siliconomas and the intrapulmonal siliconoma were validated by histopathologic analysis. Six female patients suffered from bilateral rupture of silicone implants after breast augmentation. In five patients, we identified peripheral located cutaneous siliconomas which were surgically excised. One patient suffered from an intrapulmonal siliconoma. In this unique case a lobectomy with resection of the pulmonal segment 10 had to be performed. Clinical findings of peripheral cutaneous and even intrapulmonary siliconomas after bilateral rupture of silicone breast implants indicate a systemic hematogen or lymphatic pathway of silicone. These findings suggest that it is mandatory to inform the patient about the potential risk of local siliconomas, but also about the potential risk of peripheral cutaneous or even intrapulmonary siliconomas caused by systemic hematogen or lymphatic pathways of silicone after silent implant failure.

Aesthetic and functional correction of female, asymmetric funnel chest - a combined approach.

There is still sparse information published about the surgical correction of female funnel chest deformity. Women with severe asymmetric funnel chest deformity often present with asymmetric, hypoplastic breasts. These patients frequently complain of physiological limitations in connection with gross aesthetic impairment. To correct these two features a combined approach is presented in this study. 10 women were operated with correction of the thoracic wall deformity by open retrosternal mobilisation and metal plate fixation. Either during the same procedure or in a secondary operation, submuscular breast augmentation was performed to correct breast hypoplasia and asymmetry. All patients tolerated the operation very well without any complications. Aesthetic outcome was rated good to excellent in secondary breast augmentation, whereas simultaneous implant positioning was prone to cause symmastia. In conclusion we recommend correction of female asymmetric funnel chest by primary sternal reduction with secondary breast augmentation during metal plate removal 1 year after.

Acute and diffuse postoperative bleeding after free latissimus dorsi flap--Factor XIII deficiency: a case report and review of the literature.

BACKGROUND: Factor XIII deficiency is a rare inherited bleeding disorder that is often difficult to diagnose. As there are no standard screening tests established patients with Factor XIII deficiency are not correctly identified. Especially postoperative bleeding and haemorrhage after difficult plastic reconstructive operations such as free flap transfer may lead the plastic surgeon to the wrong diagnosis. This again leads to the wrong indication such as revision with the aim to find a surgical origin of bleeding. Instead a haematological deficiency such as Factor XIII is the reason for acute postoperative bleeding and haemorrhage. CASE REPORT: We report the case of a 69-year old Caucasian male who received a free latissimus dorsi flap to the right knee after osteomyelitis and infection of a knee total endoprothesis. The patient had severe postoperative bleeding and haemorrhage from all 8 drains including the donor side of the split thickness skin graft area. Shortly before the indication of performing a revision and trying to find the surgical origin of bleeding a factor XIII test was performed. The results showed a high deficiency of factor XIII which was immediately replaced by 2500 Units (i.E.) Fibrogammin. Within 12 hours the bleeding rapidly reduced and no revision was necessary. CONCLUSIONS: Postoperative acute but diffuse bleeding after free flap operations in plastic surgery may not be all due to insufficient operative techniques.

Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations.

INTRODUCTION: Dynamic external fixation systems are considered as optimal devices for treatment of fracture dislocations of the proximal interphalangeal joint (PiP). The pins and rubbers traction system (PRTS) is cheap, easy to assemble and comfortable and allows early mobilization of the affected digit. We investigated the influence of different wire positions and rubber strength and provided a follow-up of five consecutively treated patients. METHODS: Sixteen cadaver fingers (dig 2-5) were included into the biomechanical study. Forces for flexion of the PiP joint (30 degrees, 60 degrees, and 90 degrees) were measured by pulling the flexor digitorum profundus tendon; width of the PiP joint was assessed radiologically. Measurements were obtained prior and after assembly of PRTS and were repeated with three different types of rubbers and two different positions of the retention wire (distal and proximal). The clinical part of the study included five patients (21-72 years) who were treated using the PRTS. Mean follow-up was 272 days. RESULTS: The PRTS increased flexion force of the PiP joint. Proximal position of the retention wire increased forces for 30 degrees flexion. Different rubber strengths did neither increase PiP width nor influence flexion forces. In the clinical part of the study total range of motion was 74 degrees and DASH score was 10.1. Pinch grip of the affected digit was 72% of the unaffected side. DISCUSSION: The PRTS allows for efficient treatment of intraarticular fractures with PiP involvement. Although standardized positioning of the wires is important, proximal position of the retraction only increased forces for 30 degrees flexion.

Foreign body reaction after usage of tissue adhesives for skin closure: a case report and review of the literature.

INTRODUCTION: The usage of tissue adhesives such as 2-octyl cyanoacrylate is a standard tool for closure of superficial wounds of the body. The benefits using 2-octyl cyanoacrylate are well known and appreciated by surgeons world wide. Especially in superficial or small wounds in children where no surgical procedure is wanted this technique is commonly used. However, so far the risks and possible complications after using 2-octyl cyanoacrylate are not sufficiently published and discussed. CASE REPORT: We report a case of foreign body reaction after 3 weeks in a 39-year-old female patient after usage of 2-octyl cyanoacrylate treating a superficial wound of the right wrist. CONCLUSION: The use of 2-octyl cyanoacrylate for the closure of superficial and small wounds or lacerations is a simple, quick and comfortable method. However, there is clinical evidence that in some cases the use of this type of tissue adhesive may lead to foreign body reaction. We suggest that each patient who is treated by this type of wound closure technique should be mandatory informed on the potential risk of a foreign body reaction.

Pseudotumors after primary abdominal lipectomy as a new sequela in patients with abdominal apron.

BACKGROUND: Malnutrition and overweight is a common problem in modern societies. Primary abdominal lipectomy is a standard surgical tool in patients with these problems. However, unknown secondary problems result from recent advances in obesity surgery. Plication of the anterior musculoaponeurotic wall is a widely and commonly used operative technique during abdominoplasty. Many different plication techniques have been published. So far no common standard and long-term effectiveness is proven. In addition, there is no sufficient literature dealing with the postoperative risks of plication of the musculoaponeurotic wall. METHODS: Four patients with development of pseudotumors were reviewed. All four patients received 12 months in advance a primary abdominal lipectomy including a vertical plication of the musculoaponeurotic wall. RESULTS: All four patients were females with mean age of 61 years and mean body mass index (BMI) of 37 kg/m(2). All four patients had developed a pseudotumor of the abdomen as a long-term complication more than 12 months after primary abdominal lipectomy including a vertical plication of the anterior rectus sheath. CONCLUSION: One should be aware of the potential long-term risk of secondary postoperative hematoma formation, with or without partial necrosis of the anterior rectus sheath after vertical plication of the anterior musculoaponeurotic wall. Viewed clinically and radiologically, such sequelas may appear as pseudotumor like masses and require immediate revision.