Caesarean section is a common operation and the best postoperative outcomes are desired. Surgical techniques have been devised or modified to reduce operative and post operative discomfort. Many studies have evaluated or compared the Joel-Cohen abdominal incision with Pfannenstiel incision and found the former to be superior for various reasons such as less postoperative febrile morbidity, less analgesia requirements, shorter operating time, less intra operative blood loss and adhesion formation, reduction in hospital stay and wound infection in the group undergoing Caesarean section by this technique. This study is to find whether better postoperative outcomes of the Joel-Cohen incision group can be justified by the explanations of fundamentals of the basic sciences. Literature was reviewed for randomized clinical trials and review articles comparing the different kinds of abdominal incisions for Caesarean section. The study revealed that the Joel-Cohen method was beneficial. The fundamentals of basic sciences were studied to try to find an explanation to the enumerated advantages of the Joel-Cohen procedure; attributing to the differences in the techniques used.
The aim of this study was to engineer skeletal muscle tissue for repair abdominal wall defects. Myoblast were seeded onto the scaffolds and cultivated in vitro for 5 days. Full thickness abdominal wall defects (3 x 4 cm) were created in 18 male New Zealand white rabbits and randomly divided into two equal groups. The defects of the first group were repaired with myoblast-seeded-bovine tunica vaginalis whereas the second group repaired with non-seeded-bovine tunica vaginalis and function as a control. Three animals were sacrificed at 7th, 14th, and 30th days of post-implantation from each group and the explanted specimens were subjected to macroscopic and microscopic analysis. In every case, seeded scaffolds have better deposition of newly formed collagen with neo-vascularisation than control group. Interestingly, multinucleated myotubes and myofibers were only detected in cell-seeded group. This study demonstrated that myoblast-seeded-bovine tunica vaginalis can be used as an effective scaffold to repair severe and large abdominal wall defects with regeneration of skeletal muscle tissue.
This study was conducted to determine a safe vertical musculo-fascial plication distance in abdominoplasty operation in order to avoid the risk of developing respiratory distress during the post operative period. Abdominoplasty is a surgical procedure that removes excess abdominal skin and fat (panneculectomy), and tightens lax anterior abdominal wall muscle; in which musculo-fascial plication is a major component of abdominoplasty in patient with significant divaricating of the recti muscles. Respiratory decompensation may occur as a result of undue plication which reduces the intra abdominal volume with diaphragmatic excursion leading to abdominal compartmental syndrome. Fifty six patients for abdominoplasty were selected prospectively, during the period from June 1998 to February 2004, male to female ratio 1:13, mean age 39.5, mean weight 95.2 kilogram. To determine a safe plication distance (PD). The difference between two pre-operative measurements of the abdominal circumference was measured, before (BB) and after (AB) application of abdominal binder. The safe plication distance (PD) in centimeters = (BB) - (AB). The mean plication distance is 13.5cm. The changes in the pulmonary functions test before and after surgery were clinically insignificant. Pre-operative determination of safe plication distance is simple and convenient method which reduces the risk of developing respiratory distress in patients undergoing abdominoplasty in the post-operative period.
The aim of this study was to evaluate bovine pericardium surgical patch in rat model. Bovine pericardial sacs collected from local abattoir were cleaned, disinfected and cut into pieces of 3 by 2.5cm and preserved in 99.5% glycerol. Full thickness abdominal wall defects of 3 by 2.5 cm were created in 30 adult male Sprague Dawley rats and repaired with glycerol preserved pieces. The rats were serially sacrificed in a group of six rats at 1,3,6,9 and 18 weeks post-surgical intervals for morphological and tensometeric study. Macroscopically, no mortality or postoperative surgical complications was encountered except slight adhesions between implanted grafts and some visceral organs in 10% of the rats. Microscopically no calcification or foreign body giant cell formation was found in the explanted grafts. The implanted grafts were replaced gradually with recipient tissue, which made mainly of dense collagenous bundles. The healing strength between the implanted grafts and the recipient abdominal wall was gradually increased with time. The results of this study showed that glycerol preserved bovine pericardium act as scaffold for transformation into living tissue without clinical complications such as that associated with prostheses.
Extensive full thickness anterior abdominal wall defects pose a difficult challenge to the reconstructive surgeon. The objectives of reconstruction are the support of the intra-abdominal structures in order to preserve the functional integrity and achieve an aesthetically-acceptable appearance. Autologous tissues are versatile and provide the best reconstructive option in this type of defects. The tensor fascia latae myocutaneous flap provides identical abdominal wall musculofascial cover for full thickness defects. In extensive defects, the extended tensor fascia latae flap is a versatile option with a second microvascular anastomosis at the distal end of the flap. A total anterior abdominal wall soft tissue tumour resection defect was reconstructed with the use of the double pedicle extended free tensor fascia latae myocutaneous flap in a 60-year-old man. The patient however succumbed to the disease process six months post-reconstruction. During the follow-up period, there was no evidence of hernia at the anterior abdominal wall.
We report an unusual case of abscess of the abdominal wall as the initial symptom of a perforated right-sided colon cancer in a 62-year old man. Clinical examination revealed a non-fluctuating, tender, firm mass approximately 7 x 5 cm in diameter with overlying cellulitis in the right loin. Abdominal examination showed a fixed mass on the right side of the abdomen. Computed tomography (CT scan) confirmed the presence of a mass arising from the right colon with infiltration of the subcutaneous tissue by this intra-abdominal mass. Right hemicolectomy with lymph node dissection and en-bloc partial resection of the adherent parietal wall was performed and the final pathology showed a moderately differentiated mucinous adenocarcinoma. We report a case of ascending colon cancer presenting by an abscess of the abdominal wall.
This study investigates the effect of preservation methods on the performance of bovine parietal pericardium grafts in a rat model. Mid-ventral full thickness abdominal wall defects of 3 x 2.5 cm in size were created in 90 male Sprague-Dawley rats (300-400 g), which were divided into three groups of 30 rats each. The abdominal defects of group one and two were repaired with lyophilized and glycerolized bovine pericardium grafts, while the defects of group three were repaired with expanded polytetrafluoroethylene (ePTFE) Mycro Mesh as a positive control. Another group of 30 rats underwent sham operation and was used for comparison as negative control. Each group of rats (n = 30) was divided into five subgroups (n = 6) and killed at 1, 3, 6, 9 and 18 weeks post-surgery for gross and morphological evaluations. The rats tolerated the surgical procedure well with a total mortality of 0.05%. No serious post-operative clinical complications or signs of rejection were encountered. Adhesions between the grafts and the underlying visceral organs observed in the study were mostly results of post-surgical complications. Glycerol preservation delayed degradation and replacement of the grafts, whereas lyophilization caused early resorption and replacement of the grafts. The glycerolized grafts were replaced with thick dense fibrous tissue, and the lyophilized grafts were replaced with thin loose fibrous tissue. The healing characteristic of the bovine pericardium grafts was similar to those of the sham-operated group, and quite different from those of the ePTFE Mycro Mesh. The outcome of the present study confirmed the superiority of glycerolized bovine pericardium grafts over its lyophilized counter part.
Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.