• Archives of Plastic Surgery
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• v.43 no.3
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• pp.258-264
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• 2016

Background The survival rate of newborns with severe congenital abdominal wall defects has increased. After successfully addressing life-threatening complications, it is necessary to focus on the cosmetic and functional outcomes of the abdominal wall. Methods We performed a chart review of five cases treated in our institution. Results Five patients, ranging from seven to 18 years of age, underwent the following surgical approaches: simple approximation of the rectus abdominis fascia, the rectus abdominis sheath turnover flap, the placement of submuscular tissue expanders, mesh repair, or a combination of these techniques depending on the characteristics of each individual case. Conclusions Patients with severe congenital abdominal wall defects require individualized surgical treatment to address both the aesthetic and functional issues related to the sequelae of their defects.

• Journal of Veterinary Clinics
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• v.26 no.5
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• pp.467-471
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• 2009

This report describes Neural Tube Defects (NTDs) with Abdominal Wall Defects (AWDs) on the sibling of Yorkshire terriers. The NTDs and AWDs are rare serious congenital defects. The NTDs are neurulation abnormality that results from to failed transformation of the neurual tube by the incomplete closure of the embryonic neural plate. These dysraphic states range form mild to severe according to developmental malformation that include fusion defects of skull (crania bifida; CB) and fusion defects of vertebrae (spina bifida; SB). The AWDs are genetic defects that results from to failed formation of abdominal wall and cavity. These dysraphic states are omphalocele and gastroschisis. The 12-month dam was delivered by caesarian section and 4 littermate had obvious malformations. One male dead stillbirth fetus (L1) was revealed the extruded abdominal viscera, omphalocele. One female fetus (L2) was died within 1 hour after birth with defects of abdominal muscle upper umbilicus, gastroschisis. 3rd fetus (L3) was died within 36 hours after parturition and revealed a copious dermal and vertebral defects on the midline thorax, upper SB asperta. 4th fetus (L4) is still growing well now at 6 months but at the 2 week age, appears hairy nevus on the frontal cranium and dorsal thoracic portion. The radiograph of L1 and L2 are shown decrease bony density of calvarium and L3 was shown defect of spinose processes of the T9-T13. On our knowledge, this is first report of the SB and CB in Yorkshire terrier. And also sibling of NTDs with AWDs that has not previously been reported in the dog.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.163-168
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• 2001

The defects of the abdominal wall could be brought about either congenitally, for instances in such cases as omphalocele or gastroschisis, or by various acquired causes-trauma, excision of tumors, excision of burn scar, tissue necrosis caused by infection, hematoma after abdominal surgery, tissue necrosis after radiation therapy and so on. As for the techniques of the reconstruction of the abdominal wall defects, many authors have developed and reported diverse methods. To summarize, primary closure, skin graft, local skin flaps, various myocutaneous flaps, free flap, fascia graft, artificial mesh, tissue expansion, etc could be used in the reconstruction of the abdominal wall defects. The periumbilical perforator-based island skin flap has a many advantages such as no significant sacrifice of the rectus abdominis muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for flap, and for middle-aged, obese patients, the donor site may be the best from the cosmetic point of view. We used perforator-based island skin flap in 5 cases with reasonable result from March 1999 to May 2001. There were no significant complications and donor sites could be repaired primarily.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.91-95
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• 2018

Managing large infected midline abdominal defects are clinically challenging and technically demanding. The alloplastic materials, regional flaps, and component separation are usually infeasible because of the size, location, depth, and state of the defects. In these cases, the free flap is the only option with a large well-vascularized tissue that is free to inset regardless of the location. Herein, we report a case of 44-year-old man with a large infected midline abdominal wall defect who was completely treated with a latissimus dorsi myocutaeous free flap followed by negative pressure wound therapy.

• Carbon letters
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• v.6 no.1
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• pp.15-24
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• 2005

Sixteen clinically healthy New Zealand white rabbits of either sex were divided into two equal groups I and II of 8 animals each. Under thiopental sodium (2.5%) anaesthesia a linear full thickness abdominal wall defect of 3 cm in length was created and repaired with continuous suture pattern using 3000 filaments of carbon fibres and 1~0 black braided nylon suture, ingroup I and II respectively. Increased vascularity was observed in carbon fibres (group I) and on day 30 the carbon fibres were covered by white fibrous tissue. Significantly higher (P < 0.05) values of glucose was seen on day 14 in group I, whereas, decrease in glucose value was observed in group II. Histopathologically, the carbon fiber implant induced extensive fibrous tissue (collagen fiber) reaction. Negligible inflammatory cells in the stroma indicate the host tissue tolerance to carbon fibers. Histochemically, gradually increased alkaline phosphatase activity up to day 14 in group I, suggested the proliferation of fibroblasts in early stages.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.114-121
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• 1998

The purpose of this study is to investigate the appropriate management of severe radionecrotic wounds of the anterior chest wall associated with infection of the soft tissues and ribs and exposure of vital structures(heart and lung), and present our strategies for reconstruction of these complicated patients. 9 patients have undergone radical debridement and immediate microsurgical reconstruction for severe radionecrotic wounds of the anterior chest wall over last 7 years. All patients had extensive osteomyelitis of the ribs or sternum, and chronic infection or cutaneous fistulae. 2 patients had pericardial effusions due to longstanding inflammation, and 6 patients had pleural effusions. 2 patients had ipsilateral lung collapse. 10 free flaps were performed for coverage of the huge defects. One patient required 2 free flaps to control the inflammation. 8 free TRAM flaps were used for coverage of the defects and in addition, the rectus abdominis muscle was packed into any deep cavity. 1 patients underwent latissimus dorsi muscle free flap because of previous abdominal surgery. After extensive debridement of the infected, radionecrotic wounds, all 10 free flaps were successful. All the extensive radionecrotic defects of the anterior chest wall were completely healed. Free flaps successfully covered the exposed vital structures of the heart and lungs. Patients with severe radionecrotic defects of the anterior chest wall after ablative breast cancer surgery and radiotherapy were successfully treated by radical debridement and immediate free flap surgery. The TRAM flap together with the rectus muscle is the treatment of choice for these huge defects. The latissimus dorsi muscle flap was the second choice in patients with previous abdominal surgery. The recipient vessel should be carefully selected because of possible radiation damage and inflammation.

• Carbon letters
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• v.8 no.4
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• pp.269-273
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• 2007

During a 4-year period (2001-2005) 09 animals were surgically treated because of abdominal wall defects (hernia). Out of 9 animals 8 were bovines and one caprine. In each case the defect was repaired with carbon fibre mesh. All the cases were successfully treated and no complication was observed up to six months postoperatively.

• Archives of Plastic Surgery
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• v.37 no.6
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• pp.736-741
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• 2010

Purpose: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. Methods: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. Results: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between $15{\times}15$ and $25{\times}25\;cm$. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. Conclusion: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.135-142
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• 2011

Purpose: Deficiencies of the abdominal wall can be the a result of infection, surgery, trauma, or primary herniation. For abdominal wall reconstruction, synthetic materials have been shown to provide a better long-term success rate than primary fascial repair. But, synthetic materials cannot elicit angiogenesis or produce growth factor and are therefore plagued by an inability to clear infection. As a result of the inherent drawbacks of synthetic, significant effort has been spent on the identification of new bioprosthetic materials. The aim of our study is to evaluate the effectiveness of a synthetic material (PROCEED$^{(R)}$) and an ADM ($SureDerm^{TM}$) to repair abdominal wall defects in a rabbit models. Methods: We measured the tensile strength of the $SureDerm^{TM}$ and PROCEED$^{(R)}$ by a Tension meter (Instron 4482). 16 Rabbit models were assigned to this study for abdominal wall reconstruction. Abdominal defect of 8 rabbits were reconstructed by PROCEED$^{(R)}$ and the rest were reconstructed by $SureDerm^{TM}$. We assessed gross and histologic examinations for the reconstructed abdominal wall. Results: The tensile strength of $SureDerm^{TM}$ and Gore Tex$^{(R)}$ is $14.64{\pm}0.51Mpa$, $8.54{\pm}0.45Mpa$. PROCEED$^{(R)}$ was estimated above the limits of measurement. Inflammatory reaction of PROCEED$^{(R)}$ persisted for 32weeks, but $SureDerm^{TM}$ decreased after 16weeks. Vascular ingrowth into the $SureDerm^{TM}$ was seen after 32 weeks. The basement membrane of $SureDerm^{TM}$ changed into a form of pseudoperitoneum. In PROCEED$^{(R)}$, it seemed like pseudoepithelial lining was made from the fibrosis around the mesh. Conclusion: In our study, the $SureDerm^{TM}$ not only have less inflammatory reaction and presented more angiogenesis than the PROCEED$^{(R)}$, but also have pseudoperitoneum formation. It is expected that $SureDerm^{TM}$ is useful for abdominal wall reconstruction. However, a long-term study of its usage consequences are thought to be needed.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.655-662
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• 2011

Purpose: The anterolateral thigh flap is versatile flap for soft-tissue reconstruction for defects located at various sites of the body. This useful flap offers a thick and vascular fascia lata component with large amounts that can be soft tissue coverage for different reconstructive purposes. We present our clinical experience with the use of vascular fascia lata, combined with anterolateral thigh flap for various reconstructive goals. Methods: From April 2008 to February 2011, we transferred anterolateral thigh flaps with fascia lata component to reconstruct soft-tissue defects for different purposes in 11 patients. The fascia lata component of the flap was used for tendon gliding surface in hand/forearm reconstruction in 4 patients, for reconstruction medial and lateral patellar synovial membrane and retinaculum in 2 patients, for reconstruction of plantar aponeurosis in the foot in 2 patients, for reconstruction of fascial and peritoneal defect in the abdominal wall in 2 patient, and for dural defect reconstruction in the scalp in the remaining one. Results: Complete loss of the flap was not seen in all cases. Partial flap necrosis occurred in 2 patients. These complications were treated successfully with minimal surgical debridement and dressing. Infection occurred in 1 patient. In this case, intravenous antibiotics treatment was effective. Conclusion: Anterolateral thigh flap has thick vascular fascia with large amounts. This fascial component of the flap is useful for different reconstructive aims, such as for tendon, ligament, aponeurosis defects, abdominal wall or dura reconstruction. It should be considerated as an important advantage of the flap, together with other well-known advantages.