Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life

Aliotta, Rachel E.; Gatherwright, James; Krpata, David M.; Rosenblatt, Steven; Rosen, Michael J.; Gürünlüoğlu, Raffi

doi:10.1007/s10029-019-01916-w

Cited by 21 publications

(23 citation statements)

References 28 publications

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“…[12][13][14] Four were case series that applied multidisciplinary care. Two articles 15,16 included limited prospective analyses with patient outcomes reported up to 50 months, while the remaining articles 17,18 included retrospective analyses with up to 67.8 months' follow up.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies address objective risk stratification prior to CAWH repair. [12][13][14][15][16][17] Specific tools include the Ventral Hernia Working Group (VHWG) 12,13,15 and Carolinas Equation for Determining Associated Risk (CeDAR) 12,13 algorithms. Two articles 12,13 supported the use of such algorithms to promote lifestyle modifications (e.g.…”

Section: Preoperative Risk Stratificationmentioning

confidence: 99%

“…Three studies include a dedicated team approach to optimize patient safety and outcomes, with at least one senior general or plastic reconstructive surgeon present. 12,15,18 The majority of procedures in Muirhead et al's cohort 12 were performed by a general surgeon or as joint case between general and plastic surgeons. The exact surgical approach was not specified in each case.…”

Section: Operative Technique and Dedicated Surgical Teammentioning

confidence: 99%

“…The exact surgical approach was not specified in each case. In Aliotta et al's study, 15 all patients required free flap and/or tissue transfer to rectify major abdominal wall defects, with general and plastic surgeons performing the repairs in single-stage, multi-team procedures. Twelve patients in Hultmann et al's study 18 with large abdominal wall defects required both general surgical/trauma and plastic surgical input to achieve definitive repair.…”

Section: Operative Technique and Dedicated Surgical Teammentioning

confidence: 99%

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Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Kollias

Reid

Udayasiri

et al. 2022

ANZ Journal of Surgery

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Introduction The burden of complex abdominal wall hernia (CAWH) is increasing, with associated high morbidity and healthcare costs. This study evaluates current evidenoptce regarding multidisciplinary care for CAWH patients to improve patient outcomes. Methods A systematic review of Scopus, MEDLINE, Embase, PubMed, Web of Knowledge and Cochrane Library was conducted to identify proposed or established multidisciplinary team (MDT) pathways, necessary MDT constituents, and to evaluate patient outcomes. The pre‐optimization pathways were then compared with a recent Delphi consensus statement. Results Seven articles matched the relevant search criteria. Three were concept articles, without prospective data analysis. Four were case series that applied multidisciplinary care and included limited data analyses with outcomes reported up to 50 months. The consensus was that CAWH MDT requires multiple clinical specialties, including hernia, upper gastrointestinal, colorectal and/or plastic and reconstructive surgeons, along with allied health specialists, radiologists, anaesthetists/pain specialists and infectious diseases consultants. A successful MDT should aim to achieve pre‐optimization and plan the definitive repair. These pre‐optimization pathways were similar to the recent Delphi consensus by international hernia experts. Using these data, we propose a CAWH multidisciplinary pathway model in an Australian tertiary hospital involving a stepwise approach with well‐defined referral criteria, perioperative high‐risk management with pre‐optimization, surgical planning, postoperative care and follow‐up protocols. This pathway incorporates prospective data collection in a Clinical Quality Registry (CQR) to validate its appropriateness. Conclusions CAWH MDT can provide comprehensive, patient‐centred care with improved postoperative outcomes. CQR are important to better evaluate long‐term outcomes and ensure rigorous quality control.

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Section: Resultsmentioning

confidence: 99%

Section: Preoperative Risk Stratificationmentioning

confidence: 99%

Section: Operative Technique and Dedicated Surgical Teammentioning

confidence: 99%

Section: Operative Technique and Dedicated Surgical Teammentioning

confidence: 99%

See 2 more Smart Citations

Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Kollias

Reid

Udayasiri

et al. 2022

ANZ Journal of Surgery

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“…In both techniques, a mesh is added to reinforce abdominal wall closure and to promote long-term stability [3][4][5], and both ACS and PCS techniques have proven to be effective [5][6][7]. Furthermore, in some cases they represent the last chance to achieve a good quality of life for patients who have to modify their lifestyle due to a hernia [8,9]. However, most of the evidence regarding the use of both CSTs is derived from single experiences or high-volume hospitals [6,10].…”

Section: Introductionmentioning

confidence: 99%

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Rodríguez

Bravo-Salvá

Montcusí-Ventura

et al. 2021

Hernia

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Aim To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients. Methods All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed. Results During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004). Conclusion CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

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Abdominal wall reconstruction with the free functional L‐shaped latissimus dorsi flap: A case report

et al. 2023

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Extensive tridimensional defects of the abdominal wall are usually addressed with soft tissue flaps combined with meshes. In this scenario, the additional value of dynamic abdominal wall reconstruction with functional flaps has yet to be demonstrated. In this paper the authors describe for the first time a unique case of total abdominal wall reconstruction with the free functional L‐shaped latissimus dorsi (LD) flap, designed to increase the surface area of skin flap coverage while minimizing donor site morbidity, highlighting technical tips and long‐term outcomes. A 65‐year‐old patient underwent abdominal wall resection for a dermatofibrosarcoma protuberans, leaving her with a 23 × 15 cm full‐thickness defect. After placing a mesh, a myo‐cutaneous free LD Flap with an L‐shaped configuration was planned. The flap was composed of Paddle A, designed vertically along the anterior margin of the muscle and Paddle B, designed over the inferior aspect of the LD muscle, extending obliquely from the midline and intersecting Paddle A laterally with a 60° angle. End‐to‐end anastomoses to the deep inferior epigastric artery and vein and thoracodorsal nerve coaptation to a sizeable intercostal nerve were performed. The LD muscle was sutured according to its native tension while the two skin islands allowed an almost complete resurfacing of the abdominal wall defect. Donor site was closed primarily. Post‐operative course was uneventful. One year postoperatively, good abdominal contour was observed, with adequate abdominal tone at rest in laying and standing position. Muscle neurotization was confirmed with clinical examination showing voluntary contraction of the transplanted muscle and the patient reported very high functional outcomes at the hernia‐related quality‐of‐life (HerQles) questionnaire. The free L‐shaped LD flap represents an innovative solution to reconstruct extensive full‐thickness defects of the abdominal wall while reducing donor site morbidity. Flap neurotization should be attempted whenever possible to improve functional outcomes of the procedure.

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Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life

Cited by 21 publications

References 28 publications

Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Abdominal wall reconstruction with the free functional L‐shaped latissimus dorsi flap: A case report

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