Learning Curves in Abdominal Wall Reconstruction With Components Separation

Hultman, C. Scott; Clayton, John L.; Kittinger, Benjamin J.; Tong, Weiwei

doi:10.1097/sap.0000000000000093

Cited by 10 publications

(2 citation statements)

References 21 publications

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“…Many recent studies have shown a significantly higher complication rate among patients with higher BMI. [8, 9, 18–24] However, these studies were limited by small patient study populations, [19, 20] short postoperative follow-up, [19] or data obtained from the National Surgical Quality Improvement Program register, which only includes follow-up data occurring within 30 days of surgery. [8, 20–24] Our obesity class III (BMI ≥40 kg/m 2 ) population was limited (n=46 patients) and did not allow us to corroborate a previous study showing that complications are most likely to occur in patients with BMI over 40 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Giordano

Garvey

Baumann

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background Obesity and higher body mass index (BMI) may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction (AWR). We hypothesized that higher BMI’s result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in AWR patients. Methods We included 511 consecutive patients who underwent AWR with underlay mesh. Patients were divided into three groups on the basis of preoperative BMI: <30 kg/m2 (non-obese), 30–34.9 kg/m2 (class I obesity) and ≥35 kg/m2 (class II/III obesity). We compared postoperative outcomes among these three groups. Results Class I and class II/III obesity patients had higher surgical site occurrence rates than non-obese patients (26.4% vs. 14.9%; p=0.006 and 36.8% vs. 14.9%; p<0.001, respectively) and higher overall complication rates (37.9% vs. 24.7%; p=0.007 and 43.4% vs. 24.7%; p<0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3% vs 7.2%; p<0.001 and 26.5% vs 7.2%; p<0.001, respectively) and fat necrosis rates (10.0% vs 2.1%; p=0.001 and 11.8% vs 2.1%; p<0.001, respectively) than non-obese patients. Obesity class II/III patients had higher infection and seroma rates than non-obese patients (9.6% vs 4.3%; p=0.041 and 8.1% vs 2.1%; p=0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4% vs. 7.7%; p=0.204 and 10.3% vs. 7.7%; p=0.381, respectively) and freedom from hernia recurrence (overall log-rank p=0.41) similar to non-obese patients. Conclusions Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in AWR.

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Section: Discussionmentioning

confidence: 99%

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Giordano

Garvey

Baumann

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…[27–30] To large defect of abdominal wall resulting from electrical injury, the former should be used with caution owing to the poor wound condition and high risk of infection. [29–33] The selection of flap is influenced by the size and location of the defect and the vascular pedicle length of the flap, the 5 cases presented above with extensive defects on the various site of abdominal wall, and island retrograde LD musculocutaneous flap, free and island composite ALT musculocutaneous flap were used respectively. By means of our clinical practice, retrograde LD musculocutaneous flap can successfully repair unilateral defects of abdomen and lumber region that reach the vicinity of the middle line, and island composite ALT musculocutaneous flap can be used to cover defects of the middle and lower abdomen that are extended 6 to 8 cm above the umbilicus.…”

Section: Discussionmentioning

confidence: 99%

Early laparotomy and timely reconstruction for patients with abdominal electrical injury

Zhang

Liu²,

Ren³

et al. 2017

Medicine

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Introduction:High-tension electricity can cause devastating injuries that may result in abdominal wall loss, visceral damage, and sometimes major threat to life. The visceral organ may be exposed after debridement and require flap cover, but the tensile strength of abdominal wall may be lack even if flap transplanted.Methods:From April 2007 through May 2015, 5 patients with severe abdominal electrical injury were treated at our hospital. Exploratory laparotomy was performed based on their clinical manifestations and debridement findings of abdominal wall at early stage, and decision regarding technique for reconstruction of abdominal wall was based on an assessment of the location and extent of the defect. Medical records were reviewed for these data.Results:Clinical evaluation and debridement findings of the abdomen revealed 4 patients with suspicious visceral damage. Laparotomy was performed in 4 cases, and revealed obvious lesion in 3 cases, including segmental necrosis of small intestine, partial necrosis of diaphragm, left liver and gastric wall, and greater omentum. Five patients underwent abdominal wall reconstruction using island retrograde latissimus dorsi myocutaneous flap or free/island composite anterolateral thigh myocutaneous flap. All flaps survived, abdominal bulging occurred in 3 cases after follow-up of 12 to 36 months.Conclusions:The clinical manifestations and wound features of abdomen collectively suggest a possible requirement of laparotomy for severe abdominal electrical burns. Retrograde latissimus dorsi myocutaneous flap or composite anterolateral thigh myocutaneous flap is an effective option for reconstruction of abdominal wall loss, the long-term complication of abdominal bulging, however, remains a significant clinical challenge.

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Component separation and large incisional hernia: predictive factors of recurrence

Bueno-Lledó

Bonafé-Diana

Carbonell-Tatay

et al. 2021

Hernia

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Learning Curves in Abdominal Wall Reconstruction With Components Separation

Cited by 10 publications

References 21 publications

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Early laparotomy and timely reconstruction for patients with abdominal electrical injury

Component separation and large incisional hernia: predictive factors of recurrence

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