ABSTRACT
The authors report the successful repair of large lower abdominal hernia defects after transverse rectus abdominis muscle (TRAM) flap breast reconstruction in 11 patients using a technique of intraperitoneal application of synthetic polypropylene (Prolene) mesh anchored to the peritoneal surface of the abdominal wall tissues. Five of these patients had previously failed hernia repairs after a unipedicle TRAM flap breast reconstruction employing the onlay mesh technique, with two of the patients having undergone three previous hernia repairs. The other six patients had developed large hernias after bipedicle TRAM flap reconstruction without previous mesh supplementation of the abdominal wall repair. After their successful hernia repairs, all of the patients healed without difficulty and demonstrated no sign of recurrence in an 8 to 36-month follow-up. Each patient returned to her activity level before breast reconstruction.
Subject(s)
Hernia, Ventral/surgery , Mammaplasty/adverse effects , Polypropylenes , Surgical Flaps/adverse effects , Surgical Mesh , Abdominal Muscles/surgery , Female , Hernia, Ventral/etiology , Humans , Peritoneum/surgery , Recurrence , ReoperationABSTRACT
Early intra-abdominal packing is a lifesaving maneuver for selected patients with major liver injuries. However, the effectiveness of perihepatic packing can be limited by renewed bleeding when laparotomy pads that have become adherent to the injured liver surface are removed. A technique for intra-abdominal packing of complex liver injuries is presented that avoids the bleeding sequelae related to pack removal.
