Simultaneous Abdominoplasty and Umbilical Hernia Repair via Laparoscopy: a Preliminary Report.

BACKGROUND: Umbilical hernias (UH) are common in postpartum patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularisation with possible umbilical necrosis. To minimize this risk we associated abdominoplasty with laparoscopic UH repair. The aim of this study was to present the technique of simultaneous abdominoplasty and UH repair and the first results. MATERIALS AND METHODS: Simultaneous abdominoplasty and laparoscopic mesh UH repair was analysed in the first 10 cases. The intervention was performed by a plastic surgeon and a general surgeon. It begins as a standard abdominoplasty with flap elevation, umbilicus detachment and diastasis repair, if indicated. The second stage is the UH repair via laparoscopy using an intraperitoneal mesh. The third stage consists of umbilical transposition and closure of the abdominoplasty incision. RESULTS: We had no complications at the umbilicus or the hernia mesh. In all cases, umbilical vascularisation was preserved and no hernia recurrence was noted. CONCLUSIONS: Our first results suggest that the simultaneous UH repair with abdominoplasty is safe, minimizing the risk to the umbilicus blood supply. These first results encourage us to recommend this approach and perform a more detailed analysis of the whole series since our first case.

Nasal reconstruction with vascularized forehead flap (preliminary communication).

AIM: The authors have studied the anatomical characteristics of the vascularization of the forehead flap used for nasal reconstruction. MATERIAL AND METHODS: For the period 1990--2000 ten cadaver dissections were performed and three patients underwent reconstructions using the forehead flap. The results obtained reveal that the blood supply of the flap is provided by the suprathrochlear, supraorbital and frontal branch of the superficial temporal vessels, which form a network of anastomoses between the frontal muscle and the skin. Three cases of successful nasal reconstruction are presented. Two of the patients had traumatic injury of the nose and one was with postoperative defect in the naso-labial area, nose and maxilla obtained after ablation surgery for neoplasm (spinocellular carcinoma). The reconstruction was done with vascularized oblique forehead flap. DISCUSSION: The results were evaluated as good. There were no complications. CONCLUSION: The results of the anatomical study of the blood supply of the forehead flap and the clinical results of nasal reconstruction are discussed in relation with the literature data.

Operative treatment of postpulmonectomy empyema.

OBJECTIVE: To analyse retrospectively 10 patients with postpulmonectomy empyema. METHODS: Ten patients (9 men, 1 woman, aged 48 to 69 years) with postpulmonectomy empyema treated over a 12 year period (1991--2002) were analysed. Nine of the patients had pulmonectomy for lung carcinoma and one--for pulmonary abscess. All postpulmonectomy empyemas were managed in two stages--an open-window thoracostomy for curing the infective process in the empyema cavity and then closure of the bronchopleural fistulas and obliteration of the cavity. Video-assisted thoracoscopy (VATS) was successfully used by the authors for sterilization and debridement of the cavity, and finally to insert two thoracic drains for the cavity lavage. The obliteration of the empyema cavity was achieved by a vascular muscle flap transposition from the thoracic muscles. The latissimus dorsi muscle flap was used in 6 patients. The pectoralis major muscle flap was used in 4 patients. Additionally, a thoracoplasty was performed in the patients with pectoralis major muscle flap transposition. RESULTS: Eight patients (80%) were discharged from hospital without complications, and two patients died (20%). CONCLUSIONS: On the basis of the study results and the literature review the authors conclude that the applied therapy yields good results in the treatment of postpulmonectomy empyema.

Blood-gas and acid-base profile in dogs with severe pancreatitis.

A number of systemic disorders develop in the clinical course of acute pancreatitis. Among these important are the respiratory disorders occurring in 35-55% of the patients. They develop in the first hours after onset of pancreatitis and are the cause of death in 60% of the severe forms of acute pancreatitis. We studied the changes in the arterial blood oxygen status and acid-base status in experimentally induced severe acute pancreatitis in dogs. The animals were divided into two groups--one receiving sandostatin treatment and the other without treatment. Quickly progressing acute arterial hypoxemia was observed in the dogs with severe acute pancreatitis. Hypoxemia development was delayed by administration of sandostatin.