RESUMO
BACKGROUND: Complex abdominal wall reconstruction (CAWR) has evolved dramatically over the last 10 years and has become a speciality in its own right. Usually surgery is carried out by a General Surgeon, sometimes alone and sometimes in combination with a Plastic Surgeon. Patients frequently have multiple incisions over the abdomen, soft tissue excess and skin redundancy and planning the incisions to allow for a comprehensive abdominal wall reconstruction can be a challenge.In order to help simplify incision planning we examined our personal series of 150 cases to formulate a classification system for the incision and provide a simple algorithm. METHODS: Over an 8 year period from 2007 to 2015, 150 patients underwent complex abdominal wall reconstruction, patient demographics, outcome and complications were recorded. Preoperative photographs of the planned incisions were reviewed by the senior author and classified into 4 groups. RESULTS: All patients fell into one of four groups. Type 1, using existing incisions (28%). Type 2, using an abdominoplasty approach (26%). Type 3, a fleur-de-lys approach (43%). Type 4, a free style group where the incisions are so complex that the above three categories are not suitable (3%). CONCLUSION: Soft tissue management in CAWR can be challenging with the primary objective to achieve uncomplicated primary wound healing while optimising the aesthetic outcome. We present a simple classification system and associated algorithm, which can help surgical planning and identify cases that may benefit from a joint procedure with a Plastic Surgeon.
RESUMO
The use of fibrin sealant to secure the mesh after a hernia repair, and to reduce seroma formation after abdominoplasty, is well recognised. However, delivery of the fibrin sealant post-abdominoplasty has proved technically difficult due to the competing demands of: (1) applying instant pressure to the fibrin sealant-containing cavity and (2) accurate suturing of the skin flaps. A new technique is proposed for the application of the fibrin sealant during abdominoplasty.
Assuntos
Parede Abdominal/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Hérnia Inguinal/cirurgia , Telas Cirúrgicas , Humanos , Injeções Intralesionais , Laparoscopia/métodos , Prognóstico , Medição de Risco , Prevenção Secundária , Resistência à Tração , Resultado do TratamentoAssuntos
Ácido Aminolevulínico/análogos & derivados , Fotoquimioterapia/métodos , Transtornos de Fotossensibilidade/tratamento farmacológico , Fármacos Fotossensibilizantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/administração & dosagem , Humanos , Fototerapia , Retratamento , Resultado do TratamentoRESUMO
Attempting to separate frozen food with a knife can result in serious injury to the hand. This injury is prevalent and is a common reason for referral to hand surgeons. Ten cases were reviewed over a 3-month period; the causative frozen food varied widely. Seven of the 10 patients required surgical exploration, and of these 7 patients, 3 were found to have significant injury. The injuries varied from digital nerve injuries to damaged flexor tendons. The other 4 patients were all found to have only soft tissue damage.
