Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: A preliminary result

AIM： To present our trial using a combination of the human acellular dermal matrix （HADM） implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS： Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS： The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION： The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.

Establishing a center of excellence in abdominal wall reconstruction

Building a tertiary referral center of excellence for complex abdominal wall reconstruction is a multi-step process that requires many elements to garner and promote success.Ultimately the creation of such a center is important for continual improvement of abdominal wall reconstruction outcomes by decreasing complications,recurrences,length of hospital stay,hospital readmissions,and overall costs.Establishing a center of excellence incorporates several key components including the surgeon's desires and expertise,institutional participation,multidisciplinary collaboration,outcomes research and innovation,and financial stability.This article outlines the principal elements of building a sustainable,functional,and successful center of excellence for complex abdominal wall reconstruction.

Long-term survival of the Sister Mary Joseph nodule originating from breast cancer:A case report

BACKGROUND A Sister Mary Joseph nodule(SMJN)is an uncommon cutaneous metastasis found in the umbilicus,indicating an advanced malignancy.SMJNs typically originate from intra-abdominal sources,rarely from breast cancer.Diagnosis suggests a poor prognosis with a median survival of approximately 8 mo after detection.Managing patients with SMJNs is challenging,as most receive limited palliative care only.The optimal strategy for long-term survival of these patients remains unclear.CASE SUMMARY A 58-year-old female,previously diagnosed with right breast cancer 17 years ago and underwent breast-conserving surgery,adjuvant radiotherapy,and endocrine therapy,presented with a 2-cm umbilical nodule.Thirteen years previously,metastases were detected in the right supraclavicular,infraclavicular,hilar,and mediastinal lymph nodes.An umbilical nodule emerged four years before the date of presentation,confirmed as a skin metastasis of primary breast cancer upon excisional biopsy.Despite initial removal,the nodule recurred and grew,leading to her referral to our hospital.The patient underwent extensive excision of the umbilical tumor and immediate abdominal wall reconstruction.Endocrine therapy was continued postoperatively.Five years later,no local recurrence was observed,and the patient continued to work full-time,achieving over 9 years of survival following SMJN diagnosis.CONCLUSION This case study aimed to identify the optimal strategy for achieving extended survival outcomes in patients with SMJN through comprehensive treatment.We presented a case of the longest survival in a patient after undergoing a multidisciplinary treatment regimen.Our findings underscore the significance of adopting a multimodal treatment approach comprising timely and wide excision along with adjunctive therapy.This approach can control the disease,prolong survival,and improve the quality of life in patients with SMJN.

Flap reconstruction of the abdominal wall

Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.

Abdominal wall procedures: the beneifts of prehabilitation

Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications.It includes interventions that optimize nutrition,glycemic control,functional status,and utilization of the patient's microbiome pre-,intra-,and postoperatively.Through a multidisciplinary and anticipatory approach to patients'existing co-morbidities,the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting.With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay,it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction.Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.

Parastomal hernia repair

Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.

The use of botulinum toxin A in chemical component separation: a review of techniques and outcomes

Fascial closure is crucial for abdominal wall reconstruction (AWR) but can be especially difficult in patients with massive ventral hernias or loss domain. Recently, botulinum toxin A (BTA) has been increasingly utilized as an adjunct in AWR to aid in fascial closure. This review aims to evaluate the current literature on the use of BTA in AWR to assess current treatment regimens, side effects, outcomes and complications. A literature search was performed, yielding 10 studies that met the inclusion criteria. There was a significant amount of heterogeneity in treatment regimens, with studies differing in BTA injection timing, dosage, concentration, and location. The majority of studies showed that injection of BTA preoperatively was able to augment abdominal wall musculature, with many showing a decrease in mean transverse defect size and high rates of successful fascial closure. No major complications were reported from BTA administration, with only mild side effects reported by some studies. The most common side effects include a weak cough or sneeze, bloating, and back pain, which generally all resolved prior to surgery. While BTA appears to be a promising adjunct for AWR, further investigation is needed to determine optimal patient selection and treatment regimens.