BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fist...BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.展开更多
BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure...BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.展开更多
BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,i...BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,including debridement,tensionreduced closure(TRC),and reconstruction with mesh and a free musculocutaneous flap.During a 3-year follow-up,the patient recovered well without hernia or other problems.CONCLUSION TRC is a practical approach for the temporary closure of LAWD,particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.展开更多
BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potential...BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.展开更多
After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have s...After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have summarized some therapyon it. First, to avoid delaying surgery operation , those who are injured at that area seriously should be treated with surgeryoperations immediately without X ray and supersonic checks. Second, the positive check results of suspect patients should behelpful for diagnosis, however the negative ones also could not be excluded of the diagnosis clues. The writers think that theconcomitant observation results with the development of illness are most significant. Third, the emphasis of treatments for thoseinjuries should be paid on abdomen. Explore the abdomen is necessary for the situations that abdominal substantial organs bleedand vacuum organs break, thoracic close drainage is sufficient for treating most thoracic trauma cases. It has been improved to beconvenient to check the thoracic cavities by cutting off the diaphragma temporarily if necessary. Fourth, as it was reported that asmany as 97 per cent of patients will have visceral injury dues to abdominal gunshot wound, all gunshot wounds be done with anexploratory laparotomy without hesitation. Fifth, resuscitating of patients as soon as possible is the key to decrease the mortalityand complications. Sixth, acute pancreas injury should be treated as acute pancreatitis.展开更多
Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdomina...Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdominal wall defect after malignant tumors resection(10 × 10 cm-32 cm×32 cm) were reviewed. The defectcontributed:Ⅰ region, 2 cases; twin-Ⅱ region, 2; Ⅲ region, 2; Ⅰ and Ⅱ region of one side, 1 and total abdominal wall,one case, The tissue flaps of transposition included: gracilis myocutaneous flaps, 4; retus abdominal myocutaneous flaps, 2; external abdominal obligue musculo-fascia flaps, 2; latissimus dorsi muscle, tensor fasciae latae muscle and retus femoris muscle flaps each, 1. One patient used MycroMesh also. Results In the course of peroperation, the incisions of 8 cases healed in first time; total tissue flaps survived and all pateints started exercise left the bed in 3 weeks. All 8 patients were followed up average of 2 years and 5 months: the success rate of reconstruction展开更多
在装配整体式剪力墙结构中,由于套筒灌浆连接的质量具有一定的随机性,势必影响结构的竖向连接性能和结构抗震性能。根据不同缺陷程度的套筒灌浆拉拔试验,建立了一套等效套筒灌浆缺陷连接承载力模型,并基于某实际工程结构,建立了装配整...在装配整体式剪力墙结构中,由于套筒灌浆连接的质量具有一定的随机性,势必影响结构的竖向连接性能和结构抗震性能。根据不同缺陷程度的套筒灌浆拉拔试验,建立了一套等效套筒灌浆缺陷连接承载力模型,并基于某实际工程结构,建立了装配整体式剪力墙结构有限元模型。通过考虑灌浆缺陷的随机性,赋予连接接头相应缺陷程度的力学连接性能,来反映套筒灌浆中可能存在的缺陷。通过非线性有限元分析并结合概率密度演化方法(probability density evolution method,PDEM)进行了结构随机非线性反应分析和可靠度评估。结果表明:在动力作用下,结构非线性与随机性具有明显的耦合效应;缺陷的随机性会随着时间的推移,逐渐放大对结构响应的影响;在不同的安全域内,结构的整体可靠度将存在较大的差异。展开更多
基金Supported by Youth Project of Anhui Provincial Health Commission T,No.AHWJ2023A30225.
文摘BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.
文摘BACKGROUND Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task.An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps,restoration of the abdominal wall integrity,and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia.When treating huge full-thickness defects,composite autologous tissue flaps are a good option for the repair.CASE SUMMARY This study reported the case of a 43-year-old male patient suffering from fullthickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen.After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels,reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure.The remaining 18 cm×15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap.The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSION This approach restored the abdominal wall integrity,maintained certain muscle tension,avoided abdominal hernia,reached satisfactory aesthetic effect,and resulted in no complications in the grafting regions.
文摘BACKGROUND Large abdominal wall defect(LAWD)caused by shotgun wound is rarely reported.CASE SUMMARY Herein,we describe a case of LAWD caused by a gunshot wound in which the abdominal wall was reconstructed in stages,including debridement,tensionreduced closure(TRC),and reconstruction with mesh and a free musculocutaneous flap.During a 3-year follow-up,the patient recovered well without hernia or other problems.CONCLUSION TRC is a practical approach for the temporary closure of LAWD,particularly in cases when one-stage abdominal wall restoration is unfeasible due to significant comorbidities.
文摘BACKGROUND Congenital intestinal malrotation(CIM)is a common malformation in neonates.Early diagnosis and surgical intervention can improve the prognosis.CIM combined with congenital gastric wall defect is a potentially fatal condition.We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome.After three operations,the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARY A male neonate(age:4 d)was hospitalized due to bloody stools and vomiting for 2 d,and abdominal distention for 1 d.Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops.Bowel alignment was abnormal with congestion and dilatation of the entire intestine,and clockwise mesentery volvulus(720°).The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer(approximately 5.5 cm),and a circular perforation(approximately 3 cm diameter)at the center of this defect.Ladd’s procedure was performed and gastric wall defect was repaired.Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum,and adhesion angulated between many small intestinal loops.We performed intestinal adhesiolysis,resection of necrotic intestine,and small bowel anastomosis.CONCLUSION This case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines,and improve patient prognosis.
文摘After analyzing 15 clinical case, 2 of which is especially representative, about perforating injury at the areaintegrates thoracic and abdominal cavities in our hospital from Jan. 1988 to Aug. 2001, the writers have summarized some therapyon it. First, to avoid delaying surgery operation , those who are injured at that area seriously should be treated with surgeryoperations immediately without X ray and supersonic checks. Second, the positive check results of suspect patients should behelpful for diagnosis, however the negative ones also could not be excluded of the diagnosis clues. The writers think that theconcomitant observation results with the development of illness are most significant. Third, the emphasis of treatments for thoseinjuries should be paid on abdomen. Explore the abdomen is necessary for the situations that abdominal substantial organs bleedand vacuum organs break, thoracic close drainage is sufficient for treating most thoracic trauma cases. It has been improved to beconvenient to check the thoracic cavities by cutting off the diaphragma temporarily if necessary. Fourth, as it was reported that asmany as 97 per cent of patients will have visceral injury dues to abdominal gunshot wound, all gunshot wounds be done with anexploratory laparotomy without hesitation. Fifth, resuscitating of patients as soon as possible is the key to decrease the mortalityand complications. Sixth, acute pancreas injury should be treated as acute pancreatitis.
文摘Objective To report evaluat of division region of abdominal wall large defect after tumors resection and repair methods by tissue flaps with pedicle. Methods Form October 1992 to September 2001, 8 cases large abdominal wall defect after malignant tumors resection(10 × 10 cm-32 cm×32 cm) were reviewed. The defectcontributed:Ⅰ region, 2 cases; twin-Ⅱ region, 2; Ⅲ region, 2; Ⅰ and Ⅱ region of one side, 1 and total abdominal wall,one case, The tissue flaps of transposition included: gracilis myocutaneous flaps, 4; retus abdominal myocutaneous flaps, 2; external abdominal obligue musculo-fascia flaps, 2; latissimus dorsi muscle, tensor fasciae latae muscle and retus femoris muscle flaps each, 1. One patient used MycroMesh also. Results In the course of peroperation, the incisions of 8 cases healed in first time; total tissue flaps survived and all pateints started exercise left the bed in 3 weeks. All 8 patients were followed up average of 2 years and 5 months: the success rate of reconstruction
文摘在装配整体式剪力墙结构中,由于套筒灌浆连接的质量具有一定的随机性,势必影响结构的竖向连接性能和结构抗震性能。根据不同缺陷程度的套筒灌浆拉拔试验,建立了一套等效套筒灌浆缺陷连接承载力模型,并基于某实际工程结构,建立了装配整体式剪力墙结构有限元模型。通过考虑灌浆缺陷的随机性,赋予连接接头相应缺陷程度的力学连接性能,来反映套筒灌浆中可能存在的缺陷。通过非线性有限元分析并结合概率密度演化方法(probability density evolution method,PDEM)进行了结构随机非线性反应分析和可靠度评估。结果表明:在动力作用下,结构非线性与随机性具有明显的耦合效应;缺陷的随机性会随着时间的推移,逐渐放大对结构响应的影响;在不同的安全域内,结构的整体可靠度将存在较大的差异。
