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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report here a case of an asymptomatic lumbar hernia through a congenital defect of the posterior abdominal wall secondary to hypoplasia of the left part of the neural arch of L5 and S1. The bone defect was related to the neurofibromatosis of the patient. Plain radiograms showed a scoliosis and the bone defect. CT scan confirmed the osseous abnormalities and demonstrated a left colonic herniation through the bone defect. Many cases of lumbar hernia secondary to weakness of the abdominal muscles or following bone defects after bone graft harvesting, surgery or trauma have been described. This is, to our knowledge, the first case report of a lumbar hernia secondary to a congenital bone defect.
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PMID:[Colonic lumbar hernia secondary to congenital bone anomalies in a case of neurofibromatosis type I]. 873 10

Lumbar hernias are rare defects that involve the extrusion of retroperitoneal fat or viscera through a weakness in the posterior abdominal wall. Repairing these hernias is often difficult because of the weakness of the surrounding structures. Techniques for reconstruction usually include an incision from the 12th rib to the iliac crest with mobilization of local flaps or onlay fascial flaps or the use of prosthetic mesh. Contemporary reports have advocated extensive retroperitoneal dissection with the placement of permanent mesh extraperitoneally. We have recently repaired an extensive, primary lumbar hernia laparoscopically, securing the mesh to the 12th rib superiorly, iliac crest inferiorly, erector spinae fascia medially, and external oblique fascia laterally. The patient resumed normal activities in less than 2 weeks; 4 months postoperatively, he seems to have a solid repair. To our knowledge, this is the first report of this technique.
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PMID:Laparoscopic inferior and superior lumbar hernia repair. 933 16

The main cause of acquired inguinal hernia is weakness of Fruchaud's deep muscolofascial floor, following metabolically-determined collagen disorders. A technique for the anterior reinforcement of this structure with polypropylene mesh is described here. Following intermuscular decollement, the mesh is placed in direct contact with the surface formed by the transversalis fascia and the transversus abdominis muscle and stretched as extensively as possible. Because the posterior aspect of the inguinal canal is the true barrier to abdominal pressure, the author believe that its direct reinforcement, without interposition of the internal oblique muscle, constitutes the most correct anatomo-surgical approach to hernia repair. This is the case for both indirect hernias, in which the internal ring is reconstructed at a deeper level, and for direct hernias, in which the "tent effect" of the prosthesis is prevented. Ninety-two primary inguinal hernias (56 indirect, 29 direct and 7 direct and indirect) in 87 patients were repaired with this technique. Seventy-nine patients were followed up from 2 to 24 months. Early complications included: 7 ecchymosis, 3 seromas, 2 subcutaneous infections, 3 testicular swellings. Incision and testicular pain for longer than 6 months occurred in 2 cases. No prosthetic infections or recurrences have been detected up to the present.
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PMID:[Technique of repair of acquired inguinal hernia by anterior reinforcement of the Fruchaud floor with polypropylene mesh]. 957 32

Skin flaps devoid of rectus muscle, raised on a single musculocutaneous perforator (14 cases), and on two musculocutaneous perforators (1 case) of the deep inferior epigastric artery (DIEA) were used in 14 patients to cover various defects during a period of 3 years. The flaps were raised on the perforator arising slightly lateral to the centre of the muscle below the umbilicus, which is a sub-branch of the lateral branch of DIEA. The defects were located on the upper limb in four, the lower limb in nine, and the scalp and forehead in the remaining two cases. In one patient, the flap was preexpanded for 4 weeks prior to transfer. The longest flap was 40 x 12 cm, and the widest flap was 30 x 18 cm in dimension. All donor defects were closed primarily. Two flaps were lost due to venous thrombosis on the fourth postoperative day. Tip necrosis was observed in two flaps, both of which were salvaged from venous thrombosis at 36 hours and 5 days postoperatively. The remaining 11 flaps survived completely. The DIEA skin flap was found to provide the following benefits: (1) the largest available skin flap where the donor site could be closed primarily; (2) decreased possibility of abdominal wall weakness and hernia formation; and (3) potential of obtaining a thin flap either by trimming of the subcutaneous fat or by preexpansion.
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PMID:Deep inferior epigastric artery (DIEA) skin flap: clinical experience of 15 cases. 957 15

The free rectus abdominis muscle flap is now a routine procedure for the reconstruction of soft tissue defects in the lower extremity. We present the follow-up of 21 out of 27 patients operated in our clinic between 1986 and 1994. The recipient leg always showed a stable soft-tissue coverage. Clinical or radiological signs of osteitis were not found. In many of the cases, where the transplantion was to the ankle region, the muscle bulk led to an alteration of the shape of the leg, without impairment of function. When harvested through a low transverse abdominal incision, the aesthetic results in the donor site are convincing. The functional donor site defect is negligible as long as only a segment of the muscle is used. Abdominal muscle tests showed good results when only a segment of the muscle was used. The patients reported no impairment in daily life. Abdominal wall weakness was present only when the entire muscle was harvested. There was one hernia after postoperative wound infection and secondary wound healing. In all other cases, the abdominal wall was stable. In the segmental use of the free rectus abdominis muscle flap, the good results obtained in our examination correlate to the high degree of patient satisfaction.
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PMID:[Free microvascular rectus abdominis muscle flap for soft tissue reconstruction of the lower leg and foot: results and donor site defect]. 1008 57

Reconstruction of massive abdominal wall defects has long been a vexing clinical problem. A landmark development for the autogenous tissue reconstruction of these difficult wounds was the introduction of "components of anatomic separation" technique by Ramirez et al. This method uses bilateral, innervated, bipedicle, rectus abdominis-transversus abdominis-internal oblique muscle flap complexes transposed medially to reconstruct the central abdominal wall. Enamored with this concept, this institution sought to define the limitations and complications and to quantify functional outcome with the use of this technique. During a 4-year period (July of 1991 to 1995), 22 patients underwent reconstruction of massive midline abdominal wounds. The defects varied in size from 6 to 14 cm in width and from 10 to 24 cm in height. Causes included removal of infected synthetic mesh material (n = 7), recurrent hernia (n = 4), removal of split-thickness skin graft and dense abdominal wall cicatrix (n = 4), parastomal hernia (n = 2), primary incisional hernia (n = 2), trauma/enteric sepsis (n = 2), and tumor resection (abdominal wall desmoid tumor involving the right rectus abdominis muscle) (n = 1). Twenty patients were treated with mobilization of both rectus abdominis muscles, and in two patients one muscle complex was used. The plane of "separation" was the interface between the external and internal oblique muscles. A quantitative dynamic assessment of the abdominal wall was performed in two patients by using a Cybex TEF machine, with analysis of truncal flexion strength being undertaken preoperatively and at 6 months after surgery. Patients achieved wound healing in all cases with one operation. Minor complications included superficial infection in two patients and a wound seroma in one. One patient developed a recurrent incisional hernia 8 months postoperatively. There was one postoperative death caused by multisystem organ failure. One patient required the addition of synthetic mesh to achieve abdominal closure. This case involved a thin patient whose defect exceeded 16 cm in width. There has been no clinically apparent muscle weakness in the abdomen over that present preoperatively. Analysis of preoperative and postoperative truncal force generation revealed a 40 percent increase in strength in the two patients tested on a Cybex machine. Reoperation was possible through the reconstructed abdominal wall in two patients without untoward sequela. This operation is an effective method for autogenous reconstruction of massive midline abdominal wall defects. It can be used either as a primary mode of defect closure or to treat the complications of trauma, surgery, or various diseases.
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PMID:The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. 1069 87

Presented is a new technique in preoperative conditioning of the pedicled TRAM-flap employing an interventional-radiologic procedure, selective embolization of the deep inferior epigastric artery (DIEA). During a four year period in 40 patients with a mean age of 48.4 (31-66) years breast reconstruction was performed by a superiorly pedicled TRAM-flap following preoperative conditioning. 30 of 40 patients were eligible for follow-up one to five years postoperatively. The mean interval between embolization and surgery amounted to 3.6 months. In 25 of 30 cases embolization of the DIEA was performed bilaterally, in 5 of 30 cases unilaterally. 14 of 30 patients underwent preoperative radiotherapy for breast cancer. Applying CCDS the peak flow values were determined in the superior epigastric arteries (TRAM/contralateral side). Pre-embolization values (54.9 cm/s/55.8 cm/s), post-embolization values (57.2 cm/s/57.9 cm/s) and late postoperative values (61.0 cm/s/61.6 cm/s) proved a statistically significant effect of selective embolization on peak flow without relevant difference between TRAM and contralateral side (p < 0.05). Postoperative flap complications consisted of partial necrosis in 2 of 30, fat necrosis in 1 of 30, impaired would healing in 5 of 30 and postoperative bleeding in 2 of 30 cases. Abdominal would healing complications occurred in 5 of 30 cases, abdominal wall weakness was found in 8 of 30 and hernia formation in 4 of 30 cases. Corrective surgery was performed at the breast (TRAM-flap) in 22 of 30 and at the abdomen (donor site) in 9 of 30 cases. Patient acceptance concerning selective embolization and TRAM-flap surgery was very high. 29 of 30 patients confirmed that they would again choose this type of breast reconstruction. The pedicled TRAM-flap following preoperative conditioning by selective embolization of the DIEA constitutes a safe and reliable method of breast reconstruction with autogenous tissue. It is superior to the pedicled TRAM-flap without delay and offers definite advantages compared to alternative techniques of enhanced flap vascularization.
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PMID:[Clinical results and color-coded duplex ultrasound findings 4 years after conditioned TRAM flap-plasty]. 1070 70

Preoperative selective embolization of the deep inferior epigastric arteries constitutes a new technique in TRAM flap delay. Whereas surgical ligation of these vessels has proved to be an effective delay procedure in experimental and clinical settings, it requires an additional operative step under general anesthesia. Despite the introduction of the free TRAM leading to improved flap perfusion, this microsurgical technique is not always available because of the requirements of specialized equipment and staff, longer operating hours, and subsequently higher expenses. The search for a minimally invasive, easy, and inexpensive technique to improve perfusion of the pedicled TRAM flap led us to selective embolization of the deep inferior epigastric arteries by an angiographic procedure. After 4 years of experience with this technique, we now present the first clinical results. Breast reconstruction by a delayed pedicled TRAM flap was performed in 40 patients with a mean age of 48.4 years (range, 31 to 66 years). The mean interval between embolization and surgery was 3.6 months. Postoperative data concerning flap survival and complications were available for all patients. Embolization of the deep inferior epigastric arteries was performed bilaterally in 35 patients (87.5 percent) and unilaterally in 5 patients (12.5 percent). Radiotherapy had been applied in 21 patients (52.5 percent) before surgery. Postoperative flap complications consisted of partial necrosis in three (7.5 percent), fat necrosis in one (2.5 percent), impaired wound healing in five (12.5 percent), and postoperative bleeding in two patients (5 percent). Abdominal wound healing complications occurred in six patients (15 percent), abdominal wall weakness in eight (20 percent), and hernia formation in four (10 percent). Surgical corrections were performed at the breast (TRAM flap) in 22 patients (55 percent) and at the abdomen (donor site) in 9 (22.5 percent). Preoperative selective embolization of the deep inferior epigastric arteries constitutes an alternative delay procedure for the pedicled TRAM flap. It is superior to the conventional procedure without delay, offers several advantages compared with surgical ligation of these vessels, and represents an alternative to the free TRAM flap in selected cases.
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PMID:Clinical results of TRAM flap delay by selective embolization of the deep inferior epigastric arteries. 1112 7

We report our results in repairing wide incisional hernial defects without using any prosthetic synthetic material, but expanding rectus sheaths by multiple small, 8 to 10 mm, relaxing incisions. In this way, hernial defect becomes smaller and fascial flaps are sutured to each other in an overlapping manner. These relaxing incisions are filled with collagenous connective tissue, and consequently do not cause any abdominal wall weakness. This procedure was performed on 32 patients with hernial defect of 4 x 4 cm to 15 x 15 cm. Mean hospital stay was 6, 8 days. In the follow-up period ranging from 5 to 42 months, no patient presented recurrence of the hernia. Rectus diastasis occurred in one patient who had been operated five times previously. Wound complication such as infection, seroma, haematoma developed in 9 of the patients, and were successfully treated by wound drainage and administration of appropriate antibiotic therapy. The findings of this study led us to conclude that the technique can be used in the repair of incisional hernias as an alternative technique.
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PMID:Repair of large incisional hernias with multiple small relaxing incisions technique. 1114 23

Since many years the importance of a weakness of the soft tissue for the development of hernias is discussed controversially. The tensile strength of the tissue is supposed to depend largely on the varying proportion of type I collagen with its high tensile strength and the immature type III collagen. Their relation is regulated by several collagenases, mainly matrix metalloproteinases-1 and -13 (MMP-1 and MMP-13), whereas fibronectin plays a key role for the adherence of cells within the extracellular matrix. The aim of this study was to investigate whether an alteration in type I and type III collagen synthesis, amounts of MMP-1 and MMP-13 and the expression of fibronectin were associated with the development of inguinal hernia. We analysed the hernial sac of patients with indirect (n = 9) and direct (n = 7) inguinal hernias and peritoneum in controls (n = 7) by immunohistochemistry and Western blot analysis. The results showed that the ratio of relative amount of I/III collagen was markedly decreased in patients with either indirect or direct hernias as compared with controls (p < 0.001) with a concomitant increase in type III collagen synthesis. MMP-13 was expressed neither in the hernial sac nor in the peritoneum of the controls, but the positive reactions of MMP-1 were found in the surface of the subserosa of the hernial sac in patients with indirect or direct hernias without any difference compared to controls. Furthermore, the relative amount of fibronectin in patients with either indirect or direct hernias is not significantly different from controls (p > 0.05). In regard to the known alterations of the collagen metabolism in fascia and skin of hernia patients the changed collagen I/III ratio with its increase of type III collagen in hernial sacs support the presence of a systemic disturbance of collagen metabolism. The absence of changes of the expression of collagenases (MMP-1, MMP-13) and the constant levels of fibronectin underline the central role of collagen synthesis for the development of indirect or direct hernias.
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PMID:Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. 1134 10


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