Abdominal Wall Fascia Research Articles

Clinical Experience With Jejunostomy Feeding Tubes In 47 Small Animal Patients

SummaryThe medical records of 39 dogs and 8 cats which had jejunostomy feeding tubes placed using modifications of a previously described surgical technique were retrospectively reviewed. Modifications included the addition of a suture to anchor the feeding tube to the jejunum, the use of a continuous circumferential suture to pexy the jejunum to the abdominal wall, and the placement of a skin suture that penetrated deep into the abdominal wall fascia. All tubes were placed during surgical treatment of a primary intraabdominal disease. Tubes were used for feeding from 1 to 41 days (average 9.7 days). Sixteen patients (34%) developed mild to moderate complications such as chewing at the tube, inadvertent tube removal, tube obstruction, and cellulitis around the ostomy site. Three patients (6%) developed severe complications associated with breakdown of the surgical site. The modified jejunostomy technique was effective for placement of jejunostomy tubes as a complementary procedure to exploratory celiotomy.

Pubovaginal Slings Using Fascia Lata for the Treatment of Intrinsic Sphincter Deficiency

Various materials and techniques have been used to construct a pubovaginal sling. We believe that fascia lata has several advantages and report our experience. A total of 32 female patients with urodynamically proved intrinsic sphincter deficiency underwent a pubovaginal sling procedure using fascia lata. An unscarred fascial strip 24 to 28 x 2 cm. was attached to itself over a 3 to 4 cm. bridge of abdominal wall fascia. Results were tabulated by chart review and an independent patient survey. Chart review revealed that 28 of 32 patients (87%) required no pads, and 3 improved and 1 did not. An independent patient survey revealed that 70% of patients (21 of 30) required no pads, 20% required 1 to 3 small pads and 10% required more than 3 small pads per day. Of the patients 80% would undergo the procedure again. Excellent results can be obtained with fascia lata for the treatment of intrinsic sphincter deficiency. A long, wide strip of fascia attached to itself allows for precise tensioning and good urethral closure, and minimizes the risk of obstruction.

Repair of transversely incised abdominal wall fascia in a rabbit model

To compare several commonly used methods of closing transversely incised anterior abdominal wall in order to determine which technique results in the strongest incisional tensile strength. Thirty-six rabbits were randomized to receive either interrupted or continuous closure with 0-Vicryl. Within these groups, each animal was randomized to one of three different bite and interval techniques: 1-cm bites/0.5-cm intervals, 1-cm bites/1-cm intervals, and 2-cm bites/1-cm intervals. Each rabbit received three to four transverse abdominal wall incisions of approximately 3-8 cm in length. The incisions were excised en bloc and stored at -70C at postoperative week 1, 2, or 4 in a random fashion. Representative 1-cm strips were harvested from each incision after thawing. The Instron tensiometer was used to determine the maximum intrinsic tensile strength required to disrupt each tissue strip at the incision. Statistical analysis was performed using analysis of variance, two-sample t test, Scheffé multiple comparison, and Kruskal-Wallis test. Two hundred thirty-seven strips were analyzed. The mean maximum tensile strength of all of the interrupted and continuous suture repairs was 48 and 38 lb, respectively (P < .001). The maximum tensile strength for interrupted closures was achieved at week 1 and was similar at week 4. The continuous closure was weakest at week 1 and increased to a maximum value during week 4. There was no difference in maximum tensile strength between the interrupted and continuous closure groups at week 4. There was no significant difference in the maximum tensile strength of the three repair techniques. The mean maximum tensile strength of all specimens was significantly less among those harvested during weeks 1 and 2 compared with week 4 (P = .001). In this randomized study, the interrupted closure had a greater maximum tensile strength than the continuous closure in repair of transverse incisions during the first 2 postoperative weeks. Both repair methods were associated with a similar maximum tensile strength at 4 postoperative weeks. Repair techniques using different bite sizes and intervals resulted in similar maximum tensile strengths.

Fascial closure of laparoscopic port sites: A new technique

The laparoscopic operative procedure is not complete until the port sites are closed with a fascial suture. Herein, we report a simple new technique that uses a venous catheter for suture placement and direct laparoscopic visualization to secure the abdominal wall fascia and peritoneum.

Closure of fascial incisions made at the time of laparoscopy: development of a device.

Incisional hernias follow approximately 3% of major laparoscopic procedures when the fascia is not adequately closed. Fascial closure, however, is difficult when skin incisions are small and subcutaneous tissue is thick. We report the development of a self-contained device that sutures the anterior abdominal wall peritoneum and fascia at the completion of laparoscopic surgery without extending the cutaneous incision.

Incisional/ventral herniorrhaphy employing bilateral reversed anteriorrectus abdominissheath

Repair of a symptomatic incisional/ventral hernia that is not amenable to simple primary closure is problematic. Therapeutic options include: (1) fascial reapproximation after unilateral/bilateral horizontal parasagittal relaxing incisions (obliquus externusand transversus abdominis) with or without pre-operative pneumoperitoneum; (2) bridging a fascial defect with autologous devascularized (lata femoris, anterior rectus abdominissheath) or vascularized (abdominal wall fascia, tensor fasciae latae, myofascial, or myofascial/cutaneous rotational flaps) tissue; or (3) insertion of prosthetic/synthetic material (polypropylene, polytetrafluoroethylene, polygalactin). In the presence of abdominal infection or contaminated operative wounds use of autologous tissue is preferred, because of the risks of infection and gastroenterocolonic fistulization. Since 1985 the authors have observed excellent results with use of a bilateral reversed anterior rectus abdominissheath technique of incisional/ventral herniorrhaphy. Although the parasagittal incision parallel to the linea semilunarisand mobilization medially undoubtedly caused partial devascularization (interruption of segmental and intermuscular arteriovenous arcades, respectively), the sheath coapted in the midline maintained its integrity as evaluated clinically and radiographically. This implies that the Sheath is relatively hypometabolic, that collateral circulation is maintained and/or develops, and/or sustenance is obtained by contiguity with peritoneal secretions and subcutaneous tissue. Twenty-three patients (13 males, 10 females, age range 19–79 years) with large symptomatic mid-abdominal hernias of 8–16 months duration were so treated. Each of these patients had required multiple (three to seven) exploratory celiotomies for traumatic, infectious, inflammatory., or neoplastic entities. To date all patients have healed per primumwithout recurrence. Only one patient, who had previously received pelvic irradiation, manifested eventration. This qualitative analysis suggests that this technique has validity for patients requiring incisional/ventral herniorrhaphy with an otherwise intact rectus abdominismuscle and sheath. © 1994 Wiley-Liss, Inc.

Enhanced endothelialization of dacron grafts by external vein wrapping

The efficacy of external vein wrapping of vascular grafts in promoting the development of a luminal endothelial surface was assessed in 12 dogs who underwent thoracoabdominal bypasses with 26–29 cm × 6-mm i.d. double-velour knitted Dacron grafts. In group I ( n = 6) 6-cm segments of the grafts were wrapped with autologous jugular vein with its endothelial surface applied against the outside of the graft. In group II ( n = 6) the wrap procedure was performed using abdominal wall fascia. The degree and character of graft incorporation was quantitated in all prostheses at 28 days postimplantation. Group I vein wrap prostheses demonstrated uniform endothelial surface coverage in the vein wrap area ( x = 88% ) that was significantly greater ( P < 0.04) than coverage in adjacent unwrapped segments ( x = 48% ). Group II fascial wrap grafts demonstrated variable endothelial coverage in the wrapped area ( x = 48% ) that was consistently less than in adjacent unwrapped portions ( x = 62% ), and significantly less than vein wrap sections of group I animals ( P < 0.04). No significant differences existed in endothelial coverage of unwrapped regions of group I and II grafts. This investigation documented that wrapping knitted Dacron grafts with vein enhanced endothelialization of their luminal surface.

Transvaginal Needle Bladder Neck Suspension

Like the transabdominal bladder neck suspension, the aim of the transvaginal needle suspension of the bladder neck is to suspend the bladder neck and urethra in a fixed retropubic position. Because the transvaginal technique does not require the splitting of the abdominal wall fascia, postoperative discomfort and convalescence may be lessened. Different techniques of transvaginal needle bladder neck suspension, including suspension of the bladder neck with a fascial sling, are discussed in detail.

The role of peritoneal lavage in the management of stab wounds to the abdomen

In a 2 year period, 237 patients presented with stab wounds to the lower chest and anterior abdomen. Ninety-six patients were discharged from the emergency room after negative findings on wound exploration. There were no apparent missed injuries but two wound infections in this group for an overall morbidity of 2.1 percent. One hundred forty-one patients underwent exploratory laparotomy. Seventy-seven required emergency laparotomy because of hemodynamic signs of blood loss or peritonitis. Sixty-four patients whose only indication for laparotomy was penetration of the anterior abdominal wall fascia by local wound exploration underwent peritoneal lavage before laparotomy. If 50,000 red blood cells/mm 3 in the lavage fluid had been used to select patients for observation, the incidence of negative laparotomy would have been reduced from 58 to 3.2 percent, and only one significant visceral injury would have been missed. Peritoneal lavage in properly selected patients, used in combination with local wound exploration and careful clinical observation, can be a useful diagnostic modality both in predicting significant visceral injury and in lowering the incidence of negative findings at laparotomy in patients with stab wounds to the abdomen.

Fixation of Celestin tube to the anterior abdominal wall: A new technique

Palliative intubation in the management of an unresectable carcinoma of the esophagus can be accomplished by "push through" or "pull through" techniques. The most frequently encountered complication is tube dislodgment-proximal or distal migration. Dislodgment occurs more freqeuntly with the "push through" tubes such as the Souttar tube than with the "pull through" tubes such as the Celestin tube. The incidence of migration reported for the "pull through" tubes varies from 3 to 14 per cent. In order to prevent migration, we sutured the tube to the anterior abdominal wall in 6 patients. The sixth patient developed a gastrocutaneous fistula and fasciitis at the point of anterior abdominal wall fixation. In the next 4 cases, we used a two-suture technique, in which no single suture passed from the gastric lumen to the anterior abdominal wall fascia. The Celestin tube was fixed to the gastric wall over a Dacron felt pledget and this pledget was then anchored to the rectus fascia. This technique has prevented both migration of the tube and complications related to gastric perforation.

Ultrasound as a diagnostic aid in ventral abdominal hernia.

Preliminary results are presented of ultrasound investigations in 34 patients with suspected abdominal hernias. All patients were explored surgically on the basis of clinical indications, and the surgical findings were compared with the results of the ultrasound investigation. Small hernias in the anterior abdominal wall (fascia Spigelii and linea alba) can be demonstrated by ultrasound, but there are certain circumstances which can lead to false positive ultrasound results.

Penetration of ultra violet rays through animal tissues.

Studies on the penetration of ultra violet rays for tissues were made on living animals with the quartz spectroscope and spectrograph. For this purpose rabbits, cats and dogs were used. The animals were anesthetized, the skin of the abdomen was cut open and dissected back on one side and then the barrel of the spectrograph was introduced under the skin. The skin was then radiated from the outside with Krohmayer and Hanovia Alpine Sun Mercury Vapor Lamps and a spectrophotograph of the waves which passed through the skin was thus obtained while the animal was alive and the blood circulating. In this way it was found that a considerable number of invisible ultra violet rays passed through the rabbits', cats' and dogs' skins. Thus in the case of rabbit skins varying from 1 to 2 or more millimeters in thickness, the spectrograph showed the lines in the region of 2800 angstrom units and sometimes even shorter wave lengths. In the case of the rabbit the longer ultra violet rays penetrated not only through the skin but even through the whole thickness of the abdominal wall as shown by spectrographs made with the barrel of the instrument inserted into the peritoneal cavity. Here wave lengths of 3000 angstrom units were frequently obtained with both Alpine Sun and Kromayer lamps, although the thickness of the abdominal wall (skin, fascia, muscle, and peritoneum) was usually about 3 to 4 millimeters. The permeability of dead tissue was different from living animal tissue, depending upon the state of preservation. Thus, when skin was left at room temperature and began to undergo putrefaction, the permeability was greater than in a normal living skin. On the other hand when skin was preserved either by freezing or by preservatives such as formalin or alcohol, the coagulation of proteins and other chemical changes thus produced rendered it more opaque.