Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
【摘要】 目的 探討肥胖人群減肥后體重急劇下降導致腹壁松弛行腹壁整形手術的療效。 方法 2003年4月-2009年10月，24例減肥后體重下降導致腹壁松弛患者中男3例，女21例，年齡28~44歲，平均36歲。其中1例合并甲狀腺功能亢進，1例合并糖尿病病史；20例均通過運動、控制飲食等方式致體重下降，4例接受胃減容手術后體重下降。體重下降穩定后至腹壁整形手術時間間隔2~4年，平均2.5年；減肥前至腹壁整形手術前體重下降37~67 kg，平均下降45 kg。手術采用屈髖位，切除松弛皮膚組織，收緊腹壁及腰部松弛組織，恥骨上沿皮瓣遠端去表皮后與恥骨上沿骨膜縫合固定。所有患者隨訪5個月~2年。 結果 23例術后2周皮瓣完全成活，切口愈合良好，無切口感染；1例術后出現恥骨上切口約2 cm表皮裂開，換藥2周后切口愈合，術后腹壁平整、對稱，無皮下血腫發生。隨訪期間切口疤痕隱蔽，陰阜無上移，腹壁平坦、對稱。 結論 該腹壁整形手術方式效果良好，術后并發癥少，值得推廣。From April 2003 to October 2009, 24 obese patients, including three males and 21 females, developed abdominal chalastodermia caused by weight loss. Their age ranged from 28 to 44 years old with an average age of 36 years. Among them, one had hyperthyroidism and one had a medical history of diabetes. Twenty patients lost weight by exercise and diet, while the other four lost weight through stomach reduction surgery. Time span from weight loss to abdominal plastic surgery was two to four years, averaging at 2.5 years. During the time from before weight loss until the surgery, weight loss ranged from 37-67 kg, averaging at 45 kg. The surgery adopted the position of bending hip. The loose skin was removed; abdominal wall and loose waist tissues were tightened; and the far end of flap without skin along the upper edge of pubis was sutured with the periosteum. All patients were followed up for a time ranged from five months to two years. Results Flaps survived within two weeks after the surgery, incision healed perfectly, and no infection occurred to the incision for all the patients except in one case, there was a 2 cm of skin fissure in the upper incision which was cured after two weeks of dressing. After the surgery, the abdominal wall was flat and symmetrical without subcutaneous hematoma. During the follow-up, scars were well hidden, mons pubis was not shifted upward, and the abdominal wall was flat and symmetrical. Conclusion The abdominal wall plastic surgery has a good clinical outcome with few complications, which is worth being popularized.
目的 探討應用人工合成材料雙層聚丙烯補片修補腹壁切口疝的效果。方法 21例腹壁切口疝（15例大切口疝和及6例巨大切口疝）患者采用雙層聚丙烯補片行無張力修補，對術中及術后情況進行分析。結果 全組病例手術順利，手術時間 87～189 min，平均123 min。無嚴重并發癥發生，痊愈出院。術后隨訪5～36個月（平均 17個月），無復發病例。結論 雙層聚丙烯補片修補中下腹壁大切口疝及巨大切口疝是一種安全、有效的方法，是臨床上治療切口疝可供選擇的一種手術方式。
目的 總結纖維瘤病的治療經驗。方法 回顧性分析1998年6月至2007年6月峰峰集團孫莊礦醫院收治的39例纖維瘤病患者的臨床資料。結果 首次手術治療31例，其中治愈27例，復發4例； 保守治療的8例，與手術后復發的4例再次接受手術治療，其中10例治愈，2例復發（均為再手術病例）。結論 纖維瘤病若手術切除不徹底，易復發； 擴大切除術效果較好。
Objective To summarize the therapeutic experiences of abdominal wall bulge repair with compound patch intraperitoneal placement. Methods From October 2005 to October 2008, intraperitoneal onlay mesh with compound patch applied in 7 patients with abdominal wall bulge, whose clinical data were analyzed retrospectively. Results All the procedures were performed successfully, including 5 open operation and 2 laparoscopic repair. The mean operation time was 85 min (ranged 68 to 130 min). After operation, 1 seroma formation and 1 hemorrhage in the thoracic cavity developed and were cured with the conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged 8 to 16 d). There was no recurrence, infection, or prolonged pain during 1－4 years follow-up. Conclusion Abdominal wall bulge is caused by the weakness of abdominal wall muscle, and the intraperitoneal onlay mesh repair with compound patch is an appropriate therapy.
Objective To evaluate a new alternative method for thereconstruction of vagina with deep inferior epigastric perforator(DIEP) flap. Methods From January 2004 to May 2005, DIEP flaps were used for vaginal reconstruction in 5 patients(19 to 40 years), including 4 cases of congenital vaginal agenesis and 1 case of vaginal tumor. Before operation, the perforators were detected by theDoppler and the flaps based on the perforators ranged from 10 cm×9 cm to 12 cm×11 cm. DIEP flaps were elevated and then transferred to reconstruct the vagina. Results Deep inferior epigastric perforator flaps were used in 5 patients. Only 1 patient developed haematoma in the posterior aspect of thereconstructed vagina, but the flap was viable. The wounds healed secondarily after conservative therapy. All the flaps survived completely. No complication occurred at donor site of abdominal wall. Conclusion Despite technical difficulties in elevatingthe deep inferior epigastric perforator flap, the flap is a good choice for vaginal reconstruction.
OBJECTIVE: To evaluate the outcome of prevention of abdominal hernia in reconstruction of defect of abdominal wall with Gore-tex clinically. METHODS: Six cases of the large defects of abdominal wall were repaired with Gore-tex after surgical removal of abdominal wall tumor. RESULTS: The reconstructed cases were followed up six months to three years and there was no postoperative complication. CONCLUSION: Gore-tex is a reliable and effective biomaterial for reconstruction of the large defect of abdominal wall.
ObjectiveTo summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice. MethodsThe literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed. ResultsThis review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications. ConclusionAbdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.