By Michael J. Rosen MD FACS
An very important evaluate on stomach wall reconstruction for the final healthcare professional! issues will contain preoperative optimization of a ventral hernia sufferer, prevention of incisional hernias, laparoscopic ventral hernia fix, open ventral hernia fix, ordinary hernias, epigastric and umbilical hernias, parastomal hernia fix, flap reconstruction, artificial mesh, medical results of biologic mesh, pediatric hernias, takedown of enterocutaneous fistula, a assessment of laparoscopic as opposed to open inguinal hernia, and extra!
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Additional info for Abdominal Wall Reconstruction, an Issue of Surgical Clinics,
Clinics Review Articles SURGICAL CLINICS OF NORTH AMERICA Abdominal Wall Reconstruction Michael J. Rosen, MD, FACS Division of GI and General Surgery, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA ISSN 0039-6109 Volume 93 • Number 5 • October 2013 Table of Contents Cover image Title page Contributors Consulting Editor Editor Authors Forthcoming Issues Forthcoming Issues Recent Issues Foreword: Abdominal Wall Reconstruction Preface: Abdominal Wall Reconstruction Prevention of Incisional Hernias Key points Introduction The choice of incision Wound healing Preoperative Risk Reduction Key points Introduction Smoking Nutrition and metabolic control Preoperative metabolic preparation for surgical intervention SSI Perioperative antibiotics Perioperative blood glucose management Obesity Preoperative axial imaging Skin preparation and decolonization protocols Miscellaneous techniques and treatments to reduce risk Summary Repair of Umbilical and Epigastric Hernias Key points Introduction Anatomy Etiology Epidemiology Classification Clinical presentation Surgical technique Common techniques Special considerations Summary Laparoscopic Ventral Hernia Repair Key points Introduction Indications and patient selection Preoperative planning Surgical technique Hernias in difficult locations Recurrent hernias Postoperative care Complications Summary Open Ventral Hernia Repair with Component Separation Key points Introduction Preoperative planning Clinical anatomy Choice of mesh Surgical technique: posterior component separation Surgical technique: anterior component separation Postoperative care Postoperative complications Outcomes Summary Atypical Hernias Key points Introduction Preoperative planning Surgical technique Summary Takedown of Enterocutaneous Fistula and Complex Abdominal Wall Reconstruction Key points Introduction Acute intestinal failure and enterocutaneous fistulation Cause and classification Preoperative management Diagnosis and management of abdominal sepsis Wound and fistula care Nutritional support Psychological support Principles of definitive surgical reconstruction Operative technique Parastomal Hernia Repair Key points Introduction PSH repair PSH prevention Summary Soft Tissue Coverage in Abdominal Wall Reconstruction Key points Local flap options Regional flap options Free tissue transfer Flap donor site options Recipient vessels Abdominal wall transplantation Biology of Biological Meshes Used in Hernia Repair Key points Introduction Basic concepts Collagen cross-linking Mesh integration and host reactions Biological mesh remodeling Summary Clinical Outcomes of Biologic Mesh Key points Introduction Types of biologic mesh Clinical outcomes Summary Safety of Prosthetic Mesh Hernia Repair in Contaminated Fields Key points Introduction Early experience Midterm experience Prosthetic hernia repair in elective contaminated settings Emergent prosthetic repair of acutely strangulated hernias Prosthetic incisional hernia prophylaxis Prosthetic parastomal hernia prophylaxis Retrospective database outcomes The modern era and lightweight mesh Summary Economics of Abdominal Wall Reconstruction Key points Introduction Scope of the problem Cost-effectiveness of mesh for hernia repair Economic impact of laparoscopic hernia repair Hernia prophylaxis Economic impact of component separation procedures (open and endoscopic) Hospital costs of abdominal wall hernia repairs Biological mesh Summary Pediatric Abdominal Wall Defects Key points Introduction Inguinal hernias Femoral hernias Umbilical hernias Epigastric hernias Lumbar hernias Spigelian hernias Congenital abdominal wall defects Laparoscopic Versus Open Inguinal Hernia Repair Key points Should all hernias be repaired?
Butler Abdominal wall defects requiring soft tissue coverage can be either partial-thickness defects or full-thickness composite defects. Soft tissue flap reconstruction offers significant advantages in defects that cannot be closed primarily. Flap reconstruction is performed in a single-stage procedure obviating chronic wound management. If the defect size exceeds the availability of local soft tissue for coverage, regional pedicled flaps can be delivered into the abdominal wall while maintaining blood supply from their donor site.
Any surgeon dealing with abdominal wall defects must familiarize themselves with all aspects of the preoperative, intraoperative, and postoperative care of these very challenging but rewarding patients. Despite the clinical strides made over the past decade in dealing with these challenging problems, there remains much room for innovations and improvements. I hope that this issue of the Surgical Clinics of North America will provide the practicing surgeon with a useful foundation to improve the outcomes of their patients undergoing abdominal wall reconstruction.
Abdominal Wall Reconstruction, an Issue of Surgical Clinics, by Michael J. Rosen MD FACS