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Anterior Abdominal Wall (anterior + abdominal_wall)
Selected AbstractsThe transversus abdominis plane block: a valuable option for postoperative analgesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010A topical review The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the ,oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain, including a total of 364 patients, of whom 180 received TAP blockade. The surgical procedures included large bowel resection with a midline abdominal incision, caesarean delivery via the Pfannenstiel incision, abdominal hysterectomy via a transverse lower abdominal wall incision, open appendectomy and laparoscopic cholecystectomy. Overall, the results are encouraging and most studies have demonstrated clinically significant reductions of post-operative opioid requirements and pain, as well as some effects on opioid-related side effects (sedation and post-operative nausea and vomiting). Further studies are warranted to support the findings of the primary published trials and to establish general recommendations for the use of a TAP block. [source] A systematic review of prophylactic antimicrobials in PEG placementJOURNAL OF CLINICAL NURSING, Issue 7 2009Allyson Lipp Aim., To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. Background., Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. Design., Systematic review. Methods., We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. Results., Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0·31, 95% CI 0·22,0·44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5·8 patients to prevent one infection , NNT. Conclusions., Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. Relevance to clinical practice., The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement. [source] Unusual sonographic appearance of synovial sarcoma of the anterior abdominal wallJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2009Tomonori Kishino MD Abstract We report a case of synovial sarcoma in a 58-year-old woman arising from the anterior abdominal wall. Sonography demonstrated a large mass with an unusual complex "honeycomb" echotexture. Doppler imaging displayed increased vascularity in the solid parts of the tumor. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009 [source] Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resectionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2005S. W. Bell Background: Significant morbidity can result from perineal wounds, particularly after radiotherapy and extensive resection for cancer. Myocutaneous flaps have been used to improve healing. The purpose of this study was to evaluate the morbidity and results of primary rectus abdominis myocutaneous flap reconstruction of the vagina and perineum after extended abdominoperineal resection. Methods: Thirty-one consecutive patients undergoing one-stage rectus abdominis myocutaneous flap reconstruction of extensive perineal wounds were studied prospectively. Twenty-six patients had surgery for recurrent or persistent epidermoid anal cancer or low rectal cancer, and 21 had high-dose preoperative radiotherapy. Results: Three weeks after the operation, complete healing of the perineal wound was seen in 27 of the 31 patients. There were nine flap-related complications including three patients with partial flap necrosis, two with vaginal stenosis, one with vaginal scarring, one with small flap disunion and two with weakness of the anterior abdominal wall. There were no unhealed wounds at the completion of follow-up (median 9 months). Conclusion: The transpelvic rectus abdominis myocutaneous flap for the reconstruction of large perineal and vaginal wounds achieves wound healing with only moderate morbidity in the majority of patients after extensive abdominoperineal resection with or without radiotherapy. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Locating the arcuate line of Douglas: Is it of surgical relevance?CLINICAL ANATOMY, Issue 1 2010P.M. Mwachaka Abstract Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before harvesting the flap. This study is aimed at determining the position of the arcuate line in relation to anatomical landmarks of the anterior abdominal wall. Arcuate lines were examined in 80 (44 male, 36 female) subjects, aged between 18 and 70 years, during autopsies and dissection. The position of the arcuate line was determined in relation to the umbilicus, pubic symphysis, and intersections of rectus abdominis muscle. Sixty four (80.4%) cases had the arcuate line. In most cases (52), this line was located in the upper half of a line between the umbilicus and the pubic symphysis. Most males (93%) had the arcuate line, while more than a third of females did not have it. In all these cases, the line occurred bilaterally as a single arcade, constantly at the most distal intersection of the rectus abdominis muscle. Consequently, the arcuate line is most reliably marked superficially by the distal tendinous intersection of the rectus abdominis muscle. Harvesting of the muscle cranial to this point will minimize defects in the anterior abdominal wall that may lead to hernia formation. Clin. Anat. 23:84,86, 2010. © 2009 Wiley-Liss, Inc. [source] Reviewing the vascular supply of the anterior abdominal wall: Redefining anatomy for increasingly refined surgeryCLINICAL ANATOMY, Issue 2 2008W.M. Rozen Abstract The abdominal wall integument is becoming the standard donor tissue for postmastectomy breast reconstruction, with its vascular supply of key importance to the reconstructive surgeon. Refinements in tissue transfer, from pedicled to free flaps and musculocutaneous to perforator flaps, have required increasing understanding of finer levels of this vascular anatomy. The widespread utilization of the deep inferior epigastric artery (DIEA) perforator flap, particularly for breast reconstruction, has rekindled clinical interest in further levels of anatomical detail, in particular the location and course of the musculocutaneous perforators of the DIEA. Advances in operative techniques, and anatomical and imaging technologies, have facilitated an increase in this understanding. The current review comprises an appraisal of both the anatomical and clinical literature, with a view to highlighting the key anatomical features of the abdominal wall vasculature as related to reconstructive flaps. Clin. Anat. 21:89,98, 2008. © 2008 Wiley-Liss, Inc. [source] Mushroom cloud appearance of hemorrhage into the superficial anterior abdominal wall associated with an underlying rectus sheath hematomaCLINICAL ANATOMY, Issue 2 2005Nadim Gulamhuseinwala Abstract We present a case of rectus sheath hematoma compounded by anterior abdominal wall haemorrhage. Its clinical and anatomical relationship is discussed. Clin. Anat. 18:141,145, 2005. © 2005 Wiley-Liss, Inc. [source] | ||||||||||