OBJECTIVE: The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. METHODS: Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. RESULTS: A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance (P=0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r, −0.63; P < 0.01). CONCLUSION: We suggested the use of intradermal buried vertical mattress as a cosmetically superior skin closure method for application in cesarean sections over subcuticular stitch.
Abdominal Wound Closure Techniques ; Cesarean Section ; Cicatrix ; Cosmetic Techniques ; Female ; Humans ; Methods ; Pregnancy ; Retrospective Studies ; Skin ; Sutures ; Telephone ; Wound Healing

BACKGROUND: The objective of this study was to develop a new surgical technique by combining traditional abdominoplasty with liposuction. This combination of operations permits simpler and more accurate management of various abdominal deformities. In lipoabdominoplasty, the combination of techniques is of paramount concern. Herein, we introduce a new combination of liposuction and abdominoplasty using deep-plane flap sliding to maximize the benefits of both techniques. METHODS: Deep-plane lipoabdominoplasty was performed in 143 patients between January 2007 and May 2014. We applied extensive liposuction on the entire abdomen followed by a sliding flap through the deep plane after repairing the diastasis recti. The abdominal wound closure was completed with repair of Scarpa's fascia. RESULTS: The average amount of liposuction aspirate was 1,400 mL (700-3,100 mL), and the size of the average excised skin ellipse was 21.78×12.81 cm (from 15×10 to 25×15 cm). There were no major complications such as deep-vein thrombosis or pulmonary embolism. We encountered 22 cases of minor complications: one wound infection, one case of skin necrosis, two cases of undercorrection, nine hypertrophic scars, and nine seromas. These complications were solved by conservative management or simple revision. CONCLUSIONS: The use of deep-plane lipoabdominoplasty can correct abdominal deformities more effectively and with fewer complications than traditional abdominoplasty.
Abdomen ; Abdominal Wound Closure Techniques ; Abdominoplasty ; Asian Continental Ancestry Group* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Fascia ; Humans ; Lipectomy ; Necrosis ; Pulmonary Embolism ; Seroma ; Skin ; Venous Thrombosis ; Wound Infection

BACKGROUND: The objective of this study was to develop a new surgical technique by combining traditional abdominoplasty with liposuction. This combination of operations permits simpler and more accurate management of various abdominal deformities. In lipoabdominoplasty, the combination of techniques is of paramount concern. Herein, we introduce a new combination of liposuction and abdominoplasty using deep-plane flap sliding to maximize the benefits of both techniques. METHODS: Deep-plane lipoabdominoplasty was performed in 143 patients between January 2007 and May 2014. We applied extensive liposuction on the entire abdomen followed by a sliding flap through the deep plane after repairing the diastasis recti. The abdominal wound closure was completed with repair of Scarpa's fascia. RESULTS: The average amount of liposuction aspirate was 1,400 mL (700-3,100 mL), and the size of the average excised skin ellipse was 21.78×12.81 cm (from 15×10 to 25×15 cm). There were no major complications such as deep-vein thrombosis or pulmonary embolism. We encountered 22 cases of minor complications: one wound infection, one case of skin necrosis, two cases of undercorrection, nine hypertrophic scars, and nine seromas. These complications were solved by conservative management or simple revision. CONCLUSIONS: The use of deep-plane lipoabdominoplasty can correct abdominal deformities more effectively and with fewer complications than traditional abdominoplasty.
Abdomen ; Abdominal Wound Closure Techniques ; Abdominoplasty ; Asian Continental Ancestry Group* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Fascia ; Humans ; Lipectomy ; Necrosis ; Pulmonary Embolism ; Seroma ; Skin ; Venous Thrombosis ; Wound Infection

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9x6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.
Abdominal Wound Closure Techniques ; Adult ; Cesarean Section ; Cicatrix ; Congenital Abnormalities ; Cosmetics ; Endometriosis ; Female ; Follow-Up Studies ; Hernia ; Humans ; Menopause ; Pregnancy ; Recurrence

BACKGROUND: If a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect. METHODS: From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction. RESULTS: Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery. CONCLUSIONS: Using a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.
Abdominal Wall ; Abdominal Wound Closure Techniques ; Bandages ; Cesarean Section ; Debridement ; Esthetics ; Fascia ; Female ; Follow-Up Studies ; Humans ; Infection Control ; Length of Stay ; Muscles ; Myoma ; Peritonitis ; Pregnancy ; Rectus Abdominis ; Rupture ; Skin ; Subcutaneous Tissue ; Wound Infection

PURPOSE: To describe the experience of patients over a 7-year period who have had open abdomen (OA) surgery, at a tertiary university hospital.METHODS: The medical records of 59 patients, who were managed with OA after a laparotomy between March 2009 and December 2015, were reviewed retrospectively. The data collected included demographics, indication for OA, abdominal closure methods, abdominal closure rate, the intensive care unit stay duration, mechanical ventilation duration, hospital stay duration, and complications.RESULTS: Forty-seven patients (37 males, 78.7%) with a mean age of 52.2 ± 16.7 years were reviewed in the study. The indications for OA were traumatic intra-abdominal bleeding in 23 patients (48.9%), non-traumatic bowel perforation in 10 (21.3%), non-traumatic bleeding in 7 (14.9%), and bowel infarction in 6 (12.8%). The abdominal wall was closed in 38 patients (80.9%). Primary closures and fascial closure using an artificial mesh were performed on 21 (44.7%) and 12 patients (25.5%), respectively. The median number of dressing changes was 0 (interquartile range 0 – 1). The median duration of the intensive care unit and hospital stays were 12.0 and 32.0 days, respectively. The median interval to abdominal closure was 4 days (interquartile range 2 – 10.3 days). Twenty-seven patients developed complications, including uncontrolled sepsis (21.3%), entero-atmospheric fistula (19.1%), ventral hernia (8.5%), bleeding (4.3%), and lateralization (4.3%). The mortality rate was 44.7% with sepsis being the main cause of death (61.9%).CONCLUSION: Traumatic intra-abdominal bleeding was a common indication for OA. Primary closure was performed in most patients, and frequent complications resulted in poor patient outcomes.
Abdomen ; Abdominal Wall ; Abdominal Wound Closure Techniques ; Bandages ; Cause of Death ; Demography ; Fistula ; Hemoperitoneum ; Hemorrhage ; Hernia, Ventral ; Humans ; Infarction ; Intensive Care Units ; Intra-Abdominal Hypertension ; Intraabdominal Infections ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Mortality ; Respiration, Artificial ; Retrospective Studies ; Sepsis

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.
Abdomen* ; Abdominal Wound Closure Techniques ; Aged ; Anastomotic Leak ; Extracorporeal Membrane Oxygenation ; Fistula* ; Gastrectomy ; Hemodiafiltration ; Humans ; Intestinal Fistula ; Perforator Flap* ; Skin ; Surgeons ; Surgery, Plastic ; Transplants ; Ultrasonography ; Ultrasonography, Doppler ; Ventilators, Mechanical ; Wounds and Injuries

The ideal method of wound closure should be simple, rapid, inexpensive, painless, and bactericidal, and should achieve optimal cosmetic results. Tissue adhesives offer many of these characteristics. Until recently, the only commercially available tissue adhesive was 2-butylcyanoacrylate. A new tissue adhesive, 2-octylcyanoacrylate (Dermabond(R)), offers several advantages over 2-butylcyanoacrylate. It is more pliable and less brittle. To compare a new tissue adhesive, 2-octylcyanoacrylate, with standard wound closure techniques for the repair of open wound, two groups of each 20 rats were studied. Two groups were similar for demographic and clinical characteristics. Photographs taken at three months were rated by seven plastic surgeons blinded to the method of closure. There was no difference between two groups for appearance or complication. In conclusion, wound treated with Dermabond(R) and standard wound closure techniques have similar cosmetic results 3 months later, and Dermabond(R) is a faster method of wound repair that has cosmetic results similar to the use of sutures.
Animals ; Rats* ; Sutures ; Tissue Adhesives ; Wound Closure Techniques* ; Wounds and Injuries*

Proper suturing technique is essential for obtaining good cosmetic results and for preventing scarring and poor healing of the wound. Characteristics of an ideal wound closure technique include: providing maximal wound eversion; maintaining tensile strength throughout the healing process; being technically simple and fast for the surgeon to perform; and allowing for precise wound edge approximation without leaving suture marks. There are a large variety of suturing methods available to the plastic surgeon and more than one of these techniques may be appropriate for any single wound closure. The simple interrupted suture is the simplest and most frequently employed type of suture. The vertical mattress suture is used principally to ensure eversion of skin edges, but is rarely indicated on the face. A common technique for wound closure is to alternate a vertical mattress suture with a simple interrupted suture along the length of the wound. This report outlines a new method for closing skin wounds which combines the horizontal and vertical mattress sutures. This horizonto- vertical mattress suture is easy and quick to perform, achieves precise wound approximation, provides good eversion of skin edges maintaining uniform tensile strength, reduces the risk of suture marks and gives good cosmetic results, and it can be widely applicable to the whole body area wound, including the face.
Cicatrix ; Skin ; Sutures* ; Tensile Strength ; Wound Closure Techniques ; Wounds and Injuries

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards