The fate of rectus fascia suburethral slings.
ABSTRACT Autologous rectus fascia is commonly used to construct suburethral slings for the treatment of genuine stress incontinence. This fascia performs well and has not been associated with clinical problems related to its choice as a sling material. However, the histologic appearance of such slings after implantation has not been documented.
At the time of revision of autologous rectus fascia suburethral slings in 5 patients, biopsy specimens of the slings were obtained and submitted for histologic examination. A specimen of rectus fascia before implantation was also obtained from a sixth patient who had no symptoms.
After implantation autologous rectus fascia slings remain viable. There is fibroblast proliferation, neovascularization, and remodeling of the graft. No evidence of inflammatory reaction or of graft degeneration was detected. A linear orientation of connective tissue and fibroblasts was seen in some areas, whereas other areas had remodeled to form tissue similar to noninflammatory scar.
Autologous rectus fascia slings undergo extensive remodeling after implantation.
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ABSTRACT: A technique of reconstructing the inguinal ligament using a pedicled fascia lata flap is described. A 62-year-old man was referred with massive bilateral abdominal wall hernias, following numerous attempts at repair and subsequent recurrences. There was complete absence of the right inguinal ligament. The inguinal ligament was reconstructed using a strip of fascia lata, pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. The musculoaponeurotic abdominal wall was reconstructed with two 20cm×20cm sheets of porcine acellular dermal matrix and an overlying sheet of polypropylene mesh, sutured to the remaining abdominal wall muscles laterally, and to both inguinal ligaments. The cutaneous abdominal wall was closed with an abdominoplasty technique. The reconstruction has remained intact nine months following surgery. Complete destruction of the inguinal ligament is rare but can occur following multiple operative procedures or trauma. To date, the only published reports of inguinal ligament reconstruction have been performed using synthetic mesh. The use of autologous tissue should reduce the risk of erosion into the neurovascular bundle, seroma formation, and enhance integration into surrounding tissues. This new technique for autologous reconstruction of the inguinal ligament provides a safe alternative to the use of synthetic mesh in the operative armamentarium of plastic and hernia surgeons.International journal of surgery case reports. 05/2013; 4(9):785-788.
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ABSTRACT: A Q u a r t e r l y N e w s l e t t e r o n I n c o n t i n e n c e D i a g n o s i s , T r e a t m e n t a n d C a r e T oday, surgeons are faced with a growing number of choices when treating patients with stress urinary incontinence. Over the past several years, there has been a trend towards developing safe, effective, and minimally invasive procedures that allow women to recover more quickly. These qualities might even encourage some women, who were previously reluctant, to undergo surgery for their incontinence. Laparoscopic Burch procedure Since the introduction of the laparoscopic bladder suspension in 1991 by Vancaillie, 1 this minimally invasive approach to stress inconti-nence has become popular with many pelvic surgeons. There are many advantages of the laparoscopic approach to the Burch procedure compared with the traditional ysterectomy has become the extensive operation most commonly per-formed in North America. The incidence of post-hysterectomy vaginal vault prolapse is approximately 11.6 percent when performed for prolapse and 1.8 percent for other benign diseases. 1,2 These facts, coupled with increased life expectancy, imply a considerable increase in the incidence of vault prolapse going into the 21 st century. 3 Vault prolapse is among the most demanding and technically challenging problems facing the practitioner of female reconstructive surgery. It is imperative for the surgeon to have a comprehensive understanding of the support anatomy of the anterior, middle, and posterior pelvic compart-ments. Vault prolapse results from the lack of suspensory support from the pelvic sidewalls, the uterosacral cardinal ligament complex (figure 1A). This support can be weakened by childbirth Sacrocolpopexy with anterior and posterior mesh extensions
- Journal of Experimental & Clinical Medicine. 01/2010; 2(1):11-16.