Open abdomen management with human acellular dermal matrix in liver transplant recipients.
ABSTRACT Abdominal wall closure after liver transplantation is not always feasible and may result in increased intra-abdominal pressure along with associated complications. Various temporary closure techniques as well as open wound management have been used to address this complex problem. The aim of this series was to describe an approach to definitive wound closure of the open abdomen in liver transplant patients.
We performed a retrospective review of all liver transplant patients at our institution from September 2005 to November 2007. The management of the open abdomen in 10 liver transplant patients was reviewed, and a novel approach described to manage these defects.
Ten patients with open wounds were closed during the study period using human acellular dermal matrix (HADM). There were 7 men and 3 women of median age 55 years. Average size of HADM was 235 cm(2). The median follow-up is 10 months with no incidence of evisceration or hernia. In 1 patient, the graft failed along the lateral side due to infection; it dislodged during vacuum-assisted closure dressing change in another patient at 5 months after closure. Fascial closure was not possible due to organ edema (n = 3), a large liver (n = 4) or wound infection with dehiscence (n = 3).
HADM can be used for primary wound closure in both clean and contaminated wounds as an alternative to an open abdomen post-liver transplantation.
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ABSTRACT: This research is concerned with a stability control method with a criterion based on reaction for motion control of a mobile manipulator. Mobile manipulators can propel themselves around a work area and can operate over a wide area. Then, a stability evaluation and a stability control method must be required for mobile manipulators that are not fixed on a floor. The evaluation method based on ZMP (Zero Moment Point) criterion, in which the model is regarded as a particle system, is not satisfactory for evaluating stability of a mobile manipulator that consists of solid links. In addition, transient state during tipping over has not been discussed. In this paper, we propose a stability evaluation criterion based on reaction for the solid model of a dynamic mobile manipulator. First, equations of motion of the mobile manipulator for stable and unstable states of motion are formulated based on constraint conditions. Second, a stability criterion based on reaction is proposed by referring the formulated model. Third, the relationships between changes in reaction and changes in ZMP during tipping over are discussed through simulations. Finally, it is shown that a mobile manipulator can return from unstable transient state to stable state by performing stability compensation motion.SICE 2003 Annual Conference; 09/2003
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ABSTRACT: Complex abdominal wall defects can present a significant challenge to the reconstructive surgeon. In 2003, acellular dermal matrix (ADM) was introduced as an alternative to synthetic materials with suggestions that it has improved capacity to integrate with surrounding tissues with less inclination towards infection, erosion, extrusion, adhesion formation and rejection compared with synthetic materials. This systematic review was conducted to evaluate the existing literature describing the use of ADM for abdominal wall reconstruction in an attempt to identify factors that may affect outcomes. A review of the MEDLINE database using the search terms 'dermal matrix' and 'abdomen' or 'hernia' for prospective and retrospective human studies in English was performed. Exclusion criteria were animal studies, case reports, reviews and articles that dealt only with ADM for repair of congenital abdominal wall defects, hiatal, parastomal or inguinal hernias and enterocutaneous fistulae. Two independent reviewers performed the systematic review with the same a priori criteria, with discrepancies reconciled by the senior author. In October 2010, 3394 articles were identified as potentially inclusive based on the search term 'dermal matrix'. When filtered for 'abdomen' or 'hernia', 83 articles were found. Ultimately, 30 articles met criteria. No other systematic reviews, meta-analyses or randomised controlled trials were identified in the existing literature. At this current time, there is a paucity of high-level evidence comparing ADM with other methods interfering with the ability of physicians to make data-driven recommendations on clinical indications, surgical techniques and outcomes following ADM-assisted abdominal wall reconstruction.Journal of Plastic Reconstructive & Aesthetic Surgery 05/2011; 64(12):1562-71. · 1.44 Impact Factor
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ABSTRACT: BACKGROUND: No consensus has been reached on the use of bioprosthetics to repair abdominal wall defects. The purpose of this systematic review was to summarize the outcomes from studies describing this use of various bioprosthetics for incisional hernia repair. METHODS: Studies published by October 2011 were identified through literature searches using EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. RESULTS: A total of 491 articles were scanned, 60 met eligibility criteria. Most studies were retrospective case studies. The studies ranged considerably in methodologic quality, with a modified Methodological Index of Nonrandomized Studies score from 5 to 12. Many repairs were performed in contaminated surgical sites (47.9%). At least one complication was seen in 87% of repairs. Major complications noted were wound infections (16.9%) and seroma (12.0%). With a mean follow-up period of 13.6 months the hernia recurrence rate was 15.2%. CONCLUSIONS: There is an insufficient level of high-quality evidence in the literature on the value of bioprosthetics for incisional hernia repair. Randomized controlled trials that use standardized reporting comparing bioprosthetics with synthetic mesh for incisional hernia repair are needed.American journal of surgery 08/2012; · 2.36 Impact Factor