Kevin Bruen

Publications (2)3.76 Total impact

• Article: Successful repair of a diaphragmatic hernia through a pericardial window with acellular dermal matrix.

  Kevin Bruen, Earl Downey
  [show abstract] [hide abstract]
  ABSTRACT: A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.
  Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2007; 17(3):383-6. · 1.40 Impact Factor
• Article: Acellular dermal matrix in the management of high-risk abdominal wall defects.

  Hyong Kim, Kevin Bruen, Daniel Vargo
  [show abstract] [hide abstract]
  ABSTRACT: Ventral hernia repair in the face of a contaminated field or with questionable skin coverage requires either complex abdominal wall flaps or a staged repair. The development of biologic prostheses has altered the approach to these difficult clinical problems. The study population consisted of human acellular dermal matrix (HADM) implantation into wounds considered high risk, defined as either infected or with poor skin coverage. Patient demographics, preoperative risk factors and infection data, postoperative wound complications, and long-term results were collected. Twenty-nine patients were identified in whom ADM was implanted into high-risk hernia defects. Forty-five percent developed a postoperative wound occurrence, with 31% requiring the wound to be either treated open or with a percutaneous drain. Ninety-six percent went on to heal without event. The follow-up evaluation averaged 182 days. Eighty-nine percent were repaired successfully with one surgery. Three recurrences have been identified. The use of ADM allowed for successful primary closure in 90% of patients with intermediate- to long-term follow-up evaluation. A postoperative wound occurrence rate of 45% shows the use of this material in resisting infection. ADM can be used in ventral hernia repair in high-risk wounds with a high degree of success.
  American journal of surgery 01/2007; 192(6):705-9. · 2.36 Impact Factor