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Michael J. Rosen - Abdominal Wall Reconstruction, an Issue of Surgical Clinics,

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An important review on abdominal wall reconstruction for the general surgeon! Topics will include preoperative optimization of a ventral hernia patient, prevention of incisional hernias, laparoscopic ventral hernia repair, open ventral hernia repair, atypical hernias, epigastric and umbilical hernias, parastomal hernia repair, flap reconstruction, synthetic mesh, clinical outcomes of biologic mesh, pediatric hernias, takedown of enterocutaneous fistula, a review of laparoscopic versus open inguinal hernia, and more!

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Clinics Review Articles
SURGICAL CLINICS OF NORTH AMERICA
Abdominal Wall Reconstruction

Michael J. Rosen, MD, FACS

Division of GI and General Surgery, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA

ISSN 0039-6109
Volume 93 Number 5 October 2013

Contributors
Consulting Editor

RONALD F. MARTIN, MD, FACS

Staff Surgeon, Department of Surgery, Marshfield Clinic, Marshfield, Wisconsin; Clinical Associate Professor, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Colonel, Medical Corps, United States Army Reserve

Editor

MICHAEL J. ROSEN, MD, FACS

Co-Director, Case Acute Intestinal Failure Unit; Associate Professor of Surgery; Chief, Division of GI and General Surgery, Department of Surgery; Director, Case Comprehensive Hernia Center, Case Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio

Authors

ANDREA MARIAH ALEXANDER, MD

MIS Fellow/Clinical Instructor, Department of Surgery, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

DONALD P. BAUMANN, MD, FACS

Associate Professor, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas

CURTIS BOWER, MD

Instructor of Surgery, Section of Gastrointestinal and Minimally Invasive Surgery, Division of General Surgery, A. B. Chandler Medical Center, University of Kentucky, Lexington, Kentucky

CHARLES E. BUTLER, MD, FACS

Professor with Tenure, Director, Graduate Medical Education Programs, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas

ALFREDO M. CARBONELL, DO, FACS, FACOS

Associate Professor of Surgery, Chief, Division of Minimal Access and Bariatric Surgery, Co-director, Hernia Center, Greenville Health System, University of South Carolina School of Medicine Greenville, Greenville, South Carolina

GORDON LAWRENCE CARLSON, BSc, MD, FRCS

Professor, Department of Surgery, National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom

LEANDRO TOTTI CAVAZZOLA, MD, PhD

Assistant Professor, Department of Surgery, Universidade Federal do Rio Grande do Sul, Bairro Petrpolis, Porto Alegre, Rio Grande do Sul, Brazil

WILLIAM S. COBB, MD, FACS

Associate Professor of Surgery, Vice Chair of Clinical Affairs, Department of Surgery, Co-director, Hernia Center, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, South Carolina

RANDALL O. CRAFT, MD

Plastic and Reconstructive Surgery, Division of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona

CLIFFORD W. DEVENEY, MD

Professor, Department of Surgery, Oregon Health and Science University, Portland, Oregon

DAVID B. EARLE, MD, FACS

Director of Minimally Invasive Surgery and Esophageal Physiology Lab, Department of Surgery, Baystate Medical Center, Springfield; Associate Professor of Surgery, Tufts University School of Medicine, Boston, Massachusetts

KRISTI L. HAROLD, MD

Associate Professor, Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona

HOBART W. HARRIS, MD, MPH

J. Englebert Dunphy Chair in Surgery, Professor and Chief, Division of General Surgery, Department of Surgery, UCSF, San Francisco, California

W. BORDEN HOOKS III, MD

Assistant Professor, Department of Surgery, New Hanover Regional Medical Center, South East Area Health Education Center, University of North Carolina-Chapel Hill, Wilmington, North Carolina

WILLIAM W. HOPE, MD

Assistant Professor, Department of Surgery, New Hanover Regional Medical Center, South East Area Health Education Center, University of North Carolina-Chapel Hill, Wilmington, North Carolina

LEIF A. ISRAELSSON, MD, PhD

Associate Professor, Department of Surgery and Perioperative Science, Ume University, Ume; Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden

KATHERINE B. KELLY, MD

Division of Pediatric Surgery, Pediatric Surgery Center, Akron Childrens Hospital, Akron, Ohio

ROBERT G. MARTINDALE, MD, PhD

Professor and Chief, Division of General Surgery, Oregon Health and Science University, Portland, Oregon

JENNIFER A. MCLELLAN, MD

Minimally Invasive Surgery Fellow, Department of Surgery, Baystate Medical Center, Springfield, Massachusetts

DANIEL MILLBOURN, MD, PhD

Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden

YURI W. NOVITSKY, MD

Director, Surgical Research, Associate Professor of Surgery, Department of Surgery, Co-Director, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio

ERIC M. PAULI, MD

Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania

TODD A. PONSKY, MD, FACS

Associate Professor of Surgery and Pediatrics, Division of Pediatric Surgery, Pediatric Surgery Center, Akron Childrens Hospital, Akron, Ohio

MICHAEL J. ROSEN, MD, FACS

Co-Director, Case Acute Intestinal Failure Unit; Associate Professor of Surgery; Chief, Division of GI and General Surgery, Department of Surgery; Director, Case Comprehensive Hernia Center, Case Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio

J. SCOTT ROTH, MD

Professor of Surgery, Section Head, Section of Gastrointestinal and Minimally Invasive Surgery, Division of General Surgery, A. B. Chandler Medical Center, University of Kentucky, Lexington, Kentucky

DANIEL J. SCOTT, MD, FACS

Professor, Department of Surgery, Frank H. Kidd Jr, MD Distinguished Professorship in Surgery, Director, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

NILAY R. SHAH, MD, MS

Surgery Resident, Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona

DOMINIC ALEXANDER JAMES SLADE, MB ChB, FRCS

Department of Surgery, National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom

Contents

Ronald F. Martin

Michael J. Rosen

Leif A. Israelsson and Daniel Millbourn

The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Midline incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4.

Robert G. Martindale and Clifford W. Deveney

The success of hernia repair is measured by absence of recurrence, appearance of the surgical scar, and perioperative morbidity. Perioperative surgical site occurrence (SSO), defined as infection, seroma, wound ischemia, and dehiscence, increases the risk of recurrent hernia by at least 3-fold. The surgeon should optimize all measures that promote healing, reduce infection, and enhance early postoperative recovery. In the population with ventral hernia, the most common complication in the immediate perioperative period is surgical site infection. This article reviews several preoperative measures that have been reported to decrease SSOs and shorten length of hospital stay.

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