R E Aliotta1, J Gatherwright2, D Krpata3, S Rosenblatt3, M Rosen3, R Gurunluoglu4. 1. Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, OH, USA. 3. Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 4. Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA. gurunlr@ccf.org.
Abstract
INTRODUCTION: Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management. METHODS: Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months). RESULTS: All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences. CONCLUSION: Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.
INTRODUCTION:Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management. METHODS:Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months). RESULTS: All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences. CONCLUSION: Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.
Authors: Arielle E Kanters; David M Krpata; Jeffrey A Blatnik; Yuri M Novitsky; Michael J Rosen Journal: J Am Coll Surg Date: 2012-09-19 Impact factor: 6.113
Authors: David M Krpata; Brian J Schmotzer; Susan Flocke; Judy Jin; Jeffrey A Blatnik; Bridget Ermlich; Yuri W Novitsky; Michael J Rosen Journal: J Am Coll Surg Date: 2012-08-04 Impact factor: 6.113
Authors: D Harji; C Thomas; S A Antoniou; H Chandraratan; B Griffiths; B T Henniford; L Horgan; F Köckerling; M López-Cano; L Massey; M Miserez; A Montgomery; F Muysoms; B K Poulose; W Reinpold; N Smart Journal: BJS Open Date: 2021-03-05
Authors: T N Grove; L J Muirhead; S G Parker; D R L Brogden; S C Mills; C Kontovounisios; A C J Windsor; O J Warren Journal: Hernia Date: 2020-05-15 Impact factor: 4.739