Experimental investigation of the elasticity of the human diaphragm

<p>Abstract</p> <p>Background</p> <p>Traumatic diaphragmatic ruptures affect mainly the left side. In an experimental study in human corpses we examined the stretch behaviour of the left and right diaphragmatic halves.</p> <p>Methods</p> <p>In a total of 8 male and 8 female corpses each diaphragmatic half was divided into 4 different segments. Each segments stretch behaviour was investigated. In steps of 2 N the stretch was increased up to 24 N.</p> <p>Results</p> <p>In the female the left diaphragm showed a stronger elasticity compared to the right. Additionally the left diaphragm in females showed a higher elasticity in comparison to the left in males. Traumatic diaphragmatic ruptures affect mostly the central tendineous part or the junction between tendineous and muscular part of the diaphragmatic muscle. Accordingly we found a lower elasticity in these parts compared with the other diaphragmatic segments.</p> <p>Conclusion</p> <p>In summary it can be said that albeit some restrictions we were able to determine the elasticity of different diaphragmatic segments quantitatively and reproduceably with our presented method. Thereby a comparison of results of different diaphragmatic segments as well as of both diaphragmatic halves and of both genders was possible</p

New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report

<p>Abstract</p> <p>Introduction</p> <p>Breast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site.</p> <p>Case presentation</p> <p>We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro^®).</p> <p>Conclusion</p> <p>The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.</p

Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note

<p>Abstract</p> <p>Background</p> <p>Piezoresistive pressure measurement technique (PRM) has previously been applied for direct IAP measurement in a porcine model using two different devices. Aim of this clinical study was to assess both devices regarding complications, reliability and agreement with IVP in patients undergoing elective abdominal surgery.</p> <p>Methods</p> <p>A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach^®-probe or an Accurate++^®-probe (both MIPM, Mammendorf, Germany). Probes were placed on the greater omentum and passed through the abdominal wall paralleling routine drainages. PRM was compared with IVP measurement by t-testing and by calculating mean difference as well as limits of agreement (LA).</p> <p>Results</p> <p>There were no probe related complications. Due to technical limitations, data could be collected in 3/10 patients with Coach^®and in 7/10 patients with Accurate++^®. Analysis was carried out only for Accurate++^®. Mean values did not differ to mean IVP values. Mean difference to IVP was 0.1 ± 2.8 mmHg (LA: -5.5 to 5.6 mmHg).</p> <p>Conclusion</p> <p>Direct IAP measurement was clinically uneventful. Although results of Accurate++^®were comparable to IVP, the device might be too fragile for IAP measurements in the clinical setting. Local ethical committee trial registration: EK2024</p