Establishing a center of excellence in abdominal wall reconstruction

Building a tertiary referral center of excellence for complex abdominal wall reconstruction is a multi-step process that requires many elements to garner and promote success. Ultimately the creation of such a center is important for continual improvement of abdominal wall reconstruction outcomes by decreasing complications, recurrences, length of hospital stay, hospital readmissions, and overall costs. Establishing a center of excellence incorporates several key components including the surgeon’s desires and expertise, institutional participation, multidisciplinary collaboration, outcomes research and innovation, and financial stability. This article outlines the principal elements of building a sustainable, functional, and successful center of excellence for complex abdominal wall reconstruction

The use of botulinum toxin A in chemical component separation: a review of techniques and outcomes

Fascial closure is crucial for abdominal wall reconstruction (AWR) but can be especially difficult in patients with massive ventral hernias or loss domain. Recently, botulinum toxin A (BTA) has been increasingly utilized as an adjunct in AWR to aid in fascial closure. This review aims to evaluate the current literature on the use of BTA in AWR to assess current treatment regimens, side effects, outcomes and complications. A literature search was performed, yielding 10 studies that met the inclusion criteria. There was a significant amount of heterogeneity in treatment regimens, with studies differing in BTA injection timing, dosage, concentration, and location. The majority of studies showed that injection of BTA preoperatively was able to augment abdominal wall musculature, with many showing a decrease in mean transverse defect size and high rates of successful fascial closure. No major complications were reported from BTA administration, with only mild side effects reported by some studies. The most common side effects include a weak cough or sneeze, bloating, and back pain, which generally all resolved prior to surgery. While BTA appears to be a promising adjunct for AWR, further investigation is needed to determine optimal patient selection and treatment regimens

Human maternal-fetal lactate relationships

Peer Reviewe