The Experts below are selected from a list of 474 Experts worldwide ranked by ideXlab platform
Donald H Jenkins - One of the best experts on this subject based on the ideXlab platform.
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outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs
World Journal of Surgery, 2013Co-Authors: Benjamin Zendejas, Boris Srvantstyan, Mohammad Ali Khasawneh, Henry J Schiller, Donald H Jenkins, Martin D ZielinskiAbstract:Background Botulinum toxin A (BTX) confers flaccid paralysis and pain modulation when injected into a muscle. We hypothesized that long-term paralysis of the Abdominal Wall Musculature (i.e., chemical component paralysis, CCP) would benefit incisional hernia repair (IHR) by decreasing postoperative pain, the use of opioid analgesia, and thus opioid-related side effects.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Introduction Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009–June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of Abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial Abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-Abdominal abscess (44 %) and deep surgical site infection (33 %). The “chemical components separation” technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated Abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.
Martin D Zielinski - One of the best experts on this subject based on the ideXlab platform.
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outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs
World Journal of Surgery, 2013Co-Authors: Benjamin Zendejas, Boris Srvantstyan, Mohammad Ali Khasawneh, Henry J Schiller, Donald H Jenkins, Martin D ZielinskiAbstract:Background Botulinum toxin A (BTX) confers flaccid paralysis and pain modulation when injected into a muscle. We hypothesized that long-term paralysis of the Abdominal Wall Musculature (i.e., chemical component paralysis, CCP) would benefit incisional hernia repair (IHR) by decreasing postoperative pain, the use of opioid analgesia, and thus opioid-related side effects.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Introduction Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009–June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of Abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial Abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-Abdominal abscess (44 %) and deep surgical site infection (33 %). The “chemical components separation” technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated Abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.
Henry J Schiller - One of the best experts on this subject based on the ideXlab platform.
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outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs
World Journal of Surgery, 2013Co-Authors: Benjamin Zendejas, Boris Srvantstyan, Mohammad Ali Khasawneh, Henry J Schiller, Donald H Jenkins, Martin D ZielinskiAbstract:Background Botulinum toxin A (BTX) confers flaccid paralysis and pain modulation when injected into a muscle. We hypothesized that long-term paralysis of the Abdominal Wall Musculature (i.e., chemical component paralysis, CCP) would benefit incisional hernia repair (IHR) by decreasing postoperative pain, the use of opioid analgesia, and thus opioid-related side effects.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Introduction Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009–June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of Abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial Abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-Abdominal abscess (44 %) and deep surgical site infection (33 %). The “chemical components separation” technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated Abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.
Oscar M Ramirez - One of the best experts on this subject based on the ideXlab platform.
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abdominoplasty and Abdominal Wall rehabilitation a comprehensive approach
Plastic and Reconstructive Surgery, 2000Co-Authors: Oscar M RamirezAbstract:Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to Abdominal Wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the U-M dermolipectomy, V umbilicoplasty, the rectus abdominis myofascial release, and suction-assisted lipectomy, The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas, Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable casier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the Abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the Abdominal Wall Musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex Abdominal Wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results.
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abdominoplasty and Abdominal Wall rehabilitation a comprehensive approach
Plastic and Reconstructive Surgery, 2000Co-Authors: Oscar M RamirezAbstract:Standard abdominoplasty techniques involve a low horizontal or W skin excision, muscle plication, and umbilical transposition. Newer techniques include suction-assisted lipectomy, the use of high lateral tension with fascial suspension, and external oblique muscle advancement. The author has modified these traditional procedures and added new techniques to improve the aesthetic and functional results of the abdominoplasty procedure. This modification provides a comprehensive approach to Abdominal Wall aesthetic improvement and rehabilitation. The comprehensive approach described includes four components: the "U-M dermolipectomy," "V umbilicoplasty," the rectus abdominis "myofascial release," and suction-assisted lipectomy. The patient is marked while standing for areas of suction lipectomy and undermining. The lower incision is designed as an open U with the lateral limbs placed inside the bikini line. The upper incision is a lazy M with the higher peaks located at the level of the flanks. Subcutaneous hydration is achieved to perform suction along the flanks, waistline, and iliac areas. Gentle suction of the flaps is also performed. The umbilicus is cored out in a heart shape. The flaps within the U-M marks are excised, and the undermining is performed to the xiphoid and costal margins. The rectus diastasis is marked, and the anterior rectus fascia is incised at the junction of the medial third with the central third of the width of the rectus sheath. Horizontal figure-eight plication sutures by using the lateral fascial edge enable easier infolding of the central tissue. The new recipient of the umbilicus is made by an incision in a V shape on the Abdominal flap. The umbilicus is telescoped, and the triangular flap of the abdomen is sutured to the triangular defect of the umbilicus. Skin flap fixation to the umbilicus relieves tension in the lower portion of the flap. The upper skin flap, which is cut in an M manner, provides lateral tension and matches the length of the lower flap. A standard fascial suspension is used and closure is performed in layers. The techniques described here are intertwined procedures. Each facilitates the accomplishment of the other procedure, and they complement each other. They all attain the 12 objectives of the abdominoplasty described. These combined techniques have been used in 104 patients in a period of 11 years. Complications were minimal and easily manageable, except for one patient who required excision of a pseudobursa and retightening of the lower quadrants of the Abdominal Wall Musculature to correct extreme lordosis. A comprehensive approach for the treatment of complex Abdominal Wall aesthetic and functional defects is presented. These require thoughtful integration of the four components mentioned. This approach has allowed predictable, reproducible, and aesthetically pleasing results.
Naeem Goussous - One of the best experts on this subject based on the ideXlab platform.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Introduction Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature.
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chemical components separation with botulinum toxin a a novel technique to improve primary fascial closure rates of the open abdomen
Hernia, 2013Co-Authors: Martin D Zielinski, Henry J Schiller, Naeem Goussous, Donald H JenkinsAbstract:Failure to definitively close the open abdomen (OA) after damage control laparotomy leads to considerable morbidity and mortality. We have developed a novel technique, the “chemical components separation,” which incorporates injection of botulinum toxin A (BTX), a long-term flaccid paralytic, into the lateral Abdominal Wall Musculature. This is a retrospective review of all OA patients (age ≥18) from December 2009–June 2010 who underwent BTX injection. Under ultrasound guidance, a total of 300 units of BTX were injected into the external oblique, internal oblique and transversus abdominus. A total of 18 patients were injected with a median age of 66 years (56 % male). Indications for OA treatment included questionable bowel viability (39 %), shock (33 %), loss of Abdominal domain (6 %) and feculent contamination (17 %). Median ASA score was 3 with an APACHE 3 score of 85. Patients underwent a median of 4 serial Abdominal explorations. The primary fascial closure rate was 83 % with a partial fascial closure rate of 6 % and planned ventral hernia rate of 11 %. Of the 9 patients injected within 24 h of their initial OA procedure, 89 % achieved primary fascial closure. Mortality was 11 %; death was unrelated to BTX injection. The overall complication rate was 67 %; specific complications rates included fascial dehiscence (11 %), enterocutaneous fistula development (0 %), intra-Abdominal abscess (44 %) and deep surgical site infection (33 %). The “chemical components separation” technique described is safe and avoids the extensive dissection necessary for mechanical components separation in critically ill patients with infected/contaminated Abdominal domains. While further evaluation is required, the described technique provides potential to improve delayed primary fascial closure rates in the OA setting.
