FIELD: medicine.
SUBSTANCE: invention relates to medicine, specifically to surgery. Performing incision of anterior abdominal wall, removal of tumour with attachment of synthetic mesh for musculo-aponeurotic layer, and layer by layer wound closure. Skin incision is performed along middle line along white line with bypass umbilical ring. Dissected and separated subcutaneous fat with uncovering case right or left abdominal rectus muscles along whole length of latter. On side of injured muscle is mobilised at 3 cm in lateral rectus sheath to create platform fixation grid over external oblique muscle, umbilical ring is dissected away from the aponeurosis. Involved muscle is mobilised in a single unit to tumour along whole length of costal arch to pubic symphysis without opening abdominal peritoneum. Performing subtotal resection of abdominal rectus muscle together with front and rear aponeurosis leaves with transverse fascia below umbilical ring. Edges of external, internal oblique and transverse muscles on side edge resection continuous blanket suture absorbable suture to form a single line for fixation of mesh. Grid edge bent to supposed line of internal fixation lines, a direct internal line of sutures between a fold and aponeurosis from side not removed rectus muscle with separate interrupted sutures, which are under mesh. Similarly, edge of grid on opposite side and an arched internal line of sutures between grid and fascia on side of resected muscle, grid is fixed at upper and lower edges of defect to residues aponeurosis, periosteum pubic bone and a costal arch and previously bent edge of mesh back, placing them on top of the mobilised from fibre aponeurosis. Further, an outer line of sutures along perimeter of mesh, umbilical ring is fixed to grid on former place.
EFFECT: method reduces number of local complications and ensuring good functional and cosmetic results.
1 cl, 4 dwg, 1 ex
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Authors
Dates
2016-04-20—Published
2014-12-05—Filed