Maroney Jenna, Taylor George A, Lo Alexis, Golpanian Samuel, Prus Nelson W, Livelsberger Jon, Gassman Andrew A
Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
Department of Surgery, Temple University Hospital, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2020 Sep 23;8(9):e3051. doi: 10.1097/GOX.0000000000003051. eCollection 2020 Sep.
Tissue expanders are known adjuncts in ventral hernia repair, used in a staged approach where tissue closure or coverage of the defect is preferred but inadequate. Placement of tissue expanders in the correct tissue plane can be difficult, especially in thin patients or with loss of domain. This case series describes a technique in which tissue expander placement is facilitated by ultrasound-guided hydro-dissection, following the placement of a transversus abdominis plane (TAP) block. In short, after induction of anesthesia, the same needle used for the ultrasound-guided TAP block can be repositioned by the anesthesiologist to instill tumescent solution into the fascial plane between the internal and external oblique muscles. This allows for identification of the fascial planes in the ensuing operation. Our technique may prove to be an alternative tool in the placement of tissue expanders for ventral hernia repair, or in other procedures requiring device placement.
组织扩张器是腹疝修补术中已知的辅助工具，用于分阶段方法，即优先选择组织闭合或覆盖缺损但不足的情况。将组织扩张器放置在正确的组织平面可能很困难，尤其是在体型消瘦的患者或存在组织缺失的情况下。本病例系列描述了一种技术，即在腹横肌平面（TAP）阻滞放置后，通过超声引导下的水分离术来促进组织扩张器的放置。简而言之，麻醉诱导后，麻醉医生可将用于超声引导下TAP阻滞的同一根针重新定位，将肿胀液注入腹内斜肌和腹外斜肌之间的筋膜平面。这有助于在随后的手术中识别筋膜平面。我们的技术可能被证明是腹疝修补术或其他需要放置器械的手术中放置组织扩张器的一种替代工具。
