Thoracic Aortic Aneurysms and Arch Disease
Aortic arch and descending thoracic pathology have historically remained in the realm of open surgical repair. Technology is quickly pushing to bring these under the endovascular umbrella, with lower morbidity repairs proving safe in their early experience. Much work remains particularly for acute aortic syndromes, however, to understand who is best treated medically, surgically, endovascularly, or with hybrid approaches. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 21, 2023 Category: Surgery Authors: Ryan Gedney, Mathew Wooster Source Type: research
Lower Extremity Bypass
The original description of the lower extremity bypass (LEB) provided surgeons with a reliable method of limb revascularization. The tenets of the operation have formed the foundation for the advances of surgical care. A careful evaluation of the chronic limb-threatening ischemia patient due to the numerous comorbid conditions is paramount to obtain the best possible outcomes. Use of all adjuncts including judicious target vessels control, completion imaging, and vein harvesting techniques to ensure optimal outcomes because a functioning LEB remains a key to successful limb salvage. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 21, 2023 Category: Surgery Authors: Ajibola George Akingba, Warren Bryan Chow, Vincent Lopez Rowe Source Type: research
Contemporary Treatment of the Asymptomatic Carotid Patient
Stroke is a persistent leading cause of morbidity and mortality, and carotid artery atherosclerosis remains a treatable cause of future stroke. Although most patients with asymptomatic carotid artery disease may be at a relatively low risk for future stroke, most completed strokes are unheralded; thus, the identification and appropriate treatment of patients with asymptomatic carotid artery disease remains a critical part of overall stroke prevention. Select patients with asymptomatic carotid artery stenosis with an increased risk of future stroke based on the degree of stenosis and other imaging or patient-related charact...
Source: Surgical Clinics of North America - May 20, 2023 Category: Surgery Authors: Caron B. Rockman, Karan Garg Source Type: research
Comprehensive Care of Lower-Extremity Wounds
There are 5 common types of chronic nonhealing lower-extremity wounds: arterial, venous, diabetic foot ulcer, pressure, and mixed or atypical. Each chronic wound type has distinct features, and understanding the underlying cause will dictate the wound treatment plan. Here, the authors review the distinguishing wound properties for these 5 common chronic nonhealing lower-extremity wounds and outline a comprehensive treatment plan that addresses wound perfusion, debridement, infection control, moisture balance, and use of complementary advanced wound care products. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 19, 2023 Category: Surgery Authors: Allison Learned, Sudie-Ann Robinson, Tammy T. Nguyen Source Type: research
Abdominal Core Health
Abdominal core health encompasses the stability and function of the abdominal core and associated quality of life. Interventions to maintain core health include surgical and non-surgical therapies that integrate the functional relatedness of the abdominal core components. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 16, 2023 Category: Surgery Authors: Benjamin K. Poulose Source Type: research
Medical Management of Cardiovascular Disease
We offer an overview of lipid lowering, antiplatelet, antihypertensive, and glucose-lowering therapies for vascular surgeons and their respective medical teams. Further reviews should offer additional guidance on smoking cessation, exercise therapy, and nutritional optimization. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 16, 2023 Category: Surgery Authors: Kyle Steiger, Ana Fuentes, Young Erben Source Type: research
Abdominal Core Health
The most basic definition of a hernia is a defect in the abdominal wall that allows content to go through it that should not. The historical perception of a hernia is one that fosters an inconsequential surgical problem that can often be overlooked and fall to the lap of a recent medical school grad as the “intern’s case.” As in most medical problems, there is an evolution in the understanding of the disease, which then leads to an advancement in its management. The disease of hernia is no different. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 16, 2023 Category: Surgery Authors: David M. Krpata Tags: Preface Source Type: research
Ventral Hernia Repair
Mesh positioning is a commonly discussed detail in ventral hernia repair and is often cited as a major contributor to the outcome of the operation. However, there is a paucity of data that establishes one plane as superior to others. In this article, we will provide an overview of all potential planes to place prosthetic material and review the relevant literature supporting each option and the complications associated with accessing each anatomic plane. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 15, 2023 Category: Surgery Authors: Nir Messer, Michael J. Rosen Source Type: research
Open Complex Abdominal Wall Reconstruction
This article provides an approach to open complex abdominal wall reconstruction. Herein, the authors discuss the purpose of component separation as well as its relevant indications. The techniques and anatomical considerations of both anterior and posterior component separation are described. In addition, patient selection criteria, preoperative adjuncts that may assist with fascial or soft tissue closure, and complications of component separation will be discussed. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 15, 2023 Category: Surgery Authors: Clayton C. Petro, Megan Melland-Smith Source Type: research
Parastomal Hernia Repair
Parastomal hernias (PHs) are common and contribute to significant patient morbidity. Despite 45 years of evolution, mesh-based PH repairs continue to be challenging to perform and remain associated with high rates of postoperative complications and recurrences. In this article, the authors summarize the critical factors to consider when evaluating a patient for PH repair. The authors provide an overview of the current techniques for repair, including both open and minimally invasive approaches. The authors detail the mesh-based repair options and review the evidence for choice of mesh to use for repair. (Source: Surgical...
Source: Surgical Clinics of North America - May 12, 2023 Category: Surgery Authors: Victoria R. Rendell, Eric M. Pauli Source Type: research
Devices in Hernia Surgery
This article summarizes some of the key controversies and points regarding mesh materials and regulatory processes related to mesh devices. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 12, 2023 Category: Surgery Authors: Ajita S. Prabhu Source Type: research
Hernia Mesh Complications
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection a...
Source: Surgical Clinics of North America - May 12, 2023 Category: Surgery Authors: Kathryn A. Schlosser, Jeremy A. Warren Source Type: research
Management of Chronic Postoperative Inguinal Pain
Chronic postoperative inguinal pain, CPIP, afflicts 10% to 15% of the nearly 700,000 Americans who have inguinal hernia surgery every year. CPIP is challenging to manage because it poses many diagnostic dilemmas that can be overcome with a thorough history, examination, differential diagnosis, and imaging. The initial treatment of CPIP should explore all nonsurgical therapies including medications, physical therapy, interventional pain management and cognitive therapy. When nonoperative methods fail, surgical interventions including neurectomy and hernia mesh removal have proven to be beneficial for patients with CPIP. (So...
Source: Surgical Clinics of North America - May 11, 2023 Category: Surgery Authors: David M. Krpata Source Type: research
The Minimally Invasive Inguinal Hernia: Current Trends and Considerations
Inguinal hernias are one of the most common surgical pathologies faced by the general surgeon in modern medicine. The cumulative incidence of an inguinal hernia is around 25% in men and 3% in women. The majority of inguinal hernias can be repaired minimally invasively, utilizing either robotic or laparoscopic approaches. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 10, 2023 Category: Surgery Authors: Thomas Q. Xu, Rana M. Higgins Source Type: research
Mesh Selection in Abdominal Wall Reconstruction
A wide array of mesh choices is available for abdominal wall reconstruction, making mesh selection confusing. Understanding mesh properties can make mesh choice simpler. Each mesh has characteristics that determine its durability, ability to clear an infection, and optimal position of placement in the abdominal wall. For clean retromuscular hernia repairs, we prefer bare, heavy weight, permanent synthetic mesh. For contaminated retromuscular abdominal wall reconstruction cases, such as parastomal hernia repairs, we typically use bare, medium weight, permanent synthetic mesh. Biologic and biosynthetic meshes also have accep...
Source: Surgical Clinics of North America - May 10, 2023 Category: Surgery Authors: Ryan Ellis, Benjamin T. Miller Source Type: research
