The main method of treatment of hernia is a musculo-aponeurotic plastic. With this method, the strengthening of the abdominal wall defect is not only the aponeurosis. and muscles. This principle of treatment is the basis of a huge number of operational methods. Most popular in the inguinal hernias were ways Girard, Spasokukotsky, Bassin, Postemskogo, Kirchner, with the umbilical - a way to Mayo, with postoperative abdominal and white line - way Sapezhko and its numerous modifications.
Also widely used plastic, with additional biological and synthetic materials.
Grafts, depending on their origin are divided into:
1. autologous (taken within the same organism);
2. allogeneic (taken in the body of the same form as the body of the recipient);
3. xenogeneic (taken in the body of another species);
4. explants (non-biological tissue);
5. combined transplants (a combination of biological, most autologous and non-biological tissue).
Indications for the use of plastic materials for ventral hernia are:
1. recurrent, especially multiple recurrent hernias;
2. primary hernias of large size at a flabby abdominal wall due to the atrophy of muscles, fascia and aponeurosis;
3. postoperative hernia with multiple hernial when herniorrhaphy with local tissues does not give complete confidence in their solvency;
4. huge hernia the size of the defect of the abdominal wall more than 10x10 cm;
5. "Difficult" inguinal hernia - long lines, oblique to the direct channel, sliding and combined with pronounced muscle atrophy, razvolokneniem aponeurosis, ligaments hypoplasia.
From biological tissues most widely used in hernia surgery were: autologous transplants of skin, allogeneic transplants of dura mater and xenogeneic grafts of peritoneum.
Numerous experimental studies suggest that any biological graft during implantation undergoes a pronounced inflammatory and destructive changes, the extent of which varies from mild degeneration to necrosis, is directly dependent on the nature of the plastic material, its antigenicity and mode of treatment.
Most favorable to replace the defect of the abdominal wall are undoubtedly autologous tissue. Biological relationship with this kind of transplant brand viagra can achieve the most reliable engraftment of plastic cloth. However, in this case, marked structural changes in the graft, which are caused by denervation and blood circulation disorders: a histologically in the early period after transplantation, there are marked inflammatory changes, and the remote - the phenomenon of partial atrophy and fibrosis.
Allogeneic transplantation and, moreover, xenogeneic tissue really is always accompanied by the reaction of transplantation immunity, which leads to the death of foreign tissues. However, in cases where the plastic fabric is not highly antigenic strength, the process of destruction of the graft occurs very slowly and slightly, and simultaneously with the destruction of developing regenerative processes, replacing lost parts of the graft. Ultimately, the graft is completely replaced by recipient tissues. This is the most favorable way of morphological transformation alien plastic tissue in the body of the recipient, ensuring the success of transplantation. In those cases where the plastic fabric has a high antigenic activity, the destruction of the graft is much faster than it is replaced by tissue of the recipient. As a rule, change ends divergence of postoperative wound and exclusion of necrotic remnants of the plastic fabric.
All plastic materials used in reconstructive surgery of the anterior abdominal wall, have these or other advantages and disadvantages. The study of long-term results indicate that with the help of transplants can dramatically reduce the number of relapses. And if now it is possible to deny the usefulness of a plastic material, to reject the method at all - it means not to notice those positive qualities that lie at its core. This is primarily a decrease traumatic operations and increase its reliability.
The clinical picture of hernia strangulation is very characteristic and is generally typical.
inhibitory effects
metabolism
choice for correction
safety
life moves
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