Abdominal wall reconstruction according to Ramirez

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Skin Incision
Opening of the Abdomen; Removal of Split-Thickness Skin
Presentation of the External Aponeurosis
Incision of the Posterior Rectus Sheath
Lateral Long Release Incision
Reconstruction of the Peritoneum/Posterior Rectus Sheath by Mesh Implantation
Union of the Two Anterior Rectus Sheaths
Wound Closure

Authors

Dr. med. Nicola Cerasani

Johanniter Krankenhaus, Bonn

Date

date of publication: 11.05.2012
date of update: 10.04.2024

Skin Incision

Soundsettings
The video clip can be played back with the automatic soundtrack of the subtitles.

In the sidebar registered users can enable and disable the automatic start of the dubbing.

Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.

Cutting around the large hernia sac in the area of the split-thickness skin graft in laparostomy.
Opening of the Abdomen; Removal of Split-Thickness Skin

Soundsettings
The video clip can be played back with the automatic soundtrack of the subtitles.

In the sidebar registered users can enable and disable the automatic start of the dubbing.

Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.

Careful pre-preparation is performed intraperitoneally with the removal of split-thickness skin. Significant adhesions to the anterior abdominal wall are not present.
Note: An interenteric adhesiolysis can be omitted in the absence of a history of obstruction.
Presentation of the External Aponeurosis

Soundsettings
The video clip can be played back with the automatic soundtrack of the subtitles.

In the sidebar registered users can enable and disable the automatic start of the dubbing.

Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.

The first step is to enter the subcutis and present the external aponeurosis from the small pelvis up to above the costal arch. The skin and subcutaneous tissue are detached epifascially laterally until the linea semilunaris is visible on both sides. This step is performed on both sides.
Incision of the Posterior Rectus Sheath

Soundsettings
The video clip can be played back with the automatic soundtrack of the subtitles.

In the sidebar registered users can enable and disable the automatic start of the dubbing.

Remark: Since this is a text-to-speech computer voice, it may mispronounce some medical terminology.

The second step is the dissection of the retromuscular space. For this, the posterior rectus sheath is visualized and incised longitudinally as close as possible to the fascial edge of the hernia defect on the medial side. Then, the rectus muscles are bluntly detached from the posterior layers of the rectus sheath. Laterally, the dissection is continued until the neurovascular bundles are reached. These must be preserved at all costs and represent the lateral boundary of the dissection.