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Schematic view of the reconstruction. Large arrow is pointing out the epiplon surrounding the tracheostoma and the esophagus. Thin arrow is on the skin graft covering the posterior side of the trachea. Head of arrow shows de microvascular anastomosis and finally de asterisk is into the stomach patch that makes up the anterior esophagus. B. Gastro-omental flap with its omentum portion below and the shaping of the stomach patch. C. At the tracheostoma level, the posterior wall of the trachea is formed by a skin graft. The omentum which will be placed around the tracheostoma and behind the skin graft will nourish it. D. The cervical trachea was moved and the new tracheal stoma was placed just 2<span class="elsevierStyleHsp" style=""></span>cm below it was before. Surrounding it the omentum covered by skin grafts. E. Vascular anastomosis under microscope between the right gastroepiploic vessels and the mammary internal ones at the third intercostal space. The white spot is on the arterial anastomosis and the black spot on the venous anastomosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Maria Viñals Viñals, Pau Tarrús Bozal, Jose Maria Serra-Mestre, Oriol Bermejo Segú, Julio Nogués Orpí" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Juan Maria" "apellidos" => "Viñals Viñals" ] 1 => array:2 [ "nombre" => "Pau" "apellidos" => "Tarrús Bozal" ] 2 => array:2 [ "nombre" => "Jose Maria" "apellidos" => "Serra-Mestre" ] 3 => array:2 [ "nombre" => "Oriol" "apellidos" => "Bermejo Segú" ] 4 => array:2 [ "nombre" => "Julio" "apellidos" => "Nogués Orpí" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X17300532" "doi" => "10.1016/j.ciresp.2017.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X17300532?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507717300595?idApp=UINPBA00004N" "url" => "/21735077/0000009500000010/v1_201712160515/S2173507717300595/v1_201712160515/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "“Iliac Hernia”, an Original Form of Ventral Hernia That Is Probably not so Uncommon" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "618" "paginaFinal" => "620" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco Martínez Rodenas, Gema Torres Soberano, Raquel Hernández Borlan, José Enrique Moreno Solórzano, José Ramón Llopart López" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Francisco" "apellidos" => "Martínez Rodenas" "email" => array:1 [ 0 => "fmrodenas@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Gema" "apellidos" => "Torres Soberano" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "Hernández Borlan" ] 3 => array:2 [ "nombre" => "José Enrique" "apellidos" => "Moreno Solórzano" ] 4 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Llopart López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Municipal de Badalona, Badalona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "«Hernia transilíaca». Una original modalidad de eventración probablemente no tan infrecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 698 "Ancho" => 950 "Tamanyo" => 89798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sagittal abdominal CT scan: portion of extra-abdominal colon, suggesting transiliac hernia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The iliac wing is frequently used as a donor area for autogenous bone tissue for grafts in orthopedic surgery due to the quality and quantity of bone available and its easy accessibility. Herniation of the intra-abdominal viscera through the created bone defect is a potentially serious complication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 76-year-old patient with metabolic syndrome (body mass index 36), who had been treated for bilateral coxarthrosis secondary to congenital dislocation of the left hip using a Müller-type bilateral prostheses at the age of 36. The patient required replacement of the left prosthetic socket due to de-cementation and replacement of the left prosthesis with autogenous bone graft of the iliac wing in the acetabular fundus at the ages of 48 and 53, respectively. The patient reported episodes of colic abdominal pain for several months, and physical examination revealed an irreducible swollen mass in the left gluteal region. Abdominal computed tomography showed a transiliac hernia and an umbilical hernia (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The surgical intervention consisted of: subumbilical midline laparotomy; incision of the left parietal peritoneum to mobilize and introduce into the abdominal cavity the segments of the descending and sigmoid colon that were herniated and incarcerated; access to the retroperitoneal space and implantation of a 20×20<span class="elsevierStyleHsp" style=""></span>cm polypropylene mesh, extended in retroperitoneal position to widely cover the hernia orifice and the adjacent musculoskeletal structures, without being in contact with the visceral peritoneum; the mesh was affixed with several cardinal non-absorbable stitches and maintained in its correct position by the intra-abdominal pressure itself. The laparotomy was closed with a double continuous suture of slowly absorbable material and repair of the umbilical hernia. There were no postoperative complications. After one year of follow-up, physical examination has shown no hernia recurrence.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Obtaining autogenous bone graft from the wing of the ilium has a morbidity rate between 12% and 20%, which is even higher if the donor area is the anterior part of the iliac crest and not the posterior (23% vs 2%, respectively). Among the various postoperative complications,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> the most important is “iliac hernia”, which is a term used in the literature to describe this condition, although it is occasionally classified as a lumbar hernia. This condition, described by Oldfield in 1945, is a poorly documented entity that is probably underestimated because fewer than 40 cases have been reported since its first publication<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a>; however, its incidence is estimated from 5% to 9%.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Its etiopathogenesis is a consequence of the surgical defect in the coxal bone, almost always related with having obtained a bone graft or, less frequently, after fractures,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> debridement due to osteomyelitis, and on rare occasion due to a congenital bone defect.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Its appearance has been reported between the first days following the operation and up to 15 years after the bone defect.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> This complication seems to be more frequent in women. The small intestine is the most commonly herniated organ, and there are reports of strangulation and torsion. Other organs, such as the liver, have also been reported.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis is suspected when a mass is confirmed in the gluteal scar, which may be difficult to assess in cases of obesity and more posterior locations. Differential diagnosis should include hematoma<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> or abscess and other less probable ailments, such as intra-abdominal neoplasms, renal cancer, muscle hernia, soft-tissue tumors and lumbosacral panniculitis. It is confirmed with abdominal computed tomography, which is the complementary test of choice as it demonstrates the herniated anatomy and contents.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical treatment, which can be difficult, should be done with some urgency to avoid potential complications (risk of incarceration and strangulation are 25% and 10%, respectively<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>), although in one selected case that had emerged after bone resection due to chondrosarcoma, the approach was “wait and see”.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Among the surgical options, the following have been proposed<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,8</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Repair with the adjacent soft tissue, mobilizing the iliac muscle, lumbar fascias and gluteus maximus (Dowd and Koontz techniques) or abdominal fascias, which are reinserted over the remaining bone.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bosworth technique: creation of an iliac “neocrest” by transposition of the anterior area of the iliac crest to the posterior, where the abdominal fascia is reimplanted.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Closure of the defect with bone allografts or grafts with synthetic mesh, done laparoscopically in favorable situations.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the case described, surgical difficulty was expected due to the obesity of the patient and the large length of colon stuck through a ring of mainly bone. These factors led us to select a laparotomic approach, although laparoscopy can be indicated in less complex circumstances due to its lower early and late morbidity. Placement of a mesh directly over the hernia orifice by an extraperitoneal lateral approach could have a higher percentage of recurrence. To avoid this, we considered it best to use a large mesh of polypropylene or polyester (polytetrafluoroethylene or mixed if there is contact with hollow viscera) that, from the inside of the abdominal cavity and held by the intra-abdominal pressure, covered the hernia orifice.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the curative intent of the various repair techniques mentioned above, the recurrence rate is high.</p><p id="par0065" class="elsevierStylePara elsevierViewall">To prevent transiliac hernia, it is advisable to obtain a bicortical bone graft instead of tricortical, and large grafts should be avoided.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Some authors have assessed the possibility of placing a prophylactic mesh in the bone defect.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Rodenas F, Torres Soberano G, Hernández Borlan R, Moreno Solórzano JE, Llopart López JR. «Hernia transilíaca». Una original modalidad de eventración probablemente no tan infrecuente. Cir Esp. 2017;95:618–620.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 684 "Ancho" => 950 "Tamanyo" => 104066 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial abdominal CT scan: herniated colon through the bone defect of the iliac wing; umbilical hernia.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 698 "Ancho" => 950 "Tamanyo" => 89798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sagittal abdominal CT scan: portion of extra-abdominal colon, suggesting transiliac hernia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The free vascularised iliac crest tissue transfer: donor site complications associated with eighty-two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. 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Scientific letter
“Iliac Hernia”, an Original Form of Ventral Hernia That Is Probably not so Uncommon
«Hernia transilíaca». Una original modalidad de eventración probablemente no tan infrecuente
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Francisco Martínez Rodenas
, Gema Torres Soberano, Raquel Hernández Borlan, José Enrique Moreno Solórzano, José Ramón Llopart López
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Hospital Municipal de Badalona, Badalona, Spain
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