Postoperative brachial plexus injuries have been reported in

Postoperative brachial plexus injuries have been reported in some surgeries, such as coronary artery bypass grafting, especially during internal mammary artery harvesting, and thoracoscopic sympathectomy for axillary hyperhidrosis, but it is rare in thoracotomy. The injury should not be caused by the procedure itself, but sternal retraction may result in injurious PF-573228 of the brachial plexus or dorsal overextension of the abducted arm during the operation. Brachial plexus injury in this patient probably resulted from limited exposure with hyper-abduction of the right arm during the operation. Treatment varies depending on the mechanism and the length of time after the injury. In those with closed injury, the nerve is probably still in continuity, and the patient may be followed clinically for 2 to 5 months. Nerve regeneration can occur if the nerve tissue components are preserved. The majority of injuries will heal in days or months; however, residual deficits may persist. If there is no reversal of the neurologic deficit by that time, surgical intervention is warranted. Moreover, an aggressive rehabilitation program is essential in the treatment of brachial plexus injuries, even those occurring postoperatively.
Introduction Lumbar hernia is a protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. The anatomy of the lumbar region has been well documented since the first case reported by Garangeot in 1731, in which there are two well-defined weak areas: the inferior lumbar triangle, first described by Petit in 1774, and the superior lumbar triangle, first described by Grynfelt in 1866. Lumbar hernias are classified as congenital (during infancy) and acquired, according to their etiology. Acquired lumbar hernias are further classified as primary (spontaneous) or secondary (a causal factor existing). Lumbar incisional hernia belongs to the secondary lumbar hernia, especially that occurring after iatrogenic incisions, and the others are related to trauma or lumbar infection. We will hereby present a case of lumbar incisional hernia repaired with prosthetic meshes.
Case report No postoperative sequela was noted. However, she experienced right lumbar and lower abdominal pain, accompanied by an intermittent bulging sensation in the right lumbar area in the last six weeks. Due to the persistent symptoms, she visited our general surgery section. On examination, an old surgical scar, 4cm in length, in her right supra-iliac region was noted, and a smooth, mildly tender mass about 5×5×3cm in size was palpated beneath the scar. In the mass, bowel sounds were audible. The abdominal CT scan revealed a right lumbar hernia involving extraperitoneal fat and the ascending colon on the posterior aspect of the right lower abdomen (Fig. 1).
Surgical repair The operation was performed under general anesthesia. The patient was placed in a lateral decubitus position, lying on the opposite side of the hernia [Fig. 2 (A)]. An incision was made on the previous surgical scar. After dissecting the subcutaneous tissue and surrounding muscles, a 5×5cm sac containing the ascending colon was noted herniating through a lumbar defect located above the iliac crest between the latissimus dorsi muscle and the external oblique muscle (Petit type) [Fig. 2 (B)]. The preperitoneal and retroperitoneal spaces were created and then a polypropylene mesh (GORE DUALMESH Biomaterial; W. L. Gore & Associates, Inc., Medical Products Division, Flagstaff, AZ, USA), named “Underlay Mesh”, 10×15cm, was placed and extended into the created preperitoneal space to cover the hernia defect. Five loop sutures (nonabsorbable 3-0 Prolene) were made to secure the mesh medially to the latissimus dorsi muscle, externally to the internal oblique muscle and external oblique muscle, and inferiorly to the periosteum of the iliac crest [Fig. 2 (C)]. Then, the latissimus dorsi muscle and external oblique muscle were approximated [Fig. 2 (D)]. Another mesh (PROLENE Polypropylene Mesh; Ethicon, Inc., Somerville, NJ, USA), named “Onlay Mesh”, 10×7.5cm, after adjustment, was anchored on the “Underlay Mesh” by the previous five loop sutures [Fig. 3 (A)]. A soft drain was placed in the subcutaneous space. The skin was then closed by a continuous absorbable suture [Fig. 3(B)].