Abdominal integument atrophy after operative procedures

THE AIM OF THE STUDY was to analyze clinical material concerning postoperative atrophy of abdominal integument. MATERIAL AND METHODS The evaluated group consisted of 29 patients with sonographically revealed atrophy of the abdominal wall. Those changes were observed after various surgical procedures: mainly after long, anterolateral laparotomies or several classical operations. Ultrasound examinations up to the year 2000 were performed with analog apparatus, in the latter years only with digital apparatus with linear transducers (7-12 MHz) and sometimes convex type conducers (3-5 MHz). The location, size and intestine stratified wall structure were evaluated. In each case the integument thickness was measured in millimeters in the site of the greatest atrophy and it was compared with the integument thickness from the side that had not been operated which enabled the calculation of the percentage reduction of integument in the area of the scar. RESULTS In 3 patients who underwent several laparotomies there was a total reduction of muscular mass in the operated area. In these cases we stated only skin and slightly echogenic subcutaneous strand; probably corresponding to fibrous tissue - the thickness of integument in this area was in the range from 3 to 8 mm. In the remaining 26 patients the integument atrophy on the scar level included muscles in a greater extent and covered an extensive area after classical urological procedures on the upper urinary tract: after nephrectomy and even ureter stone evacuation or kidney cyst excision by means of classical anterolateral approach with the integument incision on the length of almost 20 cm. Reduction in the integument thickness was observed on the smaller area after classical cholecystectomies, appendectomies and other surgical procedures with the incision across the integument. The integument atrophy in the operated sites expressed in absolute numbers was in the range of 7-20 mm (average 14 mm). These values are markedly lower than the comparative integument thickness on the not operated side: 17-52 mm (average 25.4 mm). The percentage value of the integument thickness reduction oscillated in the range of 32-67% (average 44.2%). In most cases the atrophy involved all layers of the abdominal wall, what demonstrated as regional prominence of the integument, mimicking the presence of hernia. CONCLUSIONS Ultrasonography allows precise evaluation of the size and extent of atrophy as well as depiction of other lesions simulating that effect. Establishing the correct diagnosis should prevent the unnecessary reconstructions of the abdominal integument.