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  • Under ROC curve analysis the cutoff value in


    Under ROC curve analysis, the cutoff value in fascia defect width/abdominal circumference ratio was 13.99% with high sensitivity and specificity (100% and 100%, respectively). All cases with fascia defect width/abdominal circumference ratio larger than 13.99% showed complications of different extents in our study. The other cases with fascia defect width/abdominal circumference ratio less than 13.99% showed no complications postoperatively. In addition, we also found that tolterodine tartrate the fascia defect width was another important factor to predict complications of complex abdominal wall closure. Under ROC curve analysis, the cutoff of abdominal fascia defect was 11.35 cm with high sensitivity (100%) and specificity (85.71%). In our case series, five of 11 cases had abdominal wall fascia defect greater than 11.35 cm, and four of these five patients had complications. The only one without complications (fascia defect width: 15 cm) had a low fascia defect width/abdominal circumference ratio (12.33%). The other six cases with abdominal wall fascia defect less than 11.35 cm had no complications. In Lindsey\'s study, the maximum abdominal wall fascia defect that partition technique could close was 35 cm, much larger than the maximum defect that we were able to close (18.9 cm) and three times the cutoff value in our study. This might be because individuals of Asian descent have a smaller abdominal circumference in comparison with Caucasian people. According to our study, we can explain why there is a large fascia gap between Lindsey\'s group and our series by the fascia defect width/abdominal circumference ratio. tolterodine tartrate A patient with a high fascia defect width may have a low fascia defect width/abdominal circumference ratio, similar to our patient with 15 cm in fascia defect width but only 12.33% of fascia defect width/abdominal circumference. Therefore, we would like to emphasize that the calculation of fascia defect width/abdominal circumference ratio is more important than that of the fascia defect width alone. Our study found comorbidities (hypertension, diabetes mellitus, and smoking) were not statistically significant in postoperative complications. However, Ko et al suggested that diabetes mellitus was associated with increased minor complications in components separation technique for abdominal wall repair. In addition, the rate of abdominal wound problems and wound dehiscence showed a statistical difference between smokers and nonsmokers in the study by Manassa et al. The discrepancy between our findings and those by other authors in the literature may be due to the insufficient sample size of our series. There was one drawback in this study: the sample number was not large enough, which might have influenced the reliability of the cutoff value, sensitivity, and specificity of this study. However, according to the literature review, this was the first study attempting to elucidate the related parameters to predict the complications and demonstrate their importance in clinical usage for abdominal fascia reconstruction. The concept of fascia defect width/abdominal circumference ratio may be applied to abdominal fascia defect cases reconstructed not only by the partition technique but also by the component separation method. In addition, preoperative analysis of fascia collagen may provide another way for predicting the complication rate. Fachinelli et al found a greater amount of elastin in linea alba aponeurosis in patients with abdominal wall hernias in comparison with the control group of cadavers without hernias. White et al presented the collagen I/III ratio in skin biopsies from the recurrent hernia group to be significantly lower than in control patients. Therefore, preoperative collagen analysis may also be helpful.
    Introduction Pathologic changes in the thoracic and lumbar spine frequently begin in the vertebral bodies, and occur anterior to the spinal cord and nerve roots. The anterior approach is preferred in treating pathologic conditions of the thoracic and lumbar spine because it allows direct visualization and access to the vertebral column.