Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?

Abstract Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surgery coverage can prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. Summary The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. Outlook An interdisciplinary approach of abdominal and plastic surgery is characterized by a highly developed cooperation in common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

In detail, -The "Title" is instructive.
-"Abstract" -no query -"Introduction" characterizes appropriately the reason for this topic and writing it up.
-The "Results" subtitled with "Corner points" subclassifies several interesting topics such as "Decubital ulcer" / "Coverage of soft tissue defects", "Bariatric surgery", "Abdominoperineal rectum extirpation (APE)", "Hernia surgery", "Necrotizing fasciitis", "Soft tissue tumor lesions", "Liposuction", "Lipofilling", "Lymphatic vessel reconstructions" and "Osteomyelitis", which comprise the clinically relevant Problems in daily surgical practice of plastic and abdominal surgery -a fascinating spectrum of single topics all of them with a direct or mediate association to or among the two surgical disciplines.Interestingly, "New aspects and trends" as well as "Studies / Research" plus "Academic activities"-aspects, which are often underestimated and disvalued -were included in the representative spectrum of topics.
-"References": n = 54 (appropriate number) From the reviewer`s perspective, congratulations to the great idea of the topic and the magnificent workup of the single (sub)topics -the only remaining aspects, which appear reasonable to be added, are: -What are the particular strengths and limitations of the well readable review as it is usually mentioned at the end of the manuscript right before the "Resumé"?
Based on the aspects as raised, the reviewer concludes to assess the Manuscript with "Accepted for publication with minor revisions".

Authors' Response to Reviewer Comments
Date received: 23-Jun-2023 Reviewer 1: 1) Reviewer's 1st critic was: Abstract -the method is missing, the results are too long and need to be restructured and new aspects need to highlighted RESPONSE: A method section has been included, the results section was shortened, restructured and new aspects were highlighted by underlining 2) Secondly, the reviewer mentioned: Introduction -it should be more related to the following report RESPONSE: The introduction was re-written with more relation to the following text.
3) Subsequently, the reviewer raised: Coverage of soft tissue defects -it reports of chronic fistulas after lymph node dissection -so besides coverage of the soft tissue defect lymphangioreconstruction should be mentioned RESPONSE: A section named "Lymphatic vessel reconstructions" has been included 4) Next, the reviewer's suggestion was: Hernia surgery -Component separation (Ramirez) should be included RESPONSE: A respective section has been included on page 9.
5) The following comment of the reviewer comprised: References -have to be checked, Ref. 36 is without year and pages, 4 references are older than year 2000, no references after 2018 are included.
Overall, new aspects of this important topic are hard to find in the paper and should be added by a current literature search.RESPONSE: Ref. 36 has been corrected, and several more up-to-date articles have been cited.
6) The reviewer criticized: The written English language has to be improved.RESPONSE: Language and style have been improved.

Reviewer 2:
I) First, this reviewer suggested: ... -in this context, for a balanced proportion of figures vs. tables, is there any data (e.g., from the references), which can be presented by an additional table in a compact manner?RESPONSE: Good point, we added the respective information in "Table 1".III) The reviewer demanded: -"References": n = 54 (appropriate number) In particular, please accomplish: -What are the particular strengths and limitations of the well readable review as it is usually mentioned at the end of the manuscript right before the "Resumé"?RESPONSE: Good point, we added a corresponding section right before our conclusion -see there.
Many thanks for the recommendation.
The additional text / paragraph is as follows: " … strengthen both sudisciplines on the an academic level.
Limitations (and perhaps strengths) of this review Altough written to our best knowledge, our work has several limitations that should be addressed.As this article is an attempt to present the overlapping fields of abdominal and plastic surgery in its broad variety, the cited literature is selected, bu not comprehensive.We encourage other authors to take this work as some food of thought for the writing of more detailed articles on the sub-sections we depicted here.Futhermore, this work was indended as a clinical review, so that our focus was not on basic science concepts, although briefly included.Overall, the fact that all procedures presented in this work have been applied by the authors for several years, and their description and evaluation has been made from a practical and honest point of view, may give some value to this article.

An interdisciplinary approach of … "
As far as it seemed necessary to us, remaining spelling mistakes have been corrected, and minor changes in grammar and style have been made.The article is improved and suggestions have been implemented in the new version.

Reviewers' Comments to Revised Submission
Still, some language flaws have to be corrected before publication, as well as the style of references 1., 19., 39., 49. and 51 (mainly the year of publication, in 51 the authors are also missing).Appropriately revised manuscript; ready to be published in its present form.

Comments by the Editor-in-Chief Decision on revised version
All reviewer comments were addressed adequately, and the manuscript should be published in its present stage.
36.Orhan E Efficacy of Liposuction as a Delay Method for Improving Flap Survival 48.Vergleich des Regenerativen Zytokinprofils von Adipose Derived Stromal Cells (ASCs) Gewonnen Mittels Abdominoplastik, Suction Assisted Liposuction (SAL) und Ultrasound Assisted Liposuction (UAL) with the required bibliographic data!RESPONSE: We apologize for this flaw and corrected the citations mentioned III) Finally, the reviewer asked, in particular: In particular, please accomplish: 36.Orhan E Efficacy of Liposuction as a Delay Method for Improving Flap Survival 48.Vergleich des Regenerativen Zytokinprofils von Adipose Derived Stromal Cells (ASCs)