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Background: No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons., Methods: A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed., Results: Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery., Conclusions: Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.

The long road to effective catgut sterilization began with the work of Lord Joseph Lister (1867) and did not end until 40 years later. At the end of the nineteenth century dozens of different techniques were used to "sterilize" catgut, by immersing the cord in a cold chemical solution, by exposing it to steam, or by a combination of the two techniques, yet none of these approaches offered the ultimate solution. One of the many physicians working on the catgut problem at that time was the German surgeon Franz Kuhn (1866-1929), best known as a pioneer of intubation anesthesia. This review offers a brief biographical sketch of Kuhn's life and career on the occasion of the centenary of Sterile Catgut Kuhn. The goal of the present study is to describe several landmarks in the development of the catgut sterilization method. To explain this process, two approaches are taken: first, an analysis to see whether the character traits of the typical surgeon at that time provided the soil in which innovation could thrive, and second, an epistemological examination of the conceptual models for the attainment of knowledge current at that time. Perspectives for the future are explored in light of the "imperative of responsibility" of Hans Jonas.

Mario Donati (1879-1946) was one of the foremost European surgeons of the early 20th century. During an impressive carrier as surgeon, teacher, and innovator he authored more than 200 scientific works. Already as a young teacher he won the admiration of his colleagues: "His lectures were models of clarity and conviction, his originality and brilliance as a surgeon have well earned [him] a place among the most famous of the clinical masters of surgery of all eras" (Mario Donati. J. Int. Coll. Surg. 1946;9:739). The present review offers a brief biographical sketch of Donati's life and career, presents an eyewitness account of the origin of the Donati stitch, and discusses a possible precursor of this suture technique in the Middle Ages. On the occasion of the 60th anniversary of the end of World War II, the authors would like to pay a special homage to Mario Donati, who due to his Jewish ancestry was removed from his office as Professor of Surgery at the University of Milan in 1938 and died shortly after his return from exile in Switzerland.