Reconstruction option of abdominal wounds with large tissue defects

BMC Surgery

Jan Skultety¹  Jaroslav Sekac¹  Augustin Prochotsky¹  Ivan Majesky¹  Christian Bartko¹  Martin Hutan¹ 

[1] II.nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st. Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia

关键词: Abdominal wall defect;    Split skin grafting;    NPWT;   

Others  :  1123276
DOI  :  10.1186/1471-2482-14-50

 received in 2014-02-20, accepted in 2014-07-30,  发布年份 2014

【 摘 要 】

Background

Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients.

Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent.

Case presentation

Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.

Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life.

Conclusions

Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention.

【 授权许可】

   
2014 Hutan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Ramirez OM, Ruas E, Dellon A: “Components separation” method for closure of abdominal wall defects: An anatomic and clinical study; Plast. Reconstr Surg 1990, 86:519.
• [2]Heller L, Chike-Obi C, Xue AS: Abdominal wall reconstruction with mesh and components separation. Semin Plast Surg 2012, 26(1):29-35.
• [3]Baumann DP, Butler CE: Bioprosthetic mesh in abdominal wall reconstruction. Semin Plast Surg 2012, 26(1):18-24.
• [4]Sacks JM, Broyles JM, Baumann DP: Flap coverage of anterior abdominal wall defects. Semin Plast Surg 2012, 26(1):36-39.
• [5]Lesnick GJ, Davids AM: Repair of surgical abdominal wall defect with a pedicled musculofascial flap. Ann Surg 1953, 137(4):569-572.
• [6]Hutan M, Salapa M, Jamriska J: Corium transplantation in reconstruction of ventral hernias. Bratisl Lek Listy 1994, 95(5):228-231.
• [7]Dayton MT, Buchele BA, Shirazi SS, Hunt LB: Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 1986, 121(8):954-960.
• [8]Mischinger HJ, Kornprat P, Werkgartner G, El Shabrawi A, Spendel S: Abdominal wall closure by incisional hernia and herniation after laparostoma. Chirurg 2010, 81(3):201-210.
• [9]Peppas G, Gkegkes ID, Makris MC, Falagas ME: Biological mesh in hernia repair, abdominal wall defects, and reconstruction and treatment of pelvic organ prolapse: a review of the clinical evidence. Am Surg 2010, 76(11):1290-1299.
• [10]Clifton MS, Heiss KF, Keating JJ, Mackay G, Ricketts RR: Use of tissue expanders in the repair of complex abdominal wall defects. J Pediatr Surg 2011, 46:372-377.
• [11]Cobb WS, Carbonell AM, Kalbaugh CL, Jones Y, Lokey JS: Infection risk of open placement of intraperitoneal composite mesh. Am Surg 2009, 75(9):762-767. discussion 767-8
• [12]Cobb WS, Harris JB, Lokey JS, McGill ES, Klove KL: Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 2003, 69:784-787.
• [13]Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K: Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 2001, 167:453-457.
• [14]Deysine M: Pathophysiology, prevention and management of prosthetic infections in hernia surgery. Surg Clin North Am 1998, 78:1105-1115. viii
• [15]Lal P, Kajla RK, Chander J, Saha R, Ramteke VK: Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 2003, 17:850-856.
• [16]Neumayer L, Giobbie–Hurder A, Jonasson O, Fitzgibbons R jr, Dunlop D, Gibbs J, Reda D, Henderson W: Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004, 350:1819-1827.
• [17]López-Cano M, Armengol-Carrasco M: Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation. Hernia 2013, 17(1):129-131.
• [18]Berrevoet F, Vanlander A, Sainz-Barriga M, Rogiers X, Troisi R: Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 2013, 17(1):67-73.
• [19]Meagher H, Clarke Moloney M, Grace PA: Conservative management of mesh-site infection in hernia repair surgery: a case series. HerniaEpub ahead of print
• [20]Steenvoorde P, de Roo RA, Oskam J, Neijenhuis P: Negative pressure wound therapy to treat peri-prothetic methicillin-resistant Staphylococcus aureus infection after incisional herniorrhaphy. Case Stud Lit Rev Ostomy Wound Manage 2006, 52(1):52-54.
• [21]Dietz UA, Spor L, Germer CT: Management of mesh-related infections. Chirurg 2011, 82(3):208-217.
• [22]Brock WB, Barker DE, Burns RP: Temporary closure of open abdominal wounds: the vacuum pack. Am Surg 1995, 61(1):30-35.
• [23]Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP: Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma 2000, 48(2):201-206. discussion 206-7
• [24]Barker DE, Green JM, Maxwell RA, Smith PW, Mejia VA, Dart BW, Cofer JB, Roe SM, Burns RP: Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg 2007, 204(5):784-792. discussion 792-3
• [25]Navsaria PH, Bunting M, Omoshoro-Jones J, Nicol AJ, Kahn D: Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg 2003, 90(6):718-722.
• [26]Petersson U, Acosta S, Björck M: Vacuum-assisted wound closure and mesh-mediated fascial traction–a novel technique for late closure of the open abdomen. World J Surg 2007, 31(11):2133-2137.
• [27]Hutan M Jr, Hutan M Sr: Sandwich mesh abdominal closure. Bratisl Lek Listy 2010, 111(8):461-463.