Abdominal Wall Reconstruction in a Trauma Setting

Abstract

According to the World Health Organization "Global burden of disease study", future demographics of trauma are expected to show an increase in morbidity and mortality. In the past few decades, the field of trauma surgery has evolved to provide global and comprehensive care of the injured. While the modern day trauma surgeon is well trained to deal with multitrauma patients with injuries involving several systems, the ever-increasing nature and variety of multitrauma has left lacuna in certain areas. One such area is the management of abdominal wall injuries, which has been the domain of both plastic and reconstructive and general surgeons. The trauma surgeon is adept at treating the contents of the abdomen but not always the container. If not managed properly complications associated with abdominal wall injuries can lead to increased morbidity and mortality. In considering reconstruction of the abdominal wall in multitrauma patients proper evaluation, scrupulous planning, appropriate, and meticulous technique improve the chances for success with minimal complications. In the present article, we provide a brief description of the most commonly used procedures, and more importantly we outline the principles and guidelines applied to abdominal wall reconstruction in order to inform the trauma surgeon of different available treatment options. In doing so, we hope that this review will assist trauma surgeons in their overall care of patients that present with abdominal injuries.

To close or not to close? Treatment of abdominal compartment syndrome by neuromuscular blockade without laparostomy

“…1 Nevertheless, although surgical decompression and laparostomy (usually performed through the same incision) can be life-saving, most surgeons will have witnessed both short-and long-term problems with abdominal laparostomies, particularly if early fascial closure is not possible. Lateral abdominal wall defects are much more difficult to reconstruct if early fascial closure cannot be achieved, particularly when they are close to the costal margins, 2 as was the case in the roof-top incision utilised in this patient.…”

Abdominal wall reconstruction with Two‐step Technique (TST): a prospective study in 20 patients

“…For this reason, we decided first to reduce the size with VAC therapy for the first 3 weeks. This therapy offers many advantages : (i) It is easily performed and managed. (ii) It allows for a temporary abdominal closure so as to avoid mortality and prevent contamination of the peritoneal cavity.…”

Surgical management of abdominal compartment syndrome; indications and techniques

“…The major disadvantage is the loss of abdominal and back extensor muscle functions, if fascial closure can not be achieved. This would require complex reconstruction procedures including innervated free flaps that not only restore continuity but also the functional integrity of the abdomen [ 8 ].…”