Complex Abdominal Wall Reconstruction: A Comparison of Flap and Mesh Closure

Abstract

ObjectiveTo analyze a series of patients treated for recurrent or chronic abdominal wall hernias and determine a treatment protocol for defect reconstruction. Summary Background DataComplex or recurrent abdominal wall defects may be the result of a failed prior attempt at closure, trauma, infection, radiation necrosis, or tumor resection. The use of prosthetic mesh as a fascial substitute or reinforcement has been widely reported. In wounds with unstable soft tissue coverage, however, the use of prosthetic mesh poses an increased risk for extrusion or infection, and vascularized autogenous tissue may be required to achieve herniorrhaphy and stable coverage. MethodsPatients undergoing abdominal wall reconstruction for 106 recurrent or complex defects (104 patients) were retrospectively analyzed. For each patient, hernia etiology, size and location, average time present, technique of reconstruction, and postoperative results, including recurrence and complication rates, were reviewed. Patients were divided into two groups based on defect components: Type I defects with intact or stable skin coverage over hernia defect, and Type II defects with unstable or absent skin coverage over hernia defect. The defects were also assigned to one of the following zones based on primary defect location to assist in the selection and evaluation of their treatment: Zone 1A, upper midline; Zone IB, lower midline; Zone 2, upper quadrant; Zone 3, lower quadrant. ResultsA majority of the defects (68%) were incisional hernias. Of 50 Type I defects, 10 (20%) were repaired directly, 28 (56%) were repaired with mesh only, and 12 (24%) required flap reconstruction. For the 56 Type II defects reconstructed, flaps were used in the majority of patients (n ϭ 48; 80%). The overall complication and recurrence rates for the series were 29% and 8%, respectively.

A retrospective analysis of surgical treatment of mesh infection after repair of ventral hernia or defect

“…Furthermore, at follow-ups, no hernia relapses occurred. Mathes et al (2000) reported on 100 cases in which the tensor fasciae latae was used to reconstruct abdominal wall damage after infected mesh removal. In these cases, using the component separation technique had its own limitations: the tensor fasciae latae was difficult to dissociate for umbilical defect repair; and after the flap was overturned, the dissociated vessel pedicle at the inguinal area exerted pressure on the femoral vein, increasing the risk of deep vein thrombosis.…”

Pre-expanded epigastric flap cover for ventral hernia following fungal necrotizing fascitis of caesarian section wound: An unusual complication

“…Anterior abdominal wall defects are classified into two groups based on defect components [1]: Type I with intact or stable skin coverage over hernia defect and Type II with unstable or absent skin coverage over hernia defect. The defects are assigned Zones based on primary defect location to assist in the selection and evaluation of their treatment: Zone 1A, upper midline; Zone IB, lower midline; Zone 2, upper quadrant; Zone 3, lower quadrant.…”

Reconstruction of Complex Abdominal Wall Defects

“…The disadvantages of Gore-Tex mesh are poor fixation to musculofascial layer due to poor tissue ingrowth resulting in higher incidence of reherniation and high cost of this material. The use of synthetic mesh requires adequate soft tissue coverage to avoid complications [7]. We have resorted to use of island omental flap or expanded skin whenever native skin and soft tissues are inadequate to cover the alloplastic material.…”