Incisional Hernia Repair: Abdominoplasty, Tissue Expansion, and Methods of Augmentation

Abstract

Incisional hernia repair without mesh mainly consists of tissue transfer to bridge or close the defect. Bridging includes rotational or free musculocutaneous flaps, rendering acceptable short-term results but a rather disappointing long-term outcome. Abdominal wall closure where there has been significant loss of domain, with intraperitoneal organs residing permanently outside the abdominal cavity, can only be achieved using the patients' own tissue if preoperative expansion of the abdominal cavity is performed using artificial expanders or pneumoperitoneum. From a scientific point of view, however, evidence supporting any treatment option is weak because prospective randomized controlled trials are virtually impossible to conduct owing to the inhomogeneity of the patient population being considered. Treatment of this condition by the above-mentioned means should therefore be proposed on an individual basis utilizing one or more of the many possible techniques described.

An innovative abdominal wall repair technique for infected prosthesis: the Eskimo technique

“…The aim is a full restoration of the abdominal wall function, including muscular support, prevention of visceral protrusion and adequate soft tissue coverage. [13] Although surgical techniques have improved, recurrence is still a common complication of surgically repaired abdominal walls, and is more frequent in open suture repairs than in tension-free repairs, with recurrence rates of 54% and 32%, respectively. [14][15][16][17] Given that mesh implantation appears to be the best option for abdominal wall repair, the technique has peaked the interest of the medical community, and the general research focus has shifted towards analyzing the compatibility of different materials for mesh production.…”

“…The tension-free techniques have two further subcategories: the first involves bridging the defect using the patient's own tissue, synthetic products or biological material. The second option is to draw up the natural tissues after utilizing a relaxing incision, as described by Ramirez et al, [12,13] or to employ preoperative measures such as tissue expansion or progressive pneumoperitoneum. The aim is a full restoration of the abdominal wall function, including muscular support, prevention of visceral protrusion and adequate soft tissue coverage.…”

Versorgung von Bauchdeckendefekten einschließlich der Bauchwandrelaxation aus allgemeinchirurgischer Sicht

“…Erstere verfolgt das Ziel, den Fasziendefekt entweder durch ein Kunststoffnetz im Sinne eines Bauchwandersatzes zu überbrücken (sog. "bridging") oder aber durch körper-eigenes Gewebe in Form plastischer Rekonstruktionsverfahren [16,44]. Bei der zweiten Strategie wird dagegen ein Defektverschluss angestrebt, entweder durch vorherige Mobilisierung der Bauchwandschichten in Form der sog.…”

“…Durch Kombination dieser Technik mit einer zusätzlichen Netzplastik in Sublay-Position kann auch bei sehr ausgedehnten Bauchwanddefekten eine weitere Verbesserung der Ergebnisse erreicht werden. So berichten van Geffen und Mitarbeiter über einen Rückgang der Rezidivrate von 17% nach alleiniger modifizierter Komponentenseparation auf 3,8% in Kombination mit einem Kunststoffnetz [44]. …”

The Italian Register of Biological Prostheses

“…In general, there are 2 main strategies for open surgical treatment of abdominal wall defects, namely tension-free and non-tension-free techniques [5,6]. …”