Planned Ventral Hernia Staged Management for Acute Abdominal Wall Defects

Abstract

ObjectiveAnalysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided Methods A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I-prosthetic insertion; stage 11-2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage 111-2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV-6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. ResultsEighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 1 1 % of the components separation technique. ConclusionsThe authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost-it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects. 643

Tensile strength of the posterior and anterior layer of the rectus abdominis muscle sheath in cadavers

“…In living bodies, the tension in the abdominal wall is caused by the centrifugal force of the abdominal contents and by the contraction of the abdominal muscles with a vector of lateral force (generated by the external oblique, internal oblique and transversus muscles of the abdominal wall) 10 . Moreover, following the surgical closure of the abdominal wall, bowel edema, gaseous distension, and an increase in post-operative ileum content increase the intra-abdominal pressure to varying degrees 11,12 . There were excluded cadavers that presented with alterations in the abdominal wall or intraperitoneal changes that could restrict the muscle-aponeurotic components.…”

Post-traumatic Massive Abdominal Wall Defect- A Challenge

“…In the acute stage, the abdomen can be closed temporarily with mesh allowing the surgeon to maintain domain, protect intra-abdominal contents, provide support and allow drainage. The granulating bed is split skin grafted as soon as possible to achieve temporary closure of the abdomen [3,4].…”

Staged Repair Of Severe Open Abdomens Due To High-Energy Gunshot Injuries With Early Vacuum Pack And Delayed Tissue Expansion And Dual-Sided Meshes

“…[21] Although it was declared that wide defects of 20 cm could be closed with this technique, a high ratio of recurrent hernia, which was also noted, should not be overlooked. [22][23][24] On the other hand, in traumas that damage the abdominal domain and the epigastric vessels, it's hard to use this reconstructive choice.…”