Prosthetic mesh for infected abdominal wall defects? Report of a patient with a large full thickness abdominal wall defect and colostomy due to a gunshot wound

Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction

“…Defects of the abdominal wall that result from recurrent trauma, hernias, infection, radiation necrosis, decompressive laparotomy, or tumour resection are difficult and challenging to correct 1. Small fascial defects up to 5 cm in width can be closed primarily2 as long as abdominal wall tissues are not fixed by scar, but the tension under which the fascia must be approximated frequently leads to infection, necrosis and high rates of recurrence 3 4.…”

“…Reconstructing large, contaminated abdominal wall defects poses a great challenge to surgeons due to the relative contraindication against using synthetic materials 1. Successful management of these defects requires restoration of abdominal wall integrity under tension-free repair, and this goal is generally accomplished by using autologous tissues 1.…”

“…Successful management of these defects requires restoration of abdominal wall integrity under tension-free repair, and this goal is generally accomplished by using autologous tissues 1. We present two cases of reconstructing recurrent and contaminated abdominal wall defects utilising bilateral delayed and tunnelled pedicled tensor fascia lata (TFL) myofascial flaps.…”

Options for Closure of the Infected Abdomen

“…Successful use of free tissue transfer also has been demonstrated for abdominal wall defects [56]. Free muscle flaps, using the latissimus dorsi most commonly, can be anastomosed to the deep inferior epigastric artery and placed over mesh to reconstruction large defects when the rectus abdominis muscles are not available for advancement.…”

“…Synthetic materials have been used for definitive abdominal reconstruction with components separation in morbidly obese patients, yielding a 10% surgical site infection rate with an average follow-up of 50 months [55]. Long-term abdominal wall reconstruction with PP mesh reinforcement and free latissimus dorsi muscle flap coverage has been successful in trauma patients with large full-thickness abdominal wall defects and colostomies [56]. The success of such reconstruction likely was aided by the addition of a well-vascularized piece of autologous tissue.…”