Staged Management of Giant Abdominal Wall Defects

Jernigan, T Wright; Fabian, Timothy C.; Croce, Martin A.; Moore, Natalie; Pritchard, F E; Minard, Gayle; Bee, Tiffany K.

doi:10.1097/01.sla.0000086544.42647.84

Cited by 268 publications

(210 citation statements)

References 15 publications

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“…These are also mechanic factors affecting wound healing. Wound infections of varying degrees affect the abdominal wall at different rates and they are major causes of development of incisional hernia or wound dehiscence (14,24,25). In our series, wound infection that was present in 69 patients (26%), had a significant relationship with incisional hernia (p=0.011) and wound dehiscence (p=0.001).…”

Section: Discussionmentioning

confidence: 55%

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Yılmaz

Akıncı

Doğan

et al. 2013

UCD

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Objective: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. Material and Methods:The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis.Results: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Conclusion:Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.Key Words: Abdominal surgery, wound dehiscence, incisional hernia, sinus formation, chronic incisional pain INTRODUCTIONWound dehiscence after laparotomy can manifest with different presentations varying from simple skin detachment to evisceration and eventration, leading to an increase in surgical mortality and morbidity, as well as increase in length of hospital stay and loss of work force.Anterior abdominal wall incision hernia that can be seen in the long term is also one of the common surgical complications. Known as postoperative hernia or incisional hernia, it is thought to result from insufficient closure of the fascia and/or poor healing. Factors causing chronic or prolonged postoperative intra-abdominal pressure increase and those affecting wound healing contribute to its development. The incidence of incisional hernias vary from 2% to 20% in different sources, and in addition to pain and impairment in quality of life it may also cause significant complications (1, 2). It has been reported that incarceration may occur in a rate of 15%, ...

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Section: Discussionmentioning

confidence: 55%

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Yılmaz

Akıncı

Doğan

et al. 2013

UCD

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“…Consequently, a staged reconstruction is required for this type of patients: first a temporary closing is provided, and subsequently, permanent repair should be done. [15,16] The techniques for temporary closing of the abdomen aim to protect the viscera somehow. In this sense, absorbable or non-absorbable meshes, the Bogota Bag and negativepressure wound therapy are used.…”

Section: (A) (B)mentioning

confidence: 99%

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

Alhan

Şahin

Güzey

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes series of intra-abdominal interventions. At the end of this long treatment period, persistent intestinal edema and retraction of the abdominal wall are the main factors why fascias cannot be connected at an early time. Moreover, in severe abdominal traumas like the ones caused by high-energy gunshots, trauma may not only affect the intra-abdominal components but may also cause loss of domain of the abdominal wall.A staged reconstruction protocol is required for this type of patients. Firstly, a temporary closing of the viscera is provided, and subsequently, permanent repair of the abdominal wall should be done. Many procedures have been advocated to close the viscera at the first stage. [1][2][3][4][5][6] The fundamental principle in all of these procedures is forming the granulation tissue on the open abdominal wall and closing it with partial-thickness skin graft (PTSG ABSTRACT BACKGROUND: Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases. METHODS:Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes. RESULTS:The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient. CONCLUSION:In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.

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“…Other techniques for progressive closure of the abdominal wall, in combination or not with NPWT, include dynamic wound closure systems based on continuous dynamic tension to achieve re-approximation of the fascial edges of the abdominal wall [29,30] or the use of patches of synthetic material as a temporary, gradual means for abdominal closure [31] ; (3) Patients beyond the 2-3 wk window without progress towards closure or improvement of general condition and interstitial edema ("frozen abdomen") and without bowel fistulization. In these cases, the treatment options include skin cover over the defect or allow wound granulation (absorbable synthetic mesh implant, NPWT) and thereafter cover with skin grafts and subsequent definitive delayed closure (after 6-12 mo) in the context of a "planned" incisional hernia repair [32][33][34][35][36][37] ; and (4) Patients with enteroatmospheric fistula. In these cases, the constant leak of enteric contents on the open abdomen aggravates the inflammation and encourages the formation of new fistulas.…”

Section: Treatment Optionsmentioning

confidence: 99%

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

López-Cano

Pereira

Armengol

2013

WJGS

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The so-called "burst abdomen" has been described for many years and is a well-known clinical condition, whereas the concept of the "open abdomen" is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of "acute postoperative open abdominal wall" (acute POAW) is presented, which in turn can be divided into "intentional" or planned acute POAW and "unintentional" or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

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Staged Management of Giant Abdominal Wall Defects

Cited by 268 publications

References 15 publications

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

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

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

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