Intraabdominal challenges affecting abdominal wall reconstruction

Abstract

Abdominal wall defects may arise from trauma, infection, and prior abdominal surgeries, such as tumor resections. Although ideally reconstruction should be accomplished as soon as possible to restore the integrity and function of the abdominal wall, it is not always a viable option. A successful reconstruction must take into consideration the local environment of the defect, as well as the global condition of the patient. Therefore, it is imperative that a multidisciplinary team be involved to optimize the patient's care, particularly when a defect is complicated by a wound infection, an abscess, a fistula, or a neoplasm. Our goal in this article is to explore the challenges evoked by each of these special situations, and review the necessary steps for successful management.

Keywords: abdominal wall reconstruction; enterocutaneous fistula; fistula; vesicocutaneous fistula.

Figure 1

(A) A 34-year-old man with a history of pancreatitis, currently with jejunal cutaneous fistulas and recurrent ventral hernia after first repair with Gortex mesh. (B) Fascia defect after removal of the mesh and the hernia sac. (C) The mesh and the hernia sac were removed during surgery, which caused injury to the small bowel in three areas. (D) Fascia is located after minimally invasive component separation, and the porcine acellular dermal matrix (PADM) was applied in an underlay fashion. The tunnels, through which the minimally component separation was achieved, can be seen in this image. (E) Patient 2 months after surgical repair.

Figure 2

A 78-year-old patient, with a history of abdominal wound dehiscence after cystectomy and neobladder reconstruction, underwent fascia closure with biologic mesh. A urine leakage developed after application of the biologic mesh and caused mesh disintegration.