Reconstruction of massive full-thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and split-skin grafting

Abstract

We demonstrate that it is possible to use a nonabsorbable mesh for abdominal wall reconstruction after total wound rupture and successfully split-skin graft directly on the mesh. Sufficient granulation tissue formation prior to skin grafting was obtained with long-term use of negative pressure wound therapy (NPWT).

Figure 1

Perioperative photograph with three pieces of synthetic mesh sewn together and to the facial edges (shown with peans) to substitute the abdominal wall.

Figure 2

After eight months of VAC treatment and just prior to split‐skin transplantation. Note the mesh is almost invisible and the abdominal skin has reattached to the lateral aspects of the truncus.

Figure 3

One week after split‐skin transplantation. Note good graft take, folding of the mesh in the upper aspect of the defect and yellow secretion from what turned out to be a high small bowel fistula with low output.

Figure 4

Two months after split‐skin transplantation. The inset photograph six weeks after transplantation. Huge amount of mesh eroded through the transplanted skin and cut off successively.

Figure 5

Nine months after skin transplantation. The patient is almost healed. Inset: 28 months after the hernia operation and 20 months after the skin transplantation. A chronic skin defect in the right lateral groove, presumably due to the heavy weight of the lateral role and mechanical collision.