Planned ventral hernia. Staged management for acute abdominal wall defects
- PMID: 8203973
- PMCID: PMC1243212
- DOI: 10.1097/00000658-199406000-00007
Planned ventral hernia. Staged management for acute abdominal wall defects
Abstract
Objective: Analysis 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 II--2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III--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.
Results: Eighty-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 11% of the components separation technique.
Conclusions: The 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.
Similar articles
-
Staged management of giant abdominal wall defects: acute and long-term results.Ann Surg. 2003 Sep;238(3):349-55; discussion 355-7. doi: 10.1097/01.sla.0000086544.42647.84. Ann Surg. 2003. PMID: 14501501 Free PMC article.
-
Staged reconstruction after gunshot wounds to the abdomen.Plast Reconstr Surg. 2001 Jul;108(1):83-92. doi: 10.1097/00006534-200107000-00014. Plast Reconstr Surg. 2001. PMID: 11432399
-
The use of a subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy.Plast Reconstr Surg. 2003 Sep;112(3):766-76. doi: 10.1097/01.PRS.0000070175.10990.51. Plast Reconstr Surg. 2003. PMID: 12960857
-
Polypropylene mesh closure after emergency laparotomy: morbidity and outcome.Surgery. 1995 Oct;118(4):736-40; discussion 740-1. doi: 10.1016/s0039-6060(05)80043-1. Surgery. 1995. PMID: 7570330 Review.
-
Damage control in trauma: laparotomy wound management acute to chronic.Surg Clin North Am. 2007 Feb;87(1):73-93, vi. doi: 10.1016/j.suc.2006.09.011. Surg Clin North Am. 2007. PMID: 17127124 Review.
Cited by
-
Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction.Hernia. 2024 Feb;28(1):97-107. doi: 10.1007/s10029-023-02856-2. Epub 2023 Aug 30. Hernia. 2024. PMID: 37648895
-
Use of a porcine dermal collagen implant for contaminated abdominal wall reconstruction in a 105-year-old woman: a case report and review of the literature.J Med Case Rep. 2015 Apr 29;9:95. doi: 10.1186/s13256-015-0569-9. J Med Case Rep. 2015. PMID: 25925149 Free PMC article. Review.
-
Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia.Hernia. 2012 Aug;16(4):451-60. doi: 10.1007/s10029-012-0919-0. Epub 2012 May 23. Hernia. 2012. PMID: 22618090 Free PMC article.
-
Incisional hernia repair in renal transplantation patients.Hernia. 2005 Oct;9(3):231-7. doi: 10.1007/s10029-005-0325-y. Epub 2005 Oct 22. Hernia. 2005. PMID: 15912262
-
Delayed ventral hernia repair after skin graft closure of the open abdomen: the use of tumescence for safe skin graft elevation.Arch Plast Surg. 2021 Nov;48(6):714-716. doi: 10.5999/aps.2021.01249. Epub 2021 Nov 15. Arch Plast Surg. 2021. PMID: 34818721 Free PMC article. No abstract available.
References
MeSH terms
LinkOut - more resources
Full Text Sources
Medical