Complex Abdominal Wall Defects

Posted by e-Medical PPT Monday, April 23, 2012
Risk Factors for Complex Abdominal Wall Defects
Wound Infection
Abdominal Compartment Syndrome
Trauma
Infected Mesh
Incisional Hernia
Multiple Re-operations through same wound
Tumor resection
Obesity, Malnutrition, Sepsis

Treatment Options
Primary Repair
Mesh: Rives-Stoppa
3 Stage delayed repair
“Components Separation”
Local flaps v. Free tissue transfer
Human Acellular Dermis (Alloderm)

Primary repair
Limited to small defect (<5 cm in diameter)
Highest recurrence rate (up to 27%)
Patient selection is most important
Excessive tension leads to ischemia and failure…avoided with mesh and flap

Mesh closure
Nonabsorbable is advocated
Polypropylene allows for ingrowth of tissue (as opposed to PTFE)
Important to anchor mesh to well vascularized tissue
Complications:
Infection, fistula formation, erosion, & continued drainage

“Retro-rectus” mesh repair – ant to posterior fascia or pre-peritoneal space
57pts – 6 years
26.4% prev incisional hernia repair
ePTFE: 8x8 to 20x28cm
Mean f/u 35 months
12.3% Seromas
Two (3.5%) infected mesh – removed
One hernia recurrence(removed prosthesis)

Goals of abdominal wall reconstruction
Restoration of function and integrity of the abdominal wall
Prevention of evisceration
Dynamic muscle support

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