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Reconstruction option of abdominal wounds with large tissue defects.

Hutan M, Bartko C, Majesky I, Prochotsky A, Sekac J, Skultety J - BMC Surg (2014)

Bottom Line: Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries.Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique.Functional and cosmetic effect is acceptable and patients have good postoperative quality of life.

View Article: PubMed Central - HTML - PubMed

Affiliation: II,nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st, Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia. matohuto@yahoo.com.

ABSTRACT

Background: Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients.Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent.

Case presentation: Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life.

Conclusions: Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention.

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Related in: MedlinePlus

Finalization of NPWT treatment. Patient 3, overgranulated wound prepared for split skin grafting.
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Figure 3: Finalization of NPWT treatment. Patient 3, overgranulated wound prepared for split skin grafting.

Mentions: We present three patients, in whom the only possibility of abdominal wall reconstruction was the use of a polypropylene mesh with adhesion prevention film, enhancement of the growth of granulation tissue with use of NPWT, and subsequent split skin grafting. The mesh used in all three patients was Parietene Composite 3020 (Covidien, Dublin, Ireland), which is a composite polypropylene mesh with an absorbable collagen layer. This mesh is a standard double layer mesh, used in authors’ department for sublay hernia repairs and any other intraabdominal mesh placement techniques. After resection of necrotic (patient 1 and 3) or inadequate tissue (patient 2), we sutured the mesh under the fascia in sublay fashion using single non-resorbable sutures, overlapping the mesh by at least 3-4 cm under the edge of the fascia, and placing at least two rows of sutures with a distance of no more than 3 cm from the edge (Figure 1). We tried to interpose omentum between the mesh and the bowels, but complete coverage of intestinal loops was not possible in any of our patients. Immediately after the operation, NPWT was initiated by using continuous -125 mmHg during the first 48 hours. Then we switched to intermittent mode (-30 mmHg (0 mmHg in KCI ATS)/-125 mmHg, swap every 3 min). Black polyurethane (PU) foam was used in all three patients. We used KCI ATS (KCI, Texas, USA) in the first patient, the last two patients were treated with Vivano (PAUL HARTMANN AG, Germany). NPWT redress was done every 3 days (Figure 2). During redresses the wound was washed with only small amounts of physiological solution, no other agents were used. We decided to end the NPWT treatment when the wound bed was clean and filled with granulations, without clinical signs of critical colonization or infection, and no change of granulation growth was seen since the last redress (Figure 3). Split skin grafting was done at the time of termination of NPWT, donor skin was taken from the thigh using pneumatic dermatome set to the middle skin thickness. Wound was covered with vaseline gauze (Grassolind, Atrauman, PAUL HARTMANN AG, Germany) and redress was done on the fifth day. Outpatient follow up (Figure 4) was one year after hospital release for the first patient, the other two patients were followed for two years. Further follow up was taken up by their family practitioner. Quality of life was assessed verbally by patient responses to questions concerning mobility, self-care, adjustment to everyday work, need for change of their work or even retirement, need for pain medication, and overall subjective perception of the quality of life.


Reconstruction option of abdominal wounds with large tissue defects.

Hutan M, Bartko C, Majesky I, Prochotsky A, Sekac J, Skultety J - BMC Surg (2014)

Finalization of NPWT treatment. Patient 3, overgranulated wound prepared for split skin grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127081&req=5

Figure 3: Finalization of NPWT treatment. Patient 3, overgranulated wound prepared for split skin grafting.
Mentions: We present three patients, in whom the only possibility of abdominal wall reconstruction was the use of a polypropylene mesh with adhesion prevention film, enhancement of the growth of granulation tissue with use of NPWT, and subsequent split skin grafting. The mesh used in all three patients was Parietene Composite 3020 (Covidien, Dublin, Ireland), which is a composite polypropylene mesh with an absorbable collagen layer. This mesh is a standard double layer mesh, used in authors’ department for sublay hernia repairs and any other intraabdominal mesh placement techniques. After resection of necrotic (patient 1 and 3) or inadequate tissue (patient 2), we sutured the mesh under the fascia in sublay fashion using single non-resorbable sutures, overlapping the mesh by at least 3-4 cm under the edge of the fascia, and placing at least two rows of sutures with a distance of no more than 3 cm from the edge (Figure 1). We tried to interpose omentum between the mesh and the bowels, but complete coverage of intestinal loops was not possible in any of our patients. Immediately after the operation, NPWT was initiated by using continuous -125 mmHg during the first 48 hours. Then we switched to intermittent mode (-30 mmHg (0 mmHg in KCI ATS)/-125 mmHg, swap every 3 min). Black polyurethane (PU) foam was used in all three patients. We used KCI ATS (KCI, Texas, USA) in the first patient, the last two patients were treated with Vivano (PAUL HARTMANN AG, Germany). NPWT redress was done every 3 days (Figure 2). During redresses the wound was washed with only small amounts of physiological solution, no other agents were used. We decided to end the NPWT treatment when the wound bed was clean and filled with granulations, without clinical signs of critical colonization or infection, and no change of granulation growth was seen since the last redress (Figure 3). Split skin grafting was done at the time of termination of NPWT, donor skin was taken from the thigh using pneumatic dermatome set to the middle skin thickness. Wound was covered with vaseline gauze (Grassolind, Atrauman, PAUL HARTMANN AG, Germany) and redress was done on the fifth day. Outpatient follow up (Figure 4) was one year after hospital release for the first patient, the other two patients were followed for two years. Further follow up was taken up by their family practitioner. Quality of life was assessed verbally by patient responses to questions concerning mobility, self-care, adjustment to everyday work, need for change of their work or even retirement, need for pain medication, and overall subjective perception of the quality of life.

Bottom Line: Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries.Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique.Functional and cosmetic effect is acceptable and patients have good postoperative quality of life.

View Article: PubMed Central - HTML - PubMed

Affiliation: II,nd Surgical Clinic of Medical faculty Comenius University, University Hospital Bratislava, Hospital of st, Cyril and Methodius, Antolska 11, Bratislava 85107, Slovakia. matohuto@yahoo.com.

ABSTRACT

Background: Abdominal wall defects result from trauma, abdominal wall tumors, necrotizing infections or complications of previous abdominal surgeries. Apart from cosmetics, abdominal wall defects have strong negative functional impact on the patients.Many different techniques exist for abdominal wall repair. Most problematic and troublesome are defects, where major part of abdominal wall had to be resected and tissue for transfer or reconstruction is absent.

Case presentation: Authors of the article present operative technique, in which reconstruction of abdominal wall was managed by composite polypropylene mesh with absorbable collagen film, creation of granulation tissue with use of NPWT (negative pressure wound therapy), and subsequent split skin grafting.Three patients with massive abdominal wall defect were successfully managed and abdominal wall reconstruction was performed by mentioned technique. Functional and cosmetic effect is acceptable and patients have good postoperative quality of life.

Conclusions: Patients with giant abdominal defects can benefit from described technique. It serves as the only option, with which abdominal wall is fully reconstructed without need for the secondary intervention.

Show MeSH
Related in: MedlinePlus