Abdominal Wall Reconstruction in a Trauma Setting

Pushpakumar, Sathnur; Wilhelmi, Brandon J.; van-Aalst, Vera C.; Banis, Joseph C.; Barker, John H.

doi:10.1007/s00068-007-7023-7

Cited by 11 publications

(14 citation statements)

References 52 publications

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“…1 Nevertheless, although surgical decompression and laparostomy (usually performed through the same incision) can be life-saving, most surgeons will have witnessed both short-and long-term problems with abdominal laparostomies, particularly if early fascial closure is not possible. Lateral abdominal wall defects are much more difficult to reconstruct if early fascial closure cannot be achieved, particularly when they are close to the costal margins, 2 as was the case in the roof-top incision utilised in this patient.…”

Section: Discussionmentioning

confidence: 91%

To close or not to close? Treatment of abdominal compartment syndrome by neuromuscular blockade without laparostomy

Davies

Aghahoseini

Crawford

et al. 2010

annals

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A 67-year-old man with a history of hypertension was referred to hospital with an isolated raised ALT (85 IU/l) on routine blood testing. On subsequent abdominal imaging with ultrasound, CT, and MRI, he was found to have bilateral adrenal masses, the largest on the right, measuring 9 × 6 × 4 cm. Urinary catecholamines were raised, and a provisional diagnosis of bilateral phaeochromocytoma was made. Following stabilisation with alpha and beta blockade, he underwent bilateral adrenalectomy via a large roof-top incision. The surgery was technically difficult due to a combination of body habitus (body mass index 34 kg/m 2 with extensive intra-and extraperitoneal adipose tissue, in a rather protuberant abdomen) extensive retroperitoneal dissection, and multiple adhesions. A concurrent splenectomy was undertaken for an adhesional splenic capsular tear not controlled by conservative methods. His roof-top incision was closed in the usual fashion and he was extubated postoperatively.On the first postoperative day, he complained of increasing amounts of abdominal pain, and was noted to have a tense, distended abdomen. He was hypotensive, oliguric and his intra-abdominal pressure (IAP) was markedly raised at 40 mmHg (normal, < 12 mmHg). A presumptive diagnosis of established ACS was made and the patient was taken back to theatre for an exploratory re-laparotomy through the existing roof-top incision (principally to exclude significant postoperative bleeding as a cause for the ACS) which was opened in its entirety. Apart from a nonischaemic, moderately distended transverse colon, there were no abnormal intraperitoneal findings. After opening the incision, the IAP reduced from 40 mmHg to 28 mmHg.At this time, a decision was made not to leave the rooftop wound open as a laparostomy, but to instead to close the incision in a standard fashion and to undertake prolonged neuromuscular blockade (atracurium) with mandatory ventilation as primary therapy for his ACS for a trial period. The patient was transferred to the ICU and, during this time period, his IAP started to decrease, which was accompanied by improvement in his physiological indices. After 48 h of neuromuscular blockade, his IAP had reduced to 19 mmHg, neuromuscular blockade was stopped and he was extubated. His IAP subsequently fell to normal levels over the following few days. He made a good recovery and was discharged home 12 days after his initial operation. Histology subsequently revealed bilateral phaeochromocytomas in the resected specimens. The patient remains well 18 months following his surgery, with no clinical herniation detectable in his roof-top scar. Abdominal compartment syndrome (ACS) is a recognised postoperative complication seen frequently in the intensive care unit (ICU). Surgical decompression and laparostomy remain the gold standard treatment for established ACS, combined with supportive non-surgical therapy, such as nasogastric decompression. In the following case report, we describe our successful management of a patient with established postop...

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Section: Discussionmentioning

confidence: 91%

To close or not to close? Treatment of abdominal compartment syndrome by neuromuscular blockade without laparostomy

Davies

Aghahoseini

Crawford

et al. 2010

annals

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“…For this reason, we decided first to reduce the size with VAC therapy for the first 3 weeks. This therapy offers many advantages : (i) It is easily performed and managed. (ii) It allows for a temporary abdominal closure so as to avoid mortality and prevent contamination of the peritoneal cavity.…”

Section: Discussionmentioning

confidence: 99%

Abdominal wall reconstruction with Two‐step Technique (TST): a prospective study in 20 patients

Zarouni

Trelles

Leclère

2013

International Wound Journal

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Abdominal wall defects continue to be a challenging problem for reconstructive surgeons. The aim of our study was to report a 3-year experience using a simple Two-step Technique (TST) to treat abdominal wall defects. Between January 2008 and December 2010, 20 patients with abdominal wall defects were treated by TST. Patients had a mean age of 37·5 ± 14·9 years (range: 22-85 years); 5 were women and 15 were men. The size of the defects was prospectively analysed. Early and late complications were recorded. Hospital stay, post-procedure downtime and patient overall satisfaction were systematically assessed. A secondary defect resulting from self-manipulation and an infection were responsible for a complication rate of 10%. Both underwent successful surgical revision which led to full resolution. The average hospital stay was 11·2 ± 4·9 weeks for the series. Long-term complications were scar hyperpigmentation in 11 cases, scar hypertrophy in 5 cases and scar widening in 3 cases. Mean patient satisfaction was 8·3 ± 0·5 [visual analogue scale (VAS) 0-10]. Average downtime post surgery was 4·1 ± 1·2 weeks. The mean follow-up was 24·6 ± 6·7 months. Reconstruction of abdominal wall defect with the TST is a reliable and reproducible technique. This technique provides excellent outcomes, and we anticipate that it will become widespread in the near future.

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“…The major disadvantage is the loss of abdominal and back extensor muscle functions, if fascial closure can not be achieved. This would require complex reconstruction procedures including innervated free flaps that not only restore continuity but also the functional integrity of the abdomen [ 8 ].…”

Section: Selection Of Decompressive Methodsmentioning

confidence: 99%

Surgical management of abdominal compartment syndrome; indications and techniques

Leppäniemi

2009

Scand J Trauma Resusc Emerg Med

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The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention.

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Abdominal Wall Reconstruction in a Trauma Setting

Cited by 11 publications

References 52 publications

To close or not to close? Treatment of abdominal compartment syndrome by neuromuscular blockade without laparostomy

To close or not to close? Treatment of abdominal compartment syndrome by neuromuscular blockade without laparostomy

Abdominal wall reconstruction with Two‐step Technique (TST): a prospective study in 20 patients

Surgical management of abdominal compartment syndrome; indications and techniques

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