Reconstruction of a complex anterior abdominal wall defect with autologous tissues – a case report

Abstract

Background:The anterior abdominal wall is an important complex composite structure that poses a challenge to the reconstructive surgeon. Defects produced from infection, herniation, tumour extirpation or trauma, are often encountered. Different techniques of reconstruction have been described using autologous tissues and prosthetic material with varying results, availability and cost implications. The use of totally autologous tissues presents a readily available reconstructive option that has been shown to be associated with a satisfactory outcome and low morbidity. In this report, we describe the use of autologous tissues for the reconstruction of a major abdominal wall defect. Method: This communication describes our experience of the use of purely autologous tissues for a full thickness anterior abdominal wall defect, presented as a case report. Result: The initial result that was obtained confirms that this is a useful technique with a satisfactory outcome with minimal morbidity. Conclusion: Utilizing purely autologous tissues, avoids most of the complications of the other techniques, is readily available, relatively cost-effective (especially advantageous in the developing country) and is less technically demanding.

Anterior abdominal wall reconstruction with mesh implants: indications and limitations in a developing tropical economy

“…The anterior abdominal wall is a complex, composite structure that poses a challenge to the reconstructive surgeon. Several reconstructive techniques have been described using autologous tissue and prosthetic materials with varying results, availability and cost implications [ 5 ]. In this series, our patients comprised predominantly young and middle-aged people with a preponderance of multiparous females that presented electively at the specialist surgery clinic.…”

“…In the current review, the numerous tissue-based techniques like Mayo´s technique, Keel´s operation, and component separation technique, use of tensor fascia lata as tissue replacement or vascularized pedicle flap were not employed during the operative repair. Previous investigators have documented drawbacks associated with these techniques [ 2 , 5 ]. For instance, the free or pedicle tensor fascia lata flap creates a donor site with potential morbidities [ 2 , 5 ].…”

“…Previous investigators have documented drawbacks associated with these techniques [ 2 , 5 ]. For instance, the free or pedicle tensor fascia lata flap creates a donor site with potential morbidities [ 2 , 5 ]. In Enugu, Nigeria, the use of tensor fasciae lata to manage a large ventral hernia led to a repair failure and recurrence under one year, prompting the authors to advise extreme caution with the use of tissue-based approaches for repair of large ventral hernias [ 3 ].…”

“…Anterior abdominal wall defects encompass a heterogeneous array of musculo-fascio-cutaneous abnormalities that may present a wide range of clinical behaviors [ 1 , 2 ]. The defects are commonly produced from infections, herniation, tumor extirpation, trauma and less frequently from congenital abdominal wall disorders [ 3 - 5 ]. The clinical entities encountered under this discourse include incisional hernia (IH), divarication of recti otherwise called ‘diastasis recti abdominis’ (DRA), giant primary midline abdominal wall hernias and defects that accompany abdominal wound dehiscence, tumor resection and open abdomen following damage control surgery [ 3 , 6 , 7 ].…”

“…This is particularly relevant in Sub-Saharan Africa with neglected, longstanding, voluminous, ventral hernias and the often-associated ignorance, poverty, deplorable health facilities and dearth of surgical personnel [ 10 , 11 ]. The use of autogenous materials in the reconstruction of such difficult abdominal wall defects has a long history, but the advent of prosthetic implants has diminished their clinical relevance in the developed nations [ 3 - 5 ]. Nevertheless, suture repair has remained popular in repairing these defects in many parts of Africa mainly due to poverty and surgeons´ preferences [ 10 ].…”