Two-Stage Abdominal-Wall Reconstruction of Sepsis-Induced Dehiscence

Baker, Stephan; Millard, D. Ralph

doi:10.1097/00006534-199509001-00020

Cited by 13 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the cases that this cannot be achieved to cover the abdominal contents through a temporary wall closure or a planned ventral hernia and leave the abdominal wall reconstruction for another time, probably 6–12 months later [21]. Another option is to leave the repair of the abdominal wall to a second or even third surgical procedure, as reconstructing an abdominal wall defect in a contaminated field could result in poor outcomes, higher complication rates and reoperations [22, 23]. Jernigan et al [22] reported good results with a three‐staged procedure for complicated abdominal wall defects (not only with fistulas or stomas), with 8% of the patients eventually developing a fistula.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula

2020

View full text Add to dashboard Cite

Introduction The coexistence of an enterocutaneous fistula (ECF) with large abdominal wall defects represent one of the most demanding situations seen by a surgeon. Simultaneous treatment of ECF closure with abdominal wall defect closure has been widely debated. Our objective was to determine if the type of abdominal wall closure was associated with fistula recurrence after definitive surgery for ECF. Materials and methods Consecutive patients submitted to fistula resection with primary anastomosis for ECF closure. Among several variables, total abdominal wall closure (primary independent variable) was assessed as a factor related to the recurrence of the ECF (dependent variable). Univariate and multivariate analyses were performed. Results One-hundred and fourteen patients were included. Fistula recurred in 39 patients (34%). Total abdominal wall closure was done in 37 patients (32%). ECF recurred in 16% (6 of 37 patients) when abdominal wall closure was performed, compared to 43% (33 of 77 patients) when this was not (p \ 0.02). After multivariate analyses, abdominal wall closure was found as a protective factor against recurrence (p \ 0.02). Patients with total abdominal wall closure had one-fourth of risk for recurrence compared to patients without it. Other factors associated to recurrence of ECF were multiple fistulas (p \ 0.05), intraoperative blood loss [325 mL (p \ 0.05) and preoperative C-reactive protein [0.5 mg/dL (p \ 0.01). Conclusion Our results suggest that total abdominal wall closure is a protective factor against fistula recurrence after definitive surgery for ECF.

show abstract

Section: Discussionmentioning

confidence: 99%

The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula

2020

View full text Add to dashboard Cite

show abstract

“…Consequently, a staged reconstruction is required for this type of patients: first a temporary closing is provided, and subsequently, permanent repair should be done. [15,16] The techniques for temporary closing of the abdomen aim to protect the viscera somehow. In this sense, absorbable or non-absorbable meshes, the Bogota Bag and negativepressure wound therapy are used.…”

Section: (A) (B)mentioning

confidence: 99%

Staged Repair Of Severe Open Abdomens Due To High-Energy Gunshot Injuries With Early Vacuum Pack And Delayed Tissue Expansion And Dual-Sided Meshes

Alhan

Şahin

Güzey

et al. 2015

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes series of intra-abdominal interventions. At the end of this long treatment period, persistent intestinal edema and retraction of the abdominal wall are the main factors why fascias cannot be connected at an early time. Moreover, in severe abdominal traumas like the ones caused by high-energy gunshots, trauma may not only affect the intra-abdominal components but may also cause loss of domain of the abdominal wall.A staged reconstruction protocol is required for this type of patients. Firstly, a temporary closing of the viscera is provided, and subsequently, permanent repair of the abdominal wall should be done. Many procedures have been advocated to close the viscera at the first stage. [1][2][3][4][5][6] The fundamental principle in all of these procedures is forming the granulation tissue on the open abdominal wall and closing it with partial-thickness skin graft (PTSG ABSTRACT BACKGROUND: Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases. METHODS:Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes. RESULTS:The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient. CONCLUSION:In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.

show abstract

“…. Neben der Mobilisierung der retrahierten Bauchmuskulatur [2] bei kleineren Dehiszenzen steht die Mö glichkeit der Transposition von regionalen myocutanen Transpositionslappen aus der Oberschenkelund Hü ftregion zum musculä ren Ersatz des Bauchdeckendefekts zur Verfü gung. Der große Nachteil bei Verwendung grö ßerer lokaler Lappen ist das sekundäre funktionelle Defizit an der Entnahmestelle der unteren Extremitä t, insbesondere bei jungen Patienten.…”

Section: Diskussionunclassified

Dynamische und funktionelle Bauchdeckenstabilisierung, Wiederherstellung von ausgedehnten Bauchwanddefekten

Harpf

Ninković

Kronberger

et al. 1997

Chirurg

View full text Add to dashboard Cite

The aim of any abdominal wall reconstruction is maximal functional stability and adequate soft tissue coverage. The anatomy, elevation and clinical application of the myofascial tensor fasciae latae transposition flap and of the microvascular musculocutaneous latissimus dorsi free flap are presented. Repairing extensive fascial defects and recurrent hernias with the tensor fasciae latae transposition flap provides strong, dynamic, and functional reconstruction of fascial continuity to prevent a further recurrence. Adequate functional and aesthetic repair of a full-thickness abdominal wall defect can be optimally managed by the innervated microsurgical latissimus dorsi free flap.

show abstract

Two-Stage Abdominal-Wall Reconstruction of Sepsis-Induced Dehiscence

Cited by 13 publications

References 0 publications

The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula

The Importance of Abdominal Wall Closure After Definitive Surgery for Enterocutaneous Fistula

Staged Repair Of Severe Open Abdomens Due To High-Energy Gunshot Injuries With Early Vacuum Pack And Delayed Tissue Expansion And Dual-Sided Meshes

Dynamische und funktionelle Bauchdeckenstabilisierung, Wiederherstellung von ausgedehnten Bauchwanddefekten

Contact Info

Product

Resources

About