ABDOMINAL WALL CATASTROPHE, THERAPEUTIC STRATEGY – A CASE REPORT AND REVIEW OF THE LITERATURE

Maria João Amaral; Marco Serôdio; Sara Ramos; António Manso; Henrique Alexandrino; José Guilherme Tralhão

doi:10.34635/rpc.845

Maria João Amaral Serviço de Cirurgia Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal http://orcid.org/0000-0002-7494-3218
Marco Serôdio Serviço de Cirurgia Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal http://orcid.org/0000-0001-6661-4468
Sara Ramos Serviço de Cirurgia Plástica e Reconstrutiva, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal http://orcid.org/0000-0002-2044-6267
António Manso Serviço de Cirurgia Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal http://orcid.org/0000-0002-8914-6959
Henrique Alexandrino Serviço de Cirurgia Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment, Genetics and Oncobiology (CIMAGO), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal http://orcid.org/0000-0002-0279-9659
José Guilherme Tralhão Serviço de Cirurgia Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment, Genetics and Oncobiology (CIMAGO), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal http://orcid.org/0000-0002-5641-6975

Abstract

A complete abdominal wall defect (AWD) is life-threatening, has a functional and cosmetic impact on patients’ quality of life and represents a significant challenge for surgeons, requiring a multidisciplinary treatment strategy. The goals of the reconstructive surgery in the management of these defects are to provide stable coverage of the abdominal contents, restore function and achieve complete wound closure. We present a case that shows that the use of a biological mesh (porcine dermis), negative wound pressure therapy (NPWT) and split skin grafting is suitable to manage such defects when visceral exposure is present. A biological mesh is a good and less aggressive alternative to the use of free flaps, closing the AWD in a tension-free manner in an infected field or in one that is suspected of being infected and it has been shown to be better tolerated than synthetic meshes in open abdomens, with the ability to provide vascular ingrowth and incorporate itself into the native tissue. On the other hand, NPWT showed to provide a firm bandage for the patient and a closed, moist environment, protected from the invasion of bacteria, while eliminating excessive exudation, stimulating angiogenesis and reducing the wound surface area.

Downloads

Download data is not yet available.

References

1. Hutan M, Bartko C, Majesky I, Prochotsky A, Sekac J, Skultety J. Reconstruction option of abdominal wounds with large tissue defects. BMC Surg. 2014; 14: 50.

2. Russello D, Sofia M, Conti P, Latteri S, Pesce A, Scaravilli F et al. A retrospective, Italian multicenter study of complex abdominal wall defect repair with Permacol biological mesh. Sci Rep. 2020; 10: 3367.

3. Aydin D, Paulsen IF, Bentzen VE, Asadzadeh S, Holmich LR. Reconstruction of massive full-thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and spli-skin grafting. Clin Case Rep. 2016; 4(10):982-85.

4. Roje Z, Roje Z, Matic D, Librenjak D, Dokuzovic S, Varvodic J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011; 6(1): 46.

5. Gómez MJ, Rivera NB, Sánchez JL, Hernández JRH. Evisceración abdominal traumática: reconstrucción de pared abdominal con malla biológica e terapia de presión negativa. Cir Pediatr. 2016; 29: 89-92.

6. Rasilainen SK, Mentula PJ, Leppäniemi AK. Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg. 2012; 99(12): 1725–32.

7. rti surgical. Products & Implants [Internet]. 2020 [cited 2020 april 12]. Available from: https://www.rtix.com/en_gb/products/product-implant/fortiva-tissue-matrix-15mm-and-15mm-perforated.

8. Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia. 2018; 22(2): 249-269.

9. Morris MP, Mellia JA, Christopher AN, Basta MN, Patel V, Qiu K et al. Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis. Hernia. 2021; doi: 10.1007/s10029-020-02358-5.

10. Schembari E, Santangelo A, Pesce A, Mannino M, Maria S, Russelo D et al. Biological Mesh Combined With Topical Negative Pressure Therapy in Complex Abdominal Wounds: A Short Series and a Review of the Literature. Wounds. 2020; 32(4): 93-100.

11. Smart NJ, Marshall M, Daniels IR. Biological meshes: a review of their use in abdominal wall hernia repairs. Surgeon. 2012; 10(3):159-71.

12. Medtronic. PermacolTM Surgical Implant [Internet]. 2021 [cited 2021 march 16]. Available from: https://www.medtronic.com/covidien/en-us/products/hernia-repair/permacol-surgical-implant.html.

13. Orden KV, Santos J, Stanfield B, Frost LS, Ruditsky A, Foster A et al. Bovine versus porcine acellular dermal matrix for abdominal wall herniorrhaphy or bridging. Eur J Trauma Emerg Surg. 2021; https://doi.org/10.1007/s00068-021-01641-z.

14. Mellia JA, Othman S, Naga HI, Messa CA 4th, Elfanagely O, Byrnes YM et al. Outcomes of Poly-4-hydroxybutyrate Mesh in Ventral Hernia Repair: A Systematic Review and Pooled Analysis. Plast Reconstr Surg Glob Open. 2020; 8(12): e3158.