Challenges in the Abdominal Wall Reconstruction

When a patient has had massive abdominal injuries and is unstable, trauma surgeons use the technique of bailout/damage control. The abdomen is left open after life-threatening injuries are quickly corrected so the patient can be stabilized. This commonly results in a huge abdominal hernia because the muscles of the abdomen are not reapproximated.

“The reconstruction which will be required later to correct the hernia remains among the most challenging cases we see,” said Robert Fitzgibbons, Jr., MD, Creighton University School of Medicine chair of surgery. “But there has been much progress in post-traumatic open abdominal management in the last 20 years.”

Life-saving interventions have to happen before reconstruction can begin. These can include abdominal packing, use of synthetic or biologic mesh and vacuum-assisted temporary closures.

Serial operations follow and can take days, weeks, even months, with large risk of complications.

The large defect usually requires component separation, where Dr. Fitzgibbons separates the abdominal muscles laterally to advance the muscles in the midline. “This is essential to creating a functional abdominal wall,” he said. “Component separation is a big advancement. Previously we would place mesh over and under the defect. The ability to perform component separation allows for a more secure repair.”