SURGICAL-MANAGEMENT OF ABDOMINAL-WALL DISRUPTION AFTER BLUNT TRAUMA

Abdominal wall disruption following blunt trauma is a rare but challen ging injury, both in the acute and convalescent phases, The present re port describes the recent experience with this injury at a single adul t trauma center. In a 22-month period, nine patients with traumatic ab dominal wall disruption were managed. Flank and anteroinferior abdomin al wall defects were most common. Associated injuries included 6 patie nts with a pelvic fracture and 4 patients with rectosigmoid injuries, Immediate primary repair of the defect was attempted in seven cases at the time of trauma laparotomy, but was difficult and often unsuccessf ul because of the related tissue destruction, Delayed abdominal wall r epair was performed in patients with symptomatic disability (n = 5) an d, if required, restoration of intestinal continuity was performed at a separate operation before abdominal wall repair, Delayed repair with autogenous tissue included the use of tenser fascia lata, rectus femo ris muscle, rectus abdominis fascia, and latissimus dorsi muscle. Reco nstruction with prosthetic mesh was required in two patients, One earl y and one late recurrence occurred, resulting in reoperation, In concl usion, traumatic abdominal wall disruption represents a complex challe nge for both general and plastic surgeons, The key to successful surgi cal management seems to be a delayed staged repair with autogenous tis sue when feasible.