PATCHPLASTY WITH EXPANDED POLYTETRAFLUOROETHYLENE AND SKINPLASTY FOR THE CLOSURE OF LARGE CONGENITAL ABDOMINAL-WALL DEFECTS

A combined technique of patchplasty with expanded polytetrafluoroethyl ene (PTFE) and a special skinplasty is described for congenital abdomi nal wall defects where the abdominal cavity needs enlargement but skin closure is primarily possible. The patchplasty consists of suturing t wo half-moon-shaped, expanded PTFE leaves to the sides of the muscular abdominal wall, then approximating them under observation of intra-ab dominal pressure by monitoring five parameters (urinary bladder pressu re, central venous pressure, transcutaneous oxygen saturation, ventila tion pressure, and mean arterial pressure). The skin is incised in a h orizontal manner according to the tension lines. However, after closur e, regional necrosis of the skin in the mid-portion above the incision is often observed due to lack of sufficient subcutaneous tissue at th is site. Therefore, a skinplasty is done as a preventive measure, rese cting this potential site of necrosis. The final appearance of the ski n is an inverted T-shape. The surgical and monitoring techniques are d escribed and illustrated.