RESTORING ABDOMINAL-WALL INTEGRITY IN CONTAMINATED TISSUE-DEFICIENT WOUNDS USING AUTOLOGOUS FASCIA GRAFTS

Necrotizing abdominal wall infections, enteric fistulae, or exposed pr osthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with pros thetic material is usually contraindicated in the contaminated wound b ecause of the high infection rate necessitating prosthetic removal and further abdominal wall debridement. Consequently, for the past 9 year s, we have been using free grafts of autologous fascia lata to replace deficient abdominal wall fascia and muscle in situations where prosth etic material is contraindicated and local tissue rearrangement (i.e., component separation) would be inadequate. Thirty-two patients (mean age 59 years) underwent abdominal wall reconstruction with autologous fascia lata grafts. Indications included exposed mesh (31 percent), en teric fistulae (28 percent), enteric contamination (22 percent), wound infection (13 percent), and immunosuppression alone (6 percent); 31 p ercent of all patients were immunosuppressed secondary to either a sol id organ transplant or a systemic inflammatory disorder. Fascia grafts (mean size 10 X 17 cm) were sutured to the surrounding abdominal wall and covered by local skin flap advancement and/or myocutaneous flap r otation. All abdominal reconstructions were initially successful. Subs equent local abdominal wall complications included cellulitis (n = 3), seroma (n = 2), and skin dehiscence with exposed fascia grafts (n = 7 ). Five of seven patients with skin dehiscence healed by secondary int ention, whereas two had split-thickness skin grafts successfully appli ed to the granulating fascia. Thigh donor site complications included hematoma (n = 1), skin dehiscence (n = 1), and seroma (n = 2), There h ave been no cases of lateral knee instability. The average follow-up p eriod is 27 months (range 3 to 106 months). Recurrent hernia has been seen in three patients (9 percent). Interestingly, laparotomy has been performed through an intact fascia lata patch in three patients for u nrelated intra-abdominal conditions. In each case, the graft was intac t and revascularized, confirming experimental animal data performed in our laboratory. Recurrent hernia has not been observed through the la parotomy site. Our 9-year experience has demonstrated that in the face of large, contaminated abdominal wounds where prosthetic material is contraindicated and local tissue rearrangement would be inadequate, fa scia lata autografts are a reliable adjuvant to abdominal wall reconst ruction.