AUTOLOGOUS CLOSURE OF GIANT ABDOMINAL-WALL DEFECTS

Split-thickness skin graft coverage of exposed and granulating intesti nes within large abdominal wall defects provides a life-saving permane nt biologic dressing. The resultant abdominal wall defect often is clo sed with mesh, which may infect and fistulize. This report describes b ilateral advancement flaps of the external oblique and recti muscles i n 11 patients treated over 3 years. The defects, which averaged 16 x 2 4 cm, were due to necrotizing fasciitis subsequent to trauma with bowe l perforation (3 patients), multiple ventral herniorrhaphies (2 patien ts), perforated diverticulitis (4 patients), and perforated peptic ulc er (2 patients). Eight patients were initially treated elsewhere where closure was achieved by split-thickness skin graft in five patients o r mesh in 3 patients; 3 developed enterocutaneous fistulae and were tr ansferred for closure while receiving long-term antibiotic and total p arenteral nutrition therapy. All 11 patients had successful primary cl osure. The 8 patients operated on electively had primary healing; 2 de veloped seromas, Two of the three patients operated on urgently develo ped superficial wound infections; both healed by second intent without compromise of the primary closure. The following conclusions can be d rawn: (1) the linea alba survives despite necrotizing fasciitis, (2) a tension-free primary closure is feasible; (3) morbidity is minimal, a nd (4) the long-term result is excellent.