Challenging abdominal wall defects

Background: We propose a simple algorithm for management of patients with c hallenging abdominal fascial defects. Methods: The medical records of 64 patients with complicated abdominal wall defects representing a consecutive series by a single surgeon over a 4-yea r period were reviewed. Group 1 patients presented with massive fascial def ects and closed wounds. They were reconstructed with autogenous tissue usin g either the separation of parts (SOP) procedure or free tensor fascia lata (TFL) grafts. Group 2 patients had fascial defects with open wounds. Wound closure was first accomplished with either STSG or primary skin closure ov er viscera. These patients, now "converted" into patients with closed wound s, were reconstructed months later as in group 1. Results: Average defect size was 320 cm(2). Wound closure was achieved in o ne procedure in all patients with open wounds. Time to discharge after this procedure averaged 9 days. The only morbidity of wound closure was skin gr aft donor sire pain. Average time from temporary staged closure with skin g rafts to definitive closure with autogenous tissue was 5 months. Repair of closed fascial defects with autogenous tissue was performed in 51 patients. Average time to discharge after autogenous tissue repair was 6.6 days. Rec urrence of hernia was noted in 2 (3.9%) patients with an average follow-up of 24 months. Conclusions: Treatment of challenging abdominal wall defects can be accompl ished simply and safely utilizing the above surgical algorithm. Open wounds are converted into dosed wounds and fascial defects are repaired with auto genous tissue. This treatment plan has proved to be effective in a wide var iety of situations. (C) 2001 Excerpta Medica. Inc. All rights reserved.