Recent Modalities In Reconstruction Of Anterior Abdominal Wall Defects

Abstract

Integrity of anterior abdominal wall is dependent upon the abdominal muscles and their conjoined tendons, these muscles assist in respiration and control the expulsive efforts of urination, defecation, coughing and parturition. They also work with the back muscles to flex and extend the trunk and hip, rotate the trunk at the waist, and protect viscera by becoming rigid. Knowledge of the anatomy of the anterior abdominal wall has enabled the reconstructive surgeons to achieve the goals of managing abdominal wall defects. The clinical problems that require abdominal wall reconstructions are congenital abdominal wall defects including omphalocele, gastroschisis and bladder exstrophy, and also acquired defects of the abdominal wall are caused by trauma, infection, ablative resection of primary or recurrent tumors, burns, radiation damage and complications after surgical procedures. Surgical planning for complex abdominal wall defects starts with a standard preoperative evaluation. Most patients with complex abdominal wall defects have complex past medical histories that directly influence reconstructive options. Immediate abdominal wall reconstruction is the most cost effective and efficient approach in patients who are healthy with stable wound beds. It is important to ensure that a one-stage approach is safe and reliable, while a staged approach to abdominal wall defects can improve results and decrease complications. Reconstruction should be delayed when patients are clinically unstable. There are numerous reconstructive options available to surgeons when managing complex abdominal wall defects: Small skin and subcutaneous defects of the abdominal wall usually can be closed with local advancement or split thickness skin grafts. Prosthetics are often used for the repair of ventral hernias in which a pure fascial deficit exists. Meshes require adequate skin and subcutaneous tissue coverage and a stable wound bed. A variety of synthetic materials (Prolene, PTFE, and Marelex) have been used to reconstruct the fascial defects successfully. Other materials such as human cellular dermal matrix (AlloDerm) and permacol have been reported to achieve long lasting and durable results in reconstruction of anterior abdominal wall defects. A split-thickness skin graft can be placed directly on the granulated base of this prosthetic material for temporary closure.