Abdominal Wall Reconstruction–Diagnostic and Therapeutic Algorithm

Adrian Pelinaru,Andreea Grosu-Bularda,Ioan Lascar,Tiberiu Paul Neagu,Carmen Ioana Mocanu,Sabina Grama,Razvan Nicolae Teodoreanu,Serban Arghir Popescu

doi:10.31689/rmm.2020.27.3.145

Adrian Pelinaru, Andreea Grosu-Bularda + Show 6 more

Open Access

https://doi.org/10.31689/rmm.2020.27.3.145

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Abstract

Due to its complex structure, the abdominal wall is vital as it serves to protect the internal organs, maintain the upright position and regulate the intraabdominal pressure. Complex abdominal defects are a major health problem, with challenging treatment, many complications and risks. It is not a completely elucidated pathology as there is no consensus in literature regarding the defi nition and classifi cation. Although there are various reconstruction techniques, there is no sistematic protocol in literature that allows the surgeon to choose the best treatment suitable for each patient. Therefore, the fi rst step to manage these patients is a carefull assesment of the patient background and only after that, a complete analysis of the actual wound should be made. Second step is appropriate abdominal wall closure. After the analysis of current data from international literature, we identifi ed a decision-making algorithm to offer guidance in surgical management in order to obtain an optimal functional outcome. The foundation of the algorithm is the idea of gradually improving the local tissue status, in order to deal with a clean wound as much as possible. This way, the success rate of the surgical reconstruction improves.

Highlights

ACTUAL STATE OF KNOWLEDGE IN COMPLEX ABDOMINAL DEFECT RECONSTRUCTION AnatomyThe abdominal wall has a multilayered structure that comprises the skin, subcutaneous tissue, the fascial layer, abdominal muscles, preperitoneal adipose tissue and peritoneum[4]
A good understanding of the abdominal wall structures along with its neurovascular anatomy is decisive for abdominall wall reconstruction
S J Mathes et al consider as the main particularity of a complex abdominal wall defect the failure of prior attempt at closure[5] while A

Summary

INTRODUCTION

Due to its complex structure, the abdominal wall is vital as it serves to protect the internal organs, maintain the upright position and regulate the intraabdominal pressure. There is not a consensus on the definition there are some common features that are mentioned by all authors when describing a complex abdominal wall defect These include a possible concomitant infection or a visceral fistula, multiple failed attempts of repair and lack of enough local skin to cover the defect. Considering that choosing the best option for treatment of the complex abdominal wound defects is a real challenge, as there is no protocol yet for this pathology, we identified, after the analysis of current data from international literature- an algorithm that could guide the surgeon through decision making in order to obtain an optimal functional outcome (Figure 4)

Findings

DISCUSSION

CONCLUSIONS