Repair of giant abdominal wall hernias with full-thickness skin transplants in high-risk patients

Abstract

The repair of giant abdominal hernias in high-risk obese patients remains a great challenge. There is no single simple surgical procedure to provide correction for this condition, and the risk for recurrence of hernia is high. Moreover, the insertion of a foreign material, i.e., synthetic mesh, adds an increased risk of infection, particularly in the presence of concomitant immunosuppressant therapy or diabetes. Eight patients, classified ASA 3–4, with giant abdominal wall hernias had 3 months pre-treatment with a custom-made compressive garment before abdominal wall repair. Four patients had a stoma at the time of surgery. Abdominal wall reconstruction was undertaken by realignment of the rectus muscles and fascia under tension. The fascia repair was stabilized with a full-thickness skin overlay graft. Early complications included two wound infections and one seroma. Two patients had pulmonary insufficiencies and required intensive care management. One complete recurrence of hernia was noted at follow-up. Full-thickness skin overlay grafts can be recommended in high-risk patients with abdominal wall hernias when the use of foreign material such as synthetic mesh is contraindicated.