The anterior rectus abdominis sheath flap for fascial closure in burst abdomen and midline incisional hernia

Abstract

Objectives The aim of this study is to evaluate the effect of using the anterior rectus abdominis sheath flap in the repair of burst abdomen and midline incisional hernia. Background Complex abdominal wall hernias can be challenging for the reconstructive surgeon. The use of autologous tissue is preferable when possible. This repair entails a single fascial incision releasing the anterior rectus sheath as a turnover flap for abdominal wall reconstruction. This allows large defects to be closed with autologous tissue alone in a two-layer fascial repair in a vest-over-pants manner in a simple, straightforward surgical approach. Materials and methods Thirty participants requiring open abdominal management over a 26-month period were reviewed who underwent the anterior rectus abdominis sheath flap which released by lateral incision that meeting in midline as open book closing the defect ± the mesh. Hospital and office-based charts were reviewed. Results Thirty patients included in this study have risk factors such as anaemia (14:46.7%), malnutrition (11:36.7%), smoking (17:56.7%), obesity (16:53.3%), malignancy (17:56.7%), diabetes (8:26.7%) and chest complications (chronic obstructive pulmonary disease) (12:40%), with the cause of primary lesion divided into intestinal obstruction (6:20%), gastrointestinal tract malignancy (10:33.34%), miscellaneous (gynaecological and urological) (7:23.33%) and traumatic laparatomy (7:23.33%). Postoperative complications were wound infection (6:20%), seroma (5:16.6%), skin necrosis (3:10%), recurrence (1:3.3%), haematoma (1:3.3%) and no fistula. The average length of follow-up was 6-26 months. Conclusion The use of the anterior rectus abdominis sheath flap is an important technique for fascial closure in burst abdomen and midline incisional hernia; it is a simple and natural technique and provides a fascial closure with low recurrence and acceptable complications.