Closure Of Abdominal Wall Defects Research Articles

Late presentation of bladder extrophy with fungating mass: A case report

Abstract Introduction: Exstrophy of the bladder is a rare congenital anomaly usually treated in neonatal or childhood period. Patient presenting for the first time in the adulthood with fungating mass is an extreme rarity. Case Report: A 65-year-old man presented with unreconstructed ectopia vesicae with fungating mass and (acute kidney injury (AKI). The patient underwent an incisional biopsy. Histopathology showed mucinous adenocarcinoma with signet ring cells. Positron emission tomography (PET) computed tomography (CT) showed organ-confined primary bladder malignancy. He underwent radical cystectomy with cutaneous ureterostomy with primary closure of abdominal wall defect. Histopathology showed mucinous adenocarcinoma with signet ring cells (T4aN0). Discussion: Bladder exstrophy is a rare congenital anomaly, with an estimated incidence of 1 in 50,000 live births. It is more common in males (male:female, 5:1 to 6:1). The malignant potential of the exstrophied bladder mucosa is well known. Approximately 95% are adenocarcinomas and 3%–5% are squamous cell carcinomas. Most of the malignant tumors (60%) are associated with exstrophy of bladder occurring during the fourth and fifth decades of life. Conclusion: Awareness about the malignant potential of bladder extrophy and timely correction of the deformity and monitoring perhaps improves the quality of life when a multidisciplinary approach to treatment is adopted. Efforts should be made to pick up and treat such anomalies much earlier.

Shoelace technique for gradual closure of abdominal wall defect in a child

Shoelace technique for gradual closure of abdominal wall defect in a child

The external oblique muscle flap technique for the reconstruction of abdominal wall defects

PurposeSeveral modifications to the anterior component separation technique (ACST) have been reported to facilitate the closure of abdominal wall defects. In this study, the external oblique (EO) muscle flap for modified ACST during major abdominal wall defect reconstructions has been described. MethodsA retrospective review of consecutive patients undergoing modified ACST was conducted. The clinical data were collected and retrospectively analyzed. ResultsAmong the 36 patients admitted to our hospital from December 2014 to December 2020, 9 cases had rectus abdominis tumors, 1 case had rectus abdominis trauma, and 26 cases had incisional hernias. The average age was 61.17 ± 13.76 years, and the mean BMI was 24.25 ± 3.18 kg/m2. The average width of the defect was 14.33 ± 2.90 cm. Unilateral EO muscle flap technique was used to reconstruct the abdominal wall. 3 cases of surgical site infection (8.3%), 4 cases of grade III or IV seroma (11.1%) and 2 cases of intestinal obstruction (5.5%)were reported postoperatively. Ischemic necrosis of the abdominal EO muscle flap, incision dehiscence, intestinal fistula, or other complications were not observed. 1 case of incisional hernia recurrence (2.8%) was reported. Recurrence of tumors or abdominal wall bulging were not noted during the follow-up period of 32.53 ± 14.21 months. ConclutionsThe EO muscle flap technique is associated with low postoperative morbidity and recurrence rate, which approves it a reliable technique for selected groups of patients. Further research are needed to confirm the effectiveness of this technique.

Surgical treatment of enterocutaneous fistulas in patients with ventral incisional hernia

To determine the optimal surgical treatment in patients with enterocutaneous fistulas combined with ventral incisional hernia. There were 24 patients with enterocutaneous fistulas combined with ventral incisional hernia. Enterocutaneous fistula was noted in 19 cases, enteroatmospheric fistula - in 5 patients. Simultaneous fistula closure and abdominal wall repair were performed in 14 patients (mesh repair in 5 cases and local approximation of tissues in 9 cases). Postoperative complications occurred in 8 patients, hernia recurrence in long-term period developed in 7 people. Two-stage closure of abdominal wall defect was carried out in 10 patients. Fistula closure was followed by edge-to-edge anterior abdominal wall repair in 5 cases, skin edges were approximated by interrupted sutures or open wound management was performed. There were no postoperative complications and hernia recurrence in this group. Surgical treatment of patients with enterocutaneous fistulas combined with hernia should be performed in two stages, i.e. enterocutaneous fistula closure with subsequent hernia repair.

Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study

Background: In this study, following the Bogota bag closure of abdominal wall defects created in a rat peritonitis model, the short-term efficacy of polypropylene (PP) mesh (Prolene®, Ethicon), PP Mesh+Seprafilm®, polytetrafluoroethylene (PTFE) mesh [Infinit® Mesh (Gore)] and expanded PTFE (ePTFE) [Dualmesh®plus(Gore)] in the permanent repair of the defects was investigated.Methods: 64 rats were used. The rats were randomized into four groups, each consisting of 16 subjects: PP mesh (Group 1), PP mesh+Seprafilm (Group 2), PTFE mesh (Group 3), and ePTFE mesh (Group 4). Laparotomy was performed and abdominal wall defects were created. Contamination of the peritoneal cavity was induced, and closure was undertaken using a Bogota bag. After three days, the Bogota bag was removed, and materials were placed. At the end of the follow-up period, the rats were sacrificed. Mortality, grade of adhesion, surgical site infection (SSI), and tensile strength were evaluated.Results: Mortality was calculated as 6.3%, 50%, 25%, and 0% for Groups 1, 2, 3, and 4, respectively (p=0.002). Adhesion was observed at a rate of 61.1% in Group 1 and 38.9% in Group 2 (p=0.621). There was no adhesion in Groups 3 and 4 (p=0.001). The rate of SSI was 68.8% in Group 1, %75% in Group 2, and 100% in Groups 3 and 4 (p=0.022). Tensile strength was 2196±193.6 g/cm in Group 1 and 1906±142.1 g/cm in Group 2 (p=0.258).Conclusions: We argue that PP mesh is a suitable prosthesis for the permanent repair of contaminated abdominal wall defects despite the increased adhesion risk.

Transversalis fascia scoring: a new adjunct to anterior component separation technique

Abdominal wall hernia is a significant cause for reoperation following laparotomy. Anterior component separation (ACS) is a widely used technique for closure of large abdominal wall defects. We propose that adding scoring of transversalis fascia to ACS can provide additional midline advancement of the anterior rectus sheath. Open ACS was performed in eight cadavers. The medial advancement of the anterior rectus sheath was recorded at three points bilaterally during application of constant load, and again following scoring of the transversalis fascia. This technique was then used on two patients with recurrent, complex ventral hernias which could not be closed with ACS alone. In the cadaver model, transversalis fascia scoring provides additional 34.01, 27.12, and 25.05% advancement at each point compared to ACS. Results were significant. In both patients, primary fascial closure of defects over 20 cm width at midline was achieved. Adding transversalis fascia scoring in a controlled standard fashion to ACS may help surgeons achieve closure of abdominal wall defects when ACS alone is not sufficient. Level of Evidence: Level V, therapeutic study.

Recognition of laparoscopic and robotic abdominal hernia repairs

Laparoscopic and robotic techniques change the view of groin anatomy from inside to outside. The amplification view of laparoscopy extends surgeons′ visual field, with clear and precise anatomy, less bleeding and certain outcome. Robotic flexible joints increase angle of suture to abdominal wall. In this background, hernia surgeons pay close attention to closure of abdominal wall defect, choice and fix of mesh as well as status of robotic technique in hernia filed. Key words: Hernia; Defect suture; Mesh; Lapa-roscopy; Robotic technique

The value of intra-abdominal pressure monitoring through transvesical route in the choice and outcome of management of congenital abdominal wall defects

Introduction Gastroschisis and omphalocele are most common congenital abdominal wall defects (AWDs). Surgical management aims to reduce the evisceration safely, close the defect with a cosmetically acceptable outcome under guidance of intraoperative monitoring of intra-abdominal pressure (IAP). Intravesical pressure monitoring technique recommended by (WSACS) is the most reliable technique for IAP measurement in neonates. Aim The aim of this study is to assess the value of IAP monitoring via vesical pressure measurement in the choice and outcome of management of congenital AWDs. Patients and methods This is a prospective study of 25 cases that suffered congenital anterior AWDs (gastroschisis and omphalocele) admitted to Mansoura University Children Hospital during the period from October 2013 to October 2015. They were all operated upon guided by IVP monitoring during and after repair. Results In our study, 14 (56%) cases presented with gastroschisis and 11 (44%) presented with exomphalos with a median age of 24 h. Males (56%) were slightly more than females (44%). Congenital anomalies were reported in 16 cases (64%). Primary fascial closure was successful in 15 (60%) cases, whereas Silo repair was done in six (24%) cases and skin closure in only four (16%) cases. During the attempts of closure the mean abdominal perfusion pressure was 40.24 ± 5.59, the mean peak inspiratory pressure was 24 ±6.11 and the mean IAP was 22.60± 6.89. Two cases developed intra-abdominal hypertension after abdominal closure (8%) and only one of them needed decompressive laparotomy (4%). Postoperative complications were reported in 15 (60%) cases and mortality occurred in eight (32%) cases. Conclusion Increased IAP secondary to forceful closure of the abdominal defect is associated with the occurrence of complications. IVP monitoring is feasible during closure of AWDs and a threshold of 20cm H2O is appropriate to decide between primary and staged approach. Keywords : congenital abdominal wall defect, intravesical pressure, intra-abdominal hypertension

Mesh Sutured Repairs of Abdominal Wall Defects.

Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented. One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias. Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts.

Cosmetic Outcomes of Sutureless Closure in Gastroschisis.

Purpose A sutureless gastroschisis repair allows for spontaneous closure of abdominal wall defect. We report our experience focusing on final esthetic outcome. Methods Retrospective data were collected from medical reports of all neonates with gastroschisis operated from January 2009 to December 2013. Variables recorded included patients descriptors, management modality, and cosmetic outcome. Results From the overall group of 38 patients with gastroschisis, 20 infants treated with sutureless closure were included in this study. In the analyzed cohort, 17 (85%) children were operated under general anesthesia and 3 (15%) without intubation. Primary reduction was possible in 15 (75%) cases, and in 5 (25%) we used silo. There were two (10%) deaths in late postoperative course due to septic complications. Three (15%) infants needed laparotomy because of adhesions and bowel obstruction. There were no infectious complications of the wound. Only 55% (10/18) of children presented umbilical hernia prior to discharge. Only two (11%) children with umbilical hernia were operated until now. Almost all patients (16/18; 89%) present excellent final cosmetic result without scar formation. Conclusion Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces need of intubation and provides excellent cosmetic results.

Use of small intestinal submucosal and acellular dermal matrix grafts in giant omphaloceles in neonates and a rabbit abdominal wall defect model

BackgroundThe described surgical strategies for the management of omphalocele include primary closure, staged closure, and delayed closure. A primary repair is not suitable for all giant omphaloceles. We implanted two grafts, small intestinal submucosal (SIS) and acellular dermal matrix (ADM) onto abdominal wall defects in neonates to study the safety and efficacy of SIS and ADM graft techniques for initial closure of giant omphaloceles in infants, and we also implanted these grafts onto abdominal wall defects in an animal model. MethodsTwenty-four patients with giant omphaloceles were divided into two groups (ADM group, 12 patients; SIS group, 12 patients). The operative time, skin healing time postoperatively, and the incidence of skin infections, and abdominal wall hernias were observed. In the rabbit animal model, bilateral full-thickness incisions were made through the rabbit rectus abdominus muscles and a 2×4cm longitudinal whole layer defect was created on either the left or right lateral anterior abdominal wall. A four-layered variant of the SIS graft was used to repair the right abdominal defect; ADM was used to repair the left. Tensile strength was measured using an Instron tensiometer. Electron scanning and light microscopy were used to evaluate neovascularization, collagen deposition, and muscle fibers at 2, 4, 8, and 16weeks postimplantation. ResultsIn the neonatal patients, there was no statistically significant difference between the two groups with respect to operative time, skin healing time postoperatively, the incidence of skin infections, or abdominal wall hernias. In the SIS group, only one patient developed a skin infection, which led to skin necrosis and sloughing. In the ADM group, four patients developed skin infection postoperatively, and the patch was gradually removed. In the animal study, there was no significant difference between the mean breaking strength of ADM versus SIS repairs. Scanning electron and light microscopy showed collagen deposition, increased vascularization, fibroblasts, and muscular regeneration in both SIS and ADM repairs. SEM showed that the SIS graft was absorbed, while ADM was not. Light microscopy showed foreign body macrophages in ADM, but not in the SIS repairs. ConclusionSIS and ADM grafts adequately enhance healing with a low complication rate. Compared with ADM grafts, SIS is absorbable, induces less inflammation, and is more biocompatible, and therefore might be more useful and suitable for closure of abdominal wall defects.

Technique for Minimizing Donor-site Morbidity after Pedicled TRAM-Flap Breast Reconstruction: Outcomes by a Single Surgeon's Experience.

Background:Breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flap can result in significant abdominal wall donor-site morbidity. We present our technique of transversely dividing the anterior fascia and rectus abdominis combined with reinforcement above the arcuate line for closure of the anterior abdominal wall defect to prevent contour deformities performed by a single senior surgeon and compare these results with those of our prior series.Methods:We described our new technique of closure of the abdominal wall defect and retrospectively performed the comparison between the results of pedicled TRAM flaps using the new closure technique and those of 420 pedicled TRAM flaps from our 2003 publication in terms of abdominal bulging and hernia.Results:Sixty-seven pedicled TRAM flaps in 65 patients were compared with 420 pedicled TRAM flaps of the 2003 series. The new technique was associated with 5 partial TRAM flap necroses (8%). There was no total flap loss with the new technique. The median follow-up period was 13 months (range, 4–36 months). There were no instances of abdominal hernia and bulge during follow-up in the new series. Compared with the previous 2003 series, the new technique was superior in terms of occurrence of abdominal wall hernia or bulging.Conclusions:We are still performing pedicled TRAM flap for autologous breast reconstruction. Using the technique of transversely dividing the anterior fascia and rectus abdominis combined with reinforcement above the arcuate line can reduce the occurrence of abdominal bulging and hernia.

An Obturation Technique for Closure of Body Wall Defects

Aims: In the vast majority of instances, closure of abdominal wall defects relies on the tensile strength of transposed native tissue and/or prosthetic material. The purpose of this report is to alert clinicians to a different strategy for closure that we have used successfully on several occasions. Presentation of Case: A 72 year old man had a bulky inguinal nodal metastasis from cutaneous squamous cell carcinoma. He had an extended radical groin dissection including full thickness abdominal wall resection, with primary closure, followed by external beam radiotherapy. After 30 months, he developed an abdominal wall hernia and enterocutaneous fistula at the surgical site. Direct closure and local vascularized flaps were not feasible. Obturation of the defect by omentum was employed, taking advantage of its relative incompressibility rather than its minimal tensile strength. The wound was subsequently covered by a skin graft. The patient survived 10 years with an intact hernia repair and died of unrelated causes. Discussion: The technique has yielded good results. Case Study Johnson et al.; BJMMR, 7(12): 1039-1043, 2015; Article no.BJMMR.2015.42

Transversalis Fascia Scoring

BACKGROUND: Abdominal wall hernia is the most common complication after a laparotomy and cause for a reoperation.1 More than 105, 000 ventral hernia repairs are performed annually.2 Separation of the components is a widely used technique for closure of abdominal wall defects since the original studies by Ramirez in 1990.3 We propose that adding scoring of transversalis fascia to component separation can provide additional midline advancement of the anterior rectus sheath. We have investigated the utility of this technique using a cadaver model. METHODS: We used six cadavers to investigate the results of our proposed new method. The age, sex, time of death and presence of abdominal scars were noted. We performed a component separation as originally described by Dr. Ramirez, by elevating bilateral sliding myofascial rectus abdominis flaps. The medial advancement of the anterior rectus sheath was recorded at three points along the leading edge of the anterior rectus sheath bilaterally: 7 cm proximal to umbilicus (superior), umbilicus (middle), and 7 cm distal to umbilicus (inferior) (Figure 1).Figure 1: Figure 1.The advancement was recorded in centimeters using a hand held scale (Protégé®), while applying a constant load of 5 lb. Measurements were performed independently by two of the investigators. A mean value was calculated for measurements at each point. Then, scoring of the transversalis fascia using three parallel lines to the midline, advancing lateral to medial, spaced 1 cm apart was performed. Medial advancement of the anterior rectus sheath was again recorded at the previously used points. RESULTS: Performing component separation alone provided a mean of 2.4 cm, 3.4 cm, and 3.2 cm advancement at superior, middle, and inferior points, respectively. After transversalis fascia scoring was performed, mean advancement measurements were: 3.1 cm, 4.3 cm, and 4.0 cm for superior, middle and inferior points respectively. Transversalis fascia scoring provides additional 37.0%, 31.1%, and 23.8% advancement at each point when compared to component separation alone (Table 1).Table 1: Table 1.CONCLUSION: Our results demonstrate that adding transversalis fascia scoring in a controlled standard fashion to component separation can provide greater medial advancement of the anterior rectus sheath. Our proposed technique can help plastic surgeons treat abdominal wall defects, when component separation alone is not sufficient. We find our results to be promising and plan further clinical studies to follow.

Can high risk diseases for increasing intraabdominal pressure be treated more efficiently under intravesical pressure measurement?

Increased intra-abdominal pressure (IAP) can result in multiorgan failure. Trauma, mechanical bowel obstruction (MBO), abdominal wall defects (AWD) and fluid resuscitation in septic shock are conditions associated with a high risk of increased IAP in children. It may be possible to treat these conditions more effectively using intravesical pressure measurement. This prospective study was performed between December 2009 and October 2010. Intravesical pressure (IVP) measurement was used to determine IAP. The presence of Intra-abdominal hypertension (IAP >12 mmHg) and abdominal compartment syndrome (IAP >15 mmHg + new organ dysfunction) was evaluated in all clinical decisions. IVP monitoring was applied in all patients with abdominal trauma (14), AWD (8), fluid resuscitation for septic shock (7), and MBO (6). A diagnosis of ACS was determined in 14% of trauma patients and required surgery. IAH/ACS occurred in 38% of AWD cases, which required closure. IAH occurred in 43% of patients undergoing fluid resuscitation for septic shock, requiring decompressive intervention. IAH/ACS occurred in 50 % of MBO patients, all of whom required surgery. IVP measurement is a useful method to identify candidates for surgical treatment in cases of trauma and MBO. Similarly, IVP monitoring can facilitate the closure of abdominal wall defects and the application of fluid resuscitation in septic shock.

A Proposed Classification for the Spectrum of Vanishing Gastroschisis

Infants born with gastroschisis in association with intestinal atresia are well described. We are the proposing the classification of vanishing gastroschisis. In this series of six cases, at one end of the spectrum is an infant having gastroschisis with a much narrower defect on the right side of umbilicus. The ischemic bowel loops were connected to bowel inside the abdomen by a fibrous band compressing the exposed bowel mesentery. On the other end of spectrum, an infant having extensive bowel atresia and complete closure of abdominal wall defect (gastroschisis) detected on antenatal ultrasound. These cases should raise awareness of this devastating complication in prenatal management of gastroschisis.

Primary Abdominal Wall Actinomycosis

Actinomycosis of the anterior abdominal wall is rare. We report a 50-year-old man who presented with a right lower lateral chest wall mass of six years duration Computed tomography showed a 8 cm mass projecting from right lower lateral chest wall associated with extension of the right abdominal wall. En bloc resection including muscles, 9th and 10th ribs and a partial portion of diphragm was made. And direct closure of abdominal wall defect was done. Histopathological examination of the mass was consistent with those of actinomycosis. The patient recovered completely without post-operative complications. The patient is receiving minocycline for three months now. doi:10.4021/jmc336w

Minimally Invasive Components Separation—An Updated Method for Closure of Abdominal Wall Defects

We describe a new minimally invasive percutaneous/laparoscopic-assisted technique based on the principles of the original open components separation described by Ramirez et al. The technique of minimally invasive components separation (MICS) is described in detail as a stepwise approach. The main advantages of MICS are compared with its traditional open counterpart and previously described endoscopic/laparoscopic modifications. Open components separation is associated with increased wound problems due to extensive dissection. The MICS technique minimizes the need for large myocutaneous flap dissection, which in turn decreases postoperative wound complications. We have successfully corrected abdominal defects as large as 12 cm in diameter (113 cm(2)) with our MICS technique in a high-risk group of patients with minimal morbidity. The objectives of abdominal wall reconstruction, which includes restoring structural support, providing stable soft-tissue coverage, and optimizing aesthetic appearance, were all obtained with this newly described MICS technique. We believe that MICS is a safe, practical choice for repair of ventral hernia defects, because it minimizes postoperative morbidity and restores abdominal wall physiology.

Outcomes of plastic closure in gastroschisis

Gastroschisis is a congenital abdominal wall defect in which the intestines develop outside the abdomen and are exposed to amniotic fluid. When the defect is small, lymphatic, venous, and intestinal obstruction may occur and contribute to the formation of intestinal edema, atresia, ischemia, and a thick inflammatory peel. Treatment requires early coverage of abdominal contents either by primary closure or by the placement of temporary Silastic silo followed by abdominal wall closure. Currently, both traditional suture closure and the sutureless plastic closure are being employed to repair the gastroschisis defect. The goal of the current study is to evaluate plastic closure. We predict no difference will be found in clinical outcomes between plastic closure and traditional suture closure. A retrospective review of 80 patients treated between 2000 and 2009 was performed. Plastic closure was used in 52 (65%) and traditional suture closure in 28 (35%) babies. The surgical procedure was determined by surgeon preference. Of the 31(39%) babies who required silos, 15 (19%) were treated with plastic closure and 16 (20%) underwent traditional closure. We collected the following demographic data and clinical progression data. Using SAS 9.2 (SAS Institute Inc, Cary, NC), we conducted linear regression, logistic regression, and time to event models to compare the following outcomes: days on ventilator, days to start enteral feeds, days to reach goal enteral feeds, days on total parenteral nutrition, hospital charges, duration of stay, mortality, and complications. The mean duration of follow-up was 11.4 months. Patients spent an average of 6 days on the ventilator. There were 2 mortalities. A multivariate analysis demonstrated that no differences were found between the 2 closures with most of the outcomes; however, when compared with traditional suture closure, those babies treated with plastic closure spent 4 days fewer days on the ventilator (P < .01). Those babies who underwent suture closure were more likely to have an infection or sepsis (odds ratio, 5.15; P < .001). When the entire cohort was considered, no significant difference was found between plastic and suture closure in time to start feeds, time to reach goal feeds, time on parenteral nutrition, hospital charges, duration of stay, or complications. Ventral hernias were noted in 46 (58%) patients, 32 (62%) after plastic closure and 14 (50%) after suture closure (P = .32). Hernia repair was required in 16 (20%) patients, 11 (21%) after plastic closure, and 5 (18%) after traditional repair (P = .32). In the silo cohort, children treated with plastic closure required 7.5(P < .01) fewer days to start enteral feeds than those treated with suture closure. Plastic closure of abdominal wall defects in gastroschisis is effective both as a primary procedure and after silo placement. A multivariate analysis shows plastic closure to be associated with fewer days of mechanical ventilation and less likelihood of developing infection or sepsis.

Use of tissue expanders in the repair of complex abdominal wall defects

Background/Purpose Closure of abdominal wall defects in children poses a challenge for pediatric surgeons. We describe a technique using tissue expanders placed either intraperitoneally or in the abdominal wall to aid in the reconstruction of a variety of complex abdominal wall defects. Methods The tissue expanders are inserted under general anesthesia. Initial expansion is done in the operating room with attention to peak airway pressure, urine output, and end-tidal carbon dioxide. The expanders are inflated in the outpatient setting via percutaneous access until the calculated inflation volume is achieved. They are then removed; and definitive closure is accomplished using a combination of native tissue flaps, abdominal component separation techniques, biomaterials, and synthetic material. Results Six children underwent tissue expansion for treatment of abdominal wall defects (omphalocele, n = 3), trauma (n = 1), and thoracopagus twins (n = 1 pair). One to 4 expanders were used per patient, with all having a successful reconstruction of their abdominal walls. Two to 3 operations were required to restore abdominal domain and consisted of expander insertion, removal with reconstruction, and possible revision of the reconstruction. Conclusions Tissue expanders possess a broad range of applications for abdominal wall reconstruction and can be used in patients of all ages.