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Abdominal wall reconstruction

Abdominal wall reconstruction

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Abdominal wall reconstruction

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Presentation Transcript

  1. Abdominal wall reconstruction • Ari Leppäniemi, MD • Department of Surgery • Meilahti hospital • University of Helsinki • Finland

  2. Meilahti hospital • - one of Helsinki University hospitals • - general and GI-surgery • - cardiothoracic and vascular surgery, urology • - 13.000 emergency surgical admissions/year • - 4.300 emergency operations/year (50% of all) • - acute abdomen, vascular emergencies • - cardiothoracic, urologic, soft tissue infections • - trauma (torso, neck, peripheral vascular) • - majority penetrating (SW:GSW 6:1)

  3. General/GI surgical patients in the ICU (Meilahti ICU, 1996-2001, n=340) • n % mortality • rate • Necrotizing pancreatitis 98 29% 28% • Abdominal trauma 52 15% 21% • Generalized peritonitis 49 14% 24% • Other acute abdomen 37 11% 27% • Acute GI-bleeding 11 3% 36% • Elective GI-surgery 57 17% 23% • Miscellaneous 36 11% 31%

  4. Open abdomen as a result of treatment • - abdominal sepsis • - a treatment option • - abdominal trauma • - following damage control surgery (abbreviated • laparotomy with temporary abdominal closure) • - abdominal compartment syndrome • - theraputic decompressive laparotomy with • temporary abdominal closure

  5. Bogota bag and what then ...

  6. Open packing (Faure 1928)

  7. Abdominal wall closure after open abdomen • - primary fascial closure • - direct closure within 8 days (max 2 weeks) • - component separation closure • - gradual fascial closure (vacuum-assisted closure) • - non-absorbable mesh closure • - skin only closure • - split skin grafting over bowel or absorbable mesh • - late reconstruction with vascularized autologous • tissue

  8. Damage control for liver injury with subsequent primary closure

  9. Severe pancreatitis with ACS

  10. Component separation closure

  11. Component separation closure

  12. Component separation closure

  13. Component separation closure

  14. Vacuum-assisted closure

  15. Vacuum-assisted closure

  16. Vacuum-assisted closure

  17. Vacuum-assisted closure

  18. Vacuum-assisted closure

  19. Non-absorbable mesh

  20. Non-absorbable mesh

  21. Semi-absorbable mesh

  22. Semi-absorbable mesh

  23. Stretching the skin

  24. Skin-grafting after open abdomen

  25. Absorbable mesh

  26. Delayed abdominal wall reconstruction

  27. “Finger roll” -sign

  28. Excision of the grafted skin

  29. Tensor fascia lata flap

  30. Fascial closure

  31. Fascia closed, adjusting the skin

  32. Skin closure

  33. Summary • - aim for primary fascial closure • - direct fascial closure within 1-2 weeks • - alternative (component separation) or gradual • (vacuum-assisted) closure • - if no contamination risk, non-absorbable mesh with • primary skin closure • - if primary fascial closure impossible • - skin graft over bowel or absorbable mesh • - late (9-12 months) reconstruction with a TFL-flap

  34. Joint venture

  35. Thank you!