Abdominal wall reconstruction and biological prosthesis

Abstract

The significant advancement in the management of the acute surgical and critically injured patients has led to improve survival during the last decades [1-3]. However, a significant number of patients that are victims of catastrophic abdominal injuries will develop large abdominal wall defects that require complex abdominal wall reconstruction. The damage control surgical approach often results in open abdomen. This last condition often exits in giant abdominal wall defect. The subsequent reconstruction may represent a challenge for both the patient and the surgeon. Frequent complications are associated to these procedures (i.e., wound infections, seromas, fistula formation, recurrence of the defect, and mortality) [1, 3]. Abdominal wall reconstruction following an open abdomen is often associated with decreased physical functions and high prevalence of psychiatric complications, such as post-traumatic stress disorders or depression [4]. As a counterpart of the different techniques for abdominal wall reconstruction [1, 3, 4], only few 5-year or longer follow-up clinical studies have been reported. Recurrence rates following abdominal wall reconstruction have been reported to reach 54 % [5]. These rates vary depending on multiple factors: the technique employed, the approach (open vs. laparoscopic), the type of repair (suture vs. mesh), the type of prosthesis, surgical site infection, and comorbidities [5-8]. Different surgical techniques with many modifications have been reported with promising results [5].