Tissue expanders for abdominal wall reconstruction following severe trauma: technical note and case reports

A technique of abdominal wall reconstruction without the use of prosthetic materials or myocutaneous flaps following severe abdominal trauma is described. Six weeks before abdominal reconstruction, tissue expanders are inserted on either side of the ventral defect and inflated at weekly intervals to increase the amount of local tissue for coverage. Restoration of the abdominal wall is accomplished by denuding the skin graft covering the ventral defect of its dermal elements and suturing this newly created fascial graft to the existing rectus fascia. The fascial graft is covered with full-thickness skin using local advancement flaps. This procedure has been carried out on two patients in conjunction with closure of a colostomy in one and closure of an enterocutaneous fistula in another. Both patients healed without infection, and follow-up at 3 and 12 months postoperatively demonstrated no evidence of hernia formation.