Damage control abdomen: single-stage reconstruction using a vicryl mesh buttress.

Area of Science:

• Surgical reconstruction
• Abdominal wall repair
• Trauma surgery

Background:

• Damage control laparotomy is a life-saving procedure for critical abdominal conditions.
• This approach often results in large incisional hernias, causing significant functional and aesthetic issues.
• Complex abdominal wall reconstruction is necessary to address these debilitating hernias.

Purpose of the Study:

• To present a technique for complex abdominal wall reconstruction after damage control laparotomy.
• To evaluate the outcomes, including hernia recurrence and functional recovery, of this reconstructive approach.

Main Methods:

• Retrospective review of 56 patients undergoing single-stage abdominal wall reconstruction post-damage control laparotomy (1999-2006).
• Reconstruction involved a double-layer, subfascial Vicryl mesh buttress, component separation, and rectus muscle turnover flaps.
• Outcomes assessed via clinical examination and telephone surveys for hernia recurrence and functional status.

Main Results:

• The average defect size was 865 cm², with a mean repair interval of 17 months.
• 88% of patients achieved successful repair with no recurrence; 7 cases of recurrence were noted.
• High functional recovery rates: 90% returned to full-time work and 92% to pre-injury activity levels.
• Complications included superficial skin dehiscence (12%) and abdominal compartment syndrome (7.1%), with 2 early postoperative mortalities.

Conclusions:

• Massive hernias after damage control laparotomy present a significant surgical challenge.
• The described technique, utilizing a Vicryl mesh buttress, component separation, and flaps, demonstrates high success rates in complex abdominal wall reconstruction.
• Excellent functional outcomes are achievable, with most patients regaining their pre-injury work and activity levels.