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A Case of Pediatric Abdominal Wall Reconstruction: Components Separation within the Austere War Environment
Ian Valerio1, Jennifer Sabino1, Anand Kumar1
1Plastic and Reconstructive Surgery Service, Walter Reed National Military Medical Center, Bethesda, Md.; The Department of Trauma and General Surgery, The Role 3 NATO Multinational Medical Unit, Kandahar, Afghanistan; Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.; and Department of Plastic and Reconstructive Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
Severe pediatric abdominal injuries in austere settings can be definitively treated with components separation technique. This rare reconstructive surgery for large ventral hernias in a pediatric patient showed minimal complications and no mortality.
Area of Science:
- Pediatric surgery
- Reconstructive surgery
- Trauma surgery
Background:
- Military reconstructive surgeons face challenges treating severe pediatric abdominal injuries in austere environments.
- Definitive treatment of large ventral hernias in pediatric patients in such settings requires advanced techniques.
- The safety and efficacy of components separation technique in this specific context are not well-documented.
Observation:
- A 12-month-old pediatric patient in Afghanistan sustained abdominal trauma resulting in a large ventral hernia.
- Components separation technique was necessary for definitive abdominal closure.
- The patient experienced an anastomotic leak post-small bowel resection, requiring surgical re-intervention.
Findings:
- The abdominal cavity was successfully reopened, the anastomotic leak repaired, and the abdomen closed primarily on post-injury day 9.
- The use of components separation technique in this pediatric case resulted in minimal complications.
- The procedure successfully avoided abdominal compartment syndrome and led to no mortality.
Implications:
- Components separation technique is a viable option for managing complex pediatric abdominal wall defects in austere environments.
- This case highlights the adaptability of advanced reconstructive techniques in challenging settings.
- Further research is warranted to establish the broader safety and efficacy of this technique in pediatric trauma patients.
Summary:
Reconstructive surgeons supporting military operations are required to definitively treat severe pediatric abdominal injuries in austere environments. The safety and efficacy of using a components separation technique to treat large ventral hernias in pediatric patients in this setting remains understudied. Components separation technique was required to achieve definitive closure in a 12-month-old pediatric patient in Kandahar, Afghanistan. Her course was complicated by an anastomotic leak after small bowel resection. Her abdominal was successfully reopened, the leak repaired, and closed primarily without incident on postinjury day 9. Abdominal trauma with a large ventral hernia requiring components separation is extremely rare. A pediatric patient treated with components separation demonstrated minimal complications, avoidance of abdominal compartment syndrome, and no mortality.
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