Massive traumatic abdominal wall hernia with significant tissue loss: challenges in management
Graham Skelhorne-Gross1, Jordan Nantais2, Noah Ditkofsky3
1Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada.
BMJ Case Reports
|May 6, 2021
Summary
A severe abdominal wall rupture from a car accident required a staged surgical repair. This approach successfully reconstructed the abdominal wall, restoring function and durability.
Area of Science:
- Trauma Surgery
- Abdominal Wall Reconstruction
- Plastic Surgery
Background:
- High-speed motor vehicle collisions can cause severe abdominal trauma.
- Seatbelt injuries can lead to extensive abdominal wall musculature rupture and hollow viscus injuries.
Observation:
- A 41-year-old female presented with a seatbelt-pattern injury, resulting in vertical separation of abdominal muscles and bowel evisceration without skin rupture.
- Intraoperative findings included significant tissue loss and muscle retraction, necessitating a staged repair approach.
Findings:
- Initial management focused on intra-abdominal injuries, followed by delayed abdominal wall repair using absorbable mesh and skin grafting.
- Definitive repair one year later involved components separation and a biological mesh underlay, achieving a robust reconstruction.
Implications:
- Staged abdominal wall reconstruction is effective for complex traumatic injuries.
- This stepwise approach can lead to durable and functional outcomes in patients with extensive abdominal wall defects.
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