Complex Abdominal Wall Reconstruction Involving Large Bridging Mesh at Organ Transplant Incision Site

Large-sized recurrent abdominal wall hernias are commonly repaired via component separation, involving the release of lateral abdominal wall muscles to facilitate defect closure. However, in settings without viable abdominal wall muscles or superficial soft-tissue coverage, alternative methods must be considered. This case report describes a technique of hernia repair using large bridging mesh for the treatment of a large-sized recurrent incisional hernia. Two patients with incisional hernia at previous incision measuring 15 × 35 and 23 × 15 cm² underwent repair as a joint case with transplant and plastic surgery teams. Patient 1 had previous placement of bilateral tissue expanders superior to the defect in preparation for hernia repair. The repair in both cases involved excision of the previous skin graft over the bowel, dissection of the fascial edges and costal margin, and placement of an interpositioned reinforced ovine rumen. Coverage of the mesh was completed by utilization of local fasciocutaneous advancement flaps in both patients. The patients were admitted postoperatively. Patient 1 developed a small noninfected seroma at his incision site requiring later percutaneous drainage. No other complications or hernia recurrence have been noted in either case. The surgery and postoperative care required no significant alteration of immunosuppression. Large bridging mesh combined with tissue expansion may be used as an effective technique for the treatment of large abdominal wall hernias in patients with largest losses of abdominal fascia who are not candidates for component separation.