Phase IV: Late Reconstruction Abdominal Wall Closure: Staged Management Technique

  • Timothy C. Fabian

There has been an evolution in managing the laparotomy wound associated with devastating abdominal injuries over the past 25 years. The pathophysiology of the scenario resulting in intra-abdominal hypertension has been fairly well worked out in both laboratory models as well as in clinical observational studies. It has been observed that closure of the laparotomy incision under such circumstances results in a compartment syndrome. As an alternative to closure under tension, the development of multiple methods of open abdominal wound management has evolved. However, while this progress has positively influenced some of these problems, a new dilemma has emerged: the giant ventral hernia [1, 2, 3, 4, 5, 6].


Ventral Hernia Open Abdomen Abdominal Wall Defect Fascial Closure Abdominal Wall Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg 1983; 197:532–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199(1):28–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Fietsam R, Villalba M, Glover JL, Clark K. Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am Surg 1989; 55:396–402.PubMedGoogle Scholar
  4. 4.
    Richardson JD, Trinkle JK. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 1976; 20:401–404.CrossRefPubMedGoogle Scholar
  5. 5.
    Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992; 33:45–49.CrossRefPubMedGoogle Scholar
  6. 6.
    Maxwell RA, Fabian TC, Croce MA, Davis KA. Secondary abdominal compartment syndrome: An underappreciated manifestation of severe hemorrhagic shock. J Trauma 1999; 47:995–999.CrossRefPubMedGoogle Scholar
  7. 7.
    Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: Prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998; 44:1016–1023.CrossRefPubMedGoogle Scholar
  8. 8.
    Silverman RP, Li EN, Holton LH III, Sawan KT, Goldberg NH. Ventral hernia repair using allogenic acellular dermal matrix in a swine model. Hernia. 2004; 8:336–342.CrossRefPubMedGoogle Scholar
  9. 9.
    Menon NG, Rodriguez ED, Byrnes CK, Girotto JA, Goldberg NH, Silverman RP. Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 2003; 50:523–527. Erratum in: Ann Plast Surg 2003; 51:228.CrossRefPubMedGoogle Scholar
  10. 10.
    An G, Walter RJ, Nagy K. Closure of abdominal wall defects using acelluar dermal matrix. J Trauma 2004; 56:1266–1275.CrossRefPubMedGoogle Scholar
  11. 11.
    Scott BG, Welsh FJ, Pham HQ, Carrick MM, Liscum KR, Granchi TS, Wall Jr MJ, Mattox KL, Hirshberg A. Asher Early Aggressive Closure of the Open Abdomen. J Trauma 2006; 60:17–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK. Staged management of giant abdominal wall defects: Acute and long term results. Ann Surg 2003; 238:349–357.PubMedGoogle Scholar
  13. 13.
    Jones JW, Jurkovich GJ. Polypropylene mesh closure of infected abdominal wounds. Am Surg 1989; 55(1):73–76.PubMedGoogle Scholar
  14. 14.
    Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: The vacuum pack. Am Surg 1995; 61:30–35.PubMedGoogle Scholar
  15. 15.
    Miller Pr, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: Planned ventral hernia rate is substantially reduced. Ann Surg 2004; 239:608–616.CrossRefPubMedGoogle Scholar
  16. 16.
    Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: An anatomic and clinical study. Plast Reconstr Surg 1990; 86:519–526.CrossRefPubMedGoogle Scholar
  17. 17.
    Fabian TC, Croce MA, Pritchard FE, Minard G, Hickerson WL, Howell RL, Schurr MJ, Kudsk KA. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 1994; 219:643–653.Google Scholar
  18. 18.
    Van Geffen JH, Simmermacher RK, van Vroohoven TJ, van der Werken C. Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg 2005; 201(2):206–212.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA

Personalised recommendations