The Planning for the “Planned Ventral Hernia”

Abstract

Damage-control laparotomy and temporary abdominal closure have become important components of the armamentarium of many surgeons. Although the goal was to achieve delayed primary fascial closure in these patients, the most critically injured patients will require a different management scheme. We apply a 3-staged management algorithm to patients in whom delayed fascial closure is unattainable and will require future abdominal wall reconstruction. We will share lessons that we have learned after studying abdominal wall reconstruction for the past 25 years. We found that the standard component separation technique was insufficient to close the giant abdominal wall defects. For this reason, we developed a modification that we refer to as the Memphis modification for component separation. This modification allows us to reconstruct the abdominal wall using native tissue in a greater number of patients and thus avoids insertion of prosthetics. We will review the preoperative workup for planned ventral hernia repair, give a detailed step-by-step intra-operative description of the Memphis modification, and discuss postoperative complication and long-term results.