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Cited by 119Hernia repair and managementCongenital Anomalies and Fetal SurgeryAbdominal Surgery and Complications

Current Options in the Management of Complex Abdominal Wall Defects

Ghazi, Bahair, Deigni, Olivier, Yezhelyev, Maksym, Losken, Albert·2011·Annals of Plastic Surgery
DOI 10.1097/sap.0b013e31820d18db
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Abstract

The management of complex abdominal wall defects is challenging and often requires an individualized strategy with additional measures to minimize morbidity and recurrence. We retrospectively reviewed all patients who underwent reconstruction of complex abdominal wall defects at Emory Hospital by the senior author over a 7-year period. Abdominal hernia defects were categorized into primary, secondary, and tertiary hernias; infection; composite tumor defects; and dehiscence. Charts were queried for comorbidities, surgical technique, and outcome measures such as complications and recurrence. A total of 165 patients included in the series, with an average age of 52 years, and an average body mass index of 38 kg/m. Mesh was used in 81.8% of cases, 77% of those (mesh) being acellular dermal matrices (ADM). Component separation was performed in 75 patients (45.4%). The overall complication rate was 23.6% (39/165) including infection, delayed healing, skin necrosis, and fistulae, and was higher in patients with 2 or more comorbidities and those who required synthetic mesh reconstruction. The hernia recurrence or bulge was observed in 20.6% (34/165), and 29.4% of these patients required an additional, equally complex procedure. Hernia recurrence was significantly associated with a history of previous recurrent hernia, and hypertension (P < 0.04 and P = 0.001, respectively). Recurrence was higher in patients with 2 or more comorbidities (26% vs. 14%, P = 0.022). The recurrence rate was similar for synthetic and ADM reconstructions; however, the complication rates were higher when synthetic mesh was used. Attention to surgical technique, optimization of comorbidities, and the increased use of biologic meshes will minimize the need for operative intervention of complications following reconstruction of complex abdominal wall defects. Components separation and ADM have been very useful additions to the surgical management in these high-risk patients.

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  • Application of synthetic mesh may cause an increased risk of complicated wound infections, synthetic mesh infections and erosions.

    “Although the application of synthetic mesh may cause an increased risk of complicated wound infections, synthetic mesh infections and erosions, 11 recommended perioperative management does not include standard perioperative antibiotic use. 12”

    From Caesarean Scar Endometriosis May Require Abdominoplasty (2021) · cites this paper as [11]

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Authors
Ghazi, B., Deigni, O., Yezhelyev, M., & Losken, A.
Affiliations
Emory University (US)
Venue
Annals of Plastic Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-05
Volume
66
Issue
5
Pages
488-492
ISSN
0148-7043 (ISSN-L)
DOI
10.1097/sap.0b013e31820d18db
OpenAlex
W2044210441
Cited by
119
References
20
Citations by year
2026: 4 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 6 · 2019: 6 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 7 · 2014: 12 · 2013: 24 · 2012: 9
FWCI
15.04
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Plastic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Hernia repair and management
  • Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
Keywords
abdominal wall reconstruction, abdominal wall defect, hernia recurrence, acellular dermal matrix, synthetic mesh, component separation, postoperative complications, comorbidities, hypertension, abdominal wall hernia, abdominal wall infection, abdominal wall dehiscence
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Hernia, Ventral, Humans, Male, Middle Aged, Postoperative Complications, Recurrence, Retrospective Studies, Severity of Illness Index, Surgical Flaps, Surgical Mesh, Surgical Wound Dehiscence, Cohort Studies, Treatment Outcome, Risk Assessment, Plastic Surgery Procedures, Abdominal Wall, Hernia, Abdominal, Young Adult

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