Slovenská chirurgia 4e/2023

Open Abdomen: options for definitive reconstruction of the anterior abdominal wall

Open abdomen (OA) methodology remains an essential arsenal in the hands of emergency surgery. The primary prerequisite for its success is the effort for early fascial closure, which can be achieved by using a suitable temporary cover and adequate intensive care, including early enteral nutrition. However, even with the observance of all the latest guidelines, we often encounter chronic abdominal wall defects. In such cases, the multidisciplinary cooperation of the surgeon, plastic surgeon, and intensivist is essential. The main methods of abdominal wall reconstruction include prosthetic material (mesh) or autologous material (tissue flaps). In patients with the original skin covering over the fascial defect (uncomplicated ventral hernia), the most common method is reconstruction with a synthetic mesh. Complex defects of the anterior abdominal wall require reconstruction of the musculofascial system with total replacement of soft tissues, including the skin cover. The component separation technique is the first choice of reconstruction in these cases. However, more advanced flap reconstruction procedures are necessary in specialized centers for extensive defects. This review article aims to provide a comprehensive overview of the possibilities of definitive closure of the abdominal wall, including the cases of reconstruction of chronic defects in the form of extensive ventral hernias, which arise due to the life-saving OA technique.

Keywords: open abdomen, abdominal wall defect, flap, mesh, ventral hernia