Management of acute full-thickness losses of the abdominal wall

H. H. Stone, T. C. Fabian, M. L. Turkleson, M. J. Jurkiewicz

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Over a 20-year interval, 167 patients sustained acute full-thickness abdominal wall loss due to necrotizing infection (124 patients), destructive trauma (32 patients), or en bloc tumor excision (11 patients). Polymicrobial infection or contamination was present in all but five of the patients. Of 13 patients managed by debridement and primary closure under tension, abdominal wall dehiscence occurred in each. Only two patients survived, the 11 deaths being caused by wound sepsis, evisceration, and/or bowel fistula. Debridement and gauze packing of a small defect was used in 15 patients; the single death resulted from recurrence of infectious gangrene. Pedicled flap closure, with or without a fascial prosthesis beneath, led to survival in nine of the 12 patients so-treated; yet flap necrosis from infection was a significant complication in seven patients who survived. The majority of patients (124) were managed by debridements, insertions of a fascial prosthesis (proline in 101 patients, marlex in 23 patients), and alternate day dressing changes, until the wound could be closed by skin grafts placed directly on granulations over the mesh or the bowel itself after the mesh had been removed. Sepsis and/or intestinal fistulas accounted for 25 of the 27 deaths. Major principles to evolve from this experience were: insertion of a synthetic prosthesis to bridge any sizable defect in abdominal wall rather than closure under tension or via a primarily mobilized flap; use of end bowel stomas rather than exteriorized loops or primary anastomoses in the face of active infection, significant contamination, and/or massive contusion; and delay in final reconstruction until all intestinal vents and fistulas have been closed by prior operation.

Original languageEnglish (US)
Pages (from-to)612-618
Number of pages7
JournalUnknown Journal
Volume193
Issue number5
DOIs
StatePublished - Jan 1 1981
Externally publishedYes

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Abdominal Wall
Debridement
Prostheses and Implants
Intestinal Fistula
Sepsis
Wounds and Injuries
Infection
Surgical Flaps
Gangrene
Contusions
Polypropylenes
Bandages
Coinfection
Proline
Fistula
Necrosis

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Stone, H. H., Fabian, T. C., Turkleson, M. L., & Jurkiewicz, M. J. (1981). Management of acute full-thickness losses of the abdominal wall. Unknown Journal, 193(5), 612-618. https://doi.org/10.1097/00000658-198105000-00011

Management of acute full-thickness losses of the abdominal wall. / Stone, H. H.; Fabian, T. C.; Turkleson, M. L.; Jurkiewicz, M. J.

In: Unknown Journal, Vol. 193, No. 5, 01.01.1981, p. 612-618.

Research output: Contribution to journalArticle

Stone, HH, Fabian, TC, Turkleson, ML & Jurkiewicz, MJ 1981, 'Management of acute full-thickness losses of the abdominal wall', Unknown Journal, vol. 193, no. 5, pp. 612-618. https://doi.org/10.1097/00000658-198105000-00011
Stone, H. H. ; Fabian, T. C. ; Turkleson, M. L. ; Jurkiewicz, M. J. / Management of acute full-thickness losses of the abdominal wall. In: Unknown Journal. 1981 ; Vol. 193, No. 5. pp. 612-618.
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