Planned ventral hernia: Staged management for acute abdominal wall defects

Timothy Fabian, Martin Croce, F. Elizabeth Pritchard, Gayle Minard, William Hickerson, Robert L. Howell, Michael J. Schurr, Kenneth A. Kudsk

Research output: Contribution to journalArticle

224 Citations (Scopus)

Abstract

Objective: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. Methods: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I-prosthetic insertion; stage II-2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III-2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV-6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. Results: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. Conclusions: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost-it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects.

Original languageEnglish (US)
Pages (from-to)643-653
Number of pages11
JournalAnnals of surgery
Volume219
Issue number6
DOIs
StatePublished - Jan 1 1994

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Ventral Hernia
Abdominal Wall
Prostheses and Implants
Skin
Edema
Wounds and Injuries
Transplants
Polyglactin 910
Mortality
Polypropylenes
Subcutaneous Fat
Hernia
Plastics
Fistula
Sepsis
Morbidity
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Planned ventral hernia : Staged management for acute abdominal wall defects. / Fabian, Timothy; Croce, Martin; Pritchard, F. Elizabeth; Minard, Gayle; Hickerson, William; Howell, Robert L.; Schurr, Michael J.; Kudsk, Kenneth A.

In: Annals of surgery, Vol. 219, No. 6, 01.01.1994, p. 643-653.

Research output: Contribution to journalArticle

Fabian, T, Croce, M, Pritchard, FE, Minard, G, Hickerson, W, Howell, RL, Schurr, MJ & Kudsk, KA 1994, 'Planned ventral hernia: Staged management for acute abdominal wall defects', Annals of surgery, vol. 219, no. 6, pp. 643-653. https://doi.org/10.1097/00000658-199406000-00007
Fabian, Timothy ; Croce, Martin ; Pritchard, F. Elizabeth ; Minard, Gayle ; Hickerson, William ; Howell, Robert L. ; Schurr, Michael J. ; Kudsk, Kenneth A. / Planned ventral hernia : Staged management for acute abdominal wall defects. In: Annals of surgery. 1994 ; Vol. 219, No. 6. pp. 643-653.
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abstract = "Objective: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. Methods: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I-prosthetic insertion; stage II-2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III-2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV-6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. Results: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9{\%}; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33{\%} of mesh reconstructions and 11{\%} of the components separation technique. Conclusions: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost-it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects.",
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AU - Fabian, Timothy

AU - Croce, Martin

AU - Pritchard, F. Elizabeth

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AU - Howell, Robert L.

AU - Schurr, Michael J.

AU - Kudsk, Kenneth A.

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N2 - Objective: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. Methods: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I-prosthetic insertion; stage II-2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III-2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV-6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. Results: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. Conclusions: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost-it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects.

AB - Objective: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. Methods: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I-prosthetic insertion; stage II-2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III-2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV-6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. Results: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. Conclusions: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost-it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects.

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