A Systematic Approach To The Management Of Massive Recurrent Ventral Hernias Using Tissue Expansion
Arthur Celestin, M.D.,M.P.H.1, Sivana Barron, B.A.1, Monica Morgenstern, B.S., M.S.1, Emmeline Jia, A.B., M.S.1, Shawn Diamond, M.D.2, Blakely Plaster, PA-C1, Ryan Cauley, M.D., M.P.H.1, Donald J. Morris, M.D.1.
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 2Texas Tech University Health Sciences Center, El Paso, TX, USA.
PURPOSE-Massive recurrent ventral hernias (MRVHs) in adults pose a significant challenge for reconstructive surgeons due to complexity at multiple levels. The use of staged tissue expansion is a helpful adjunct for augmentation of abdominal wall domain and skin. The senior author has performed the most extensive known series of abdominal tissue expansion to date and employs an approach that has been refined over years. This series is described and an algorithm proposed. METHODS-A retrospective review of all patients who underwent abdominal wall tissue expansion for MRVH's by the senior author over a ten-year period was performed. Outcome measures included primary fascial closure, recurrence, and surgical morbidity. RESULTS-Fifty-six patients met selection criteria, 30% were female with mean BMI of 32.6 (18.5-54.9), aged 62.5 (32-87) years-old. Hernia width averaged 18.3 cm (range 8-30). Primary musculofascial repair was obtained in 63% of patients; the remainder required bridging mesh. Average follow-up was 27 months. The recurrence rate in this highly co-morbid cohort was only 16.6%. Surgical site seroma was the most common complication. Based on this experience, a management algorithm was developed (Figure1). CONCLUSIONS-Staged abdominal wall expansion to address deficiencies in the myofascial layer and skin proved to be safe and effective in this consecutive series, the largest of its kind. An algorithm is provided based on this experience, providing systematic, experiential-based guidance for long term management of MRVHs.
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