Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXX: Reoperative Abdominal Surgery

Specific Reasons for Reoperations: Large Abdominal Wall Defects

United States Department of Defense

When a considerable portion of the abdominal wall has been lost as a result of a wound or necessary debridement, the surgeon must consider the effects of initial treatment on the subsequent course. If a primary closure is attempted, strangulation of tissue by undue tension may cause necrosis of wound edges. A too-tight closure can lead to limitation of diaphragmatic excursion and respiratory compromise. If small intestine is allowed to become the base of a granulating wound, fistula formation and intestinal obstruction may result. Both of these situations may require reoperation. The most successful form of treatment in these cases, at initial operation or reoperation, has been the insertion of a Marlex mesh prosthesis, sewn to the undersurface of the remaining viable abdominal wall. As it is becoming encased in granulation tissue, the mesh should be covered with a dressing soaked in saline. Once the base of the wound is covered by healthy granulation tissue, it can be covered by a split-thickness skin graft or a sliding pedicle graft. An occasional patient, without abdominal wall loss, may require this type of closure due to tension.

In the austere situation where Marlex or other stock prostheses are not available, the surgeon may have to improvise. Recent experimental studies have shown that these defects can be successfully covered with polyvinyl chloride (Via Flex). This is the material from which Ringer's lactate and blood bags are made. Experimental use of these bags in animals to close defects has been very encouraging.

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Operational Medicine 2001

Health Care in Military Settings

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