Landau Madeleine B, Aukerman William, Fligor Caleb, Jeon Hoonbae, Chaffin Abigail E
From the School of Medicine, Tulane University, New Orleans, LA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA.
Plast Reconstr Surg Glob Open. 2025 Mar 24;13(3):e6663. doi: 10.1097/GOX.0000000000006663. eCollection 2025 Mar.
Large-sized recurrent abdominal wall hernias are commonly repaired via component separation, involving the release of lateral abdominal wall muscles to facilitate defect closure. However, in settings without viable abdominal wall muscles or superficial soft-tissue coverage, alternative methods must be considered. This case report describes a technique of hernia repair using large bridging mesh for the treatment of a large-sized recurrent incisional hernia. Two patients with incisional hernia at previous incision measuring 15 × 35 and 23 × 15 cm underwent repair as a joint case with transplant and plastic surgery teams. Patient 1 had previous placement of bilateral tissue expanders superior to the defect in preparation for hernia repair. The repair in both cases involved excision of the previous skin graft over the bowel, dissection of the fascial edges and costal margin, and placement of an interpositioned reinforced ovine rumen. Coverage of the mesh was completed by utilization of local fasciocutaneous advancement flaps in both patients. The patients were admitted postoperatively. Patient 1 developed a small noninfected seroma at his incision site requiring later percutaneous drainage. No other complications or hernia recurrence have been noted in either case. The surgery and postoperative care required no significant alteration of immunosuppression. Large bridging mesh combined with tissue expansion may be used as an effective technique for the treatment of large abdominal wall hernias in patients with largest losses of abdominal fascia who are not candidates for component separation.
大型复发性腹壁疝通常通过成分分离术进行修复，包括松解腹壁外侧肌肉以促进缺损闭合。然而，在没有存活的腹壁肌肉或浅表软组织覆盖的情况下，必须考虑其他方法。本病例报告描述了一种使用大型桥接补片修复疝的技术，用于治疗大型复发性切口疝。两名在先前切口处患有尺寸分别为15×35和23×15厘米切口疝的患者，作为联合病例由移植和整形手术团队进行修复。患者1先前在缺损上方双侧放置了组织扩张器，为疝修复做准备。两例修复均包括切除肠管上先前的皮肤移植片、分离筋膜边缘和肋缘，以及放置一片插入的强化羊瘤胃。两名患者均通过利用局部筋膜皮瓣推进完成补片覆盖。患者术后入院。患者1在切口部位出现一个小的未感染血清肿，后来需要经皮引流。两例均未发现其他并发症或疝复发。手术和术后护理无需对免疫抑制进行重大调整。大型桥接补片联合组织扩张可作为一种有效的技术，用于治疗腹壁筋膜大量缺失且不适合成分分离术的患者的大型腹壁疝。
