Abstract
Background
Many patients requiring conventional open abdominal management need a postoperative intermediate period with a large ventral hernia. This situation, in which the granulated abdominal contents are covered only with a skin graft, carry with it a high risk of enterocutaneous fistula, and the patients ultimately require late-stage abdominal wall reconstruction. Early abdominal wall reconstruction in noncandidates for standard fascial closure has received little attention. In this study we used bilateral anterior rectus abdominis sheath turnover flaps for early fascial closure which, to date, has not been evaluated as a technique for early fascial closure.
Methods
Eleven trauma and 18 nontrauma cases requiring open abdominal management over a 7-year period were reviewed. Bilateral anterior rectus abdominis sheath turnover flaps were created by longitudinal incisions along the lateral edge of the anterior rectus sheath, which were mobilized medially and approximated. The skin was closed primarily.
Results
Twelve nontrauma and eight trauma patients survived. No enteric fistula or abdominal abscess occurred. Anterior rectus sheath turnover flaps were used in nine of the 18 nontrauma and two of the 11 trauma patients, all of whom were unsuitable for standard fascial closure of prolonged visceral edema; the respective mean intervals from initial laparotomy to fascial closure were 9.4 and 18 days. Of the 11 patients with flaps, ten survived without fascial dehiscence or herniation (maximum follow-up: 65 months).
Conclusions
Early fascial closure using the anterior rectus abdominis sheath turnover flap may reduce the need for skin grafting and subsequent abdominal wall reconstruction. This approach can be considered as an alternative technique in the early management of patients with open abdomen.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rotondo MF, Schwab CW, McGonigal MD, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35:375–383
Moore EE, Burch JM, Franciose RJ, et al. Staged physiologic restoration and damage control surgery. World J Surg 1998;22:1184–1191
Shapiro MB, Jenkins DH, Schwab CW, et al. Damage control: collective review. J Trauma 2000;49:969–978
Mcnelis J, Soffer S, Marini CP, et al. Abdominal compartment syndrome in the surgical intensive care unit. Am Surg 2002;68:18–23
Rasmussen TE, Hallett JW Jr, Noel AA, et al. Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg 2002;35:246–253
Garner GB, Ware DN, Cocanour CS, et al. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomen. Am J Surg 2001;182:630–638
Miller PR, Thompson JT, Faler BJ, et al. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma 2002;53:843–849
Wittmann DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced peritonitis managed by planned multiple laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg 1990;14:218–226
Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defect. Acute and long-term results. Ann Surg 2003;238:349–357
Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: An anatomic and clinical study. Plast Reconstr Surg 1990;86:519–526
DeFranzo AJ, Kingman GJ, Sterchi JM, et al. Recus turnover flaps for the reconstruction of large midline abdominal wall defects. Ann Plast Surg 1996;37:18–23
Ennis LS, Young JS, Gampper TJ, et al. The “Open-Book” variation of component separation for repair of massive midline abdominal wall hernia. Am Surg 2003;69:733–743
Suliburk JW, Ware DN, Balogh Z, et al. Vacuum-assisted wound closure achieves early facial closure of open abdomens after severe trauma. J Trauma 2003;55:1155–1160
Fabian TC, Croce MA, Pritchard FE, et al. Planned ventral hernia: staged management for acute abdominal wall defects. Ann Surg 1994;219:643–653
Nagy KK, Filder JJ, Mahr C, et al. Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg 1996;62:331–338
Moon HK, Taylor GI. The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 1988;82:815–832
El-Mrakby HH, Milner RH. The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches. Plast Reconstr Surg 2002;109:539–543
Boyd JB, Taylor GI, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems. Plast Reconstr Surg 1984;73:1–16
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kushimoto, S., Yamamoto, Y., Aiboshi, J. et al. Usefulness of the Bilateral Anterior Rectus Abdominis Sheath Turnover Flap Method for Early Fascial Closure in Patients Requiring Open Abdominal Management. World J. Surg. 31, 2–8 (2007). https://doi.org/10.1007/s00268-006-0282-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-006-0282-3