Tissue Expansion During Abdominal Wall Reconstruction

Abstract

Abdominal wall defects are some of the most commonly encountered reconstructive challenges. Goals of abdominal wall reconstruction include providing stable soft-tissue coverage, restoring fascial integrity, preventing hernia, protecting abdominal viscera, and restoring function. Deficiency in the skin/subcutaneous tissue can be repaired by a variety of methods: (1) primary closure if there is minimal tension between the wound edges, (2) rearrangement of existing tissue such as skin grafts, local flaps, regional flaps, and free flaps and (3) expanding the existing tissue with tissue expansion. First described in 1989 for congenital defects of the lower abdominal wall, tissue expansion remains a powerful tool to increase the amount of abdominal skin and subcutaneous tissue with subsequent skin flaps closure without tension. It involves insertion of a silicone balloon under the skin and subcutaneous tissue. The balloon is serially inflated by gradual injection of sterile saline via a remote or integrated port to inflate the skin and subcutaneous tissues over the expander. This can provide well-vascularized, autologous skin, subcutaneous tissue, and abdominal fascia for the repair of large defects. Tissue expansion can be a valuable tool in the spectrum of abdominal wall reconstruction.