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Massive traumatic abdominal wall hernia with significant tissue loss: challenges in management
  1. Graham Skelhorne-Gross1,
  2. Jordan Nantais2,
  3. Noah Ditkofsky3 and
  4. David Gomez4
  1. 1Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Surgery, Division of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3Department of Radiology, Division of Emergency, Trauma and Acute Care Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  4. 4Department of Surgery, Division of General Surgery, University of Toronto, Unity Health Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr David Gomez; David.Gomez{at}unityhealth.to

Abstract

A 41-year-old woman presented to our trauma centre following a high-speed motor vehicle collision with a seatbelt pattern of injury resulting in extensive rupture of her abdominal wall musculature and associated hollow viscus injuries. The abdominal wall had vertical separation between transected rectus, bilateral transverse abdominis and oblique muscles allowing evisceration of small and large bowel into the flanks without skin rupture. Intraoperatively, extensive liquefaction and tissue loss of the abdominal wall was found with significant retraction of the remaining musculature. Initial operative management focused on repair of concomitant intra-abdominal injuries with definitive repair performed in delayed, preplanned stages including bridging with absorbable mesh and placement of an overlying split-thickness skin graft. The patient was discharged from hospital and underwent extensive rehabilitation. One year later, the abdominal wall was definitively repaired with components separation and biological mesh underlay. This stepwise repair process provided her with a robust and enduring abdominal wall reconstruction.

  • trauma
  • general surgery

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Footnotes

  • Contributors GS-G was the primary contributing author and performed the literature review. JN assisted with writing, editing and literature review. ND assisted with writing and provided advanced interpretation of radiographical images as well as development of 3D reconstructions. DG conceived of the manuscript, assisted with writing, editing and literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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