What is abdominal wall reconstruction?
Abdominal wall reconstruction is a surgery involving the reconstruction of the abdominal wall in order to restore anatomy and function. For example, abdominal wall reconstruction can be used to repair a hernia of the front of the abdomen.
The abdominal wall (or the belly) is made up of skin, several layers of tissue, including fat and muscle. It protects the abdominal organs, such as the stomach, the liver and others and helps maintain posture while supporting the spine. The abdominal wall also assists in important body functions such as coughing, urination, and defecation.
Why is abdominal wall reconstruction done?
The indications for reconstruction of the abdominal wall can be symptomatic (for example, pain relief of certain pains or for structural defects. Large abdominal defects can lead to significant herniation (abnormal protrusion of an organ or other body structures through a defect or natural opening in the body).
Defects of the abdominal wall may be due to:
- Trauma
- Tumors
- Tumor removal surgery
- Other past abdominal surgeries
- Infection
How do you prepare for abdominal wall reconstruction surgery?
- Maintain a healthy diet and stop smoking at least 2 weeks prior to surgery. Tobacco smoking delays healing.
- Stop taking blood thinning medication five to seven days before surgery.
- Refrain from eating or drinking (including water) six to eight hours before surgery.
How is abdominal wall reconstruction done?
The surgery is performed with general anesthesia. Depending on the extent of defect or infection, the surgery can take anywhere between two to eight hours. Abdominal wall is reconstructed using the following:
- Graft harvesting the patient’s own tissue (autograft).
- Prostheses
- Bioprosthesis
- Tissue expansion
- Flaps
- Vacuum assisted closure
The method of reconstruction is decided by the surgeon based on experience and nature of defect.
PROSTHESIS
Various types of synthetic prosthetic meshes are available for abdominal reconstruction. Polypropylene mesh is the most used synthetic prosthetic material in abdominal reconstruction. It is ideal for clean defects with enough soft tissue coverage.
Prostheses are superior to grafts due to the following:
- Higher tensile strength
- Easy availability
- No donor site morbidity
- Low rate of recurrence and complications
- Low cost
The disadvantages of prostheses are:
- Susceptibility to infection
- Bowel erosion
- Adhesion formation
- Foreign body reaction
- Seroma (accumulation of fluid)
BIOPROSTHESIS
- Biological meshes are derived from human or animal sources.
- The advantage of biological meshes are lower infection rates.
TISSUE EXPANSION
- This procedure uses the ability of skin to stretch over time to promote healthy skin and tissues and replace damaged tissue.
- It is usually performed by placing a balloon-like expander beneath the skin near the damaged area. Over time, the expander is filled with saline causing the skin around it to stretch and grow.
- It is commonly used in breast reconstruction, but rarely in abdominal reconstruction.
FLAPS
- Flap is a tissue lifted from a donor site and moved to a site of defect with an intact blood supply. Based on the nature of the defect.
Types of flaps:
- Cutaneous flaps: Contain full thickness of skin and underlying superficial tissue. Ideal for small defects.
- Fascio-cutaneous flaps: Contain full thickness of skin, underlying superficial and deep tissue and more blood supply with ability to fill a larger defect.
- Musculocutaneous or myocutaneous flaps: Addition of muscle layer to fascio-cutaneous flap. Provides bulk to fill deeper defects and restore function.
- Muscle flaps: Only the use of muscle to fill defects and restore function skin can be placed over it if needed.
- Bone flaps: Used to replace bone in case of bony defects
Myocutaneous and muscle flaps are commonly used in abdominal reconstruction.
- VACUUM-ASSISTED CLOSURE THERAPY (VAC): VAC device uses a device to reduce the air pressure on the wound, hence helping wounds heal faster and reduces infection.
SLIDESHOW
Appendicitis: Symptoms, Signs, Causes, Appendectomy in Detail See SlideshowWhat can I expect after abdominal wall reconstruction?
- Painkillers and antibiotics may be administered.
- A surgical drain may be placed during surgery which may be removed after 24 to 48 hours.
- Dressing may be removed after 24 to 72 hours.
- Based on the extent of reconstruction, the patient may be discharged between two to seven days.
- Patients can walk slowly with support typically after 2 days.
- Swelling and bruising may be present, which eventually revolves.
How long does it take to recover after abdominal wall reconstruction?
- Swelling, pain, and bruising after surgery, which would subside in a week or two.
- After 5 to 7 days, patients would usually be able to walk around comfortably.
- The result may take a few months following surgery in case of major reconstruction.
- Patients are generally able to resume pre-operative activities, including sexual intercourse and exercise after 4-6 weeks.
- Regular follow-up would be required to monitor healing.
- Patients are advised to eat healthy and avoid smoking to promote healing.
What are the complications of abdominal wall reconstruction?
- Swelling and bruising
- Hematoma (blood clot)
- Seroma (accumulation of fluid)
- Bleeding
- Infection
- Recurrence of hernia
- Poor wound healing
- Itching of skin
- Scarring or keloid formation
- Temporary numbness around incision site
- Loss of umbilicus
- Failure of prosthesis
- Adhesions due to prosthesis
- Bowel obstruction
- Intra-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS): increase in pressure inside the abdomen, probably due to recurrent small bowel obstruction. Patients may present with:
- Abdominal distention
- Increased abdominal pain
- Difficulty in breathing
- Loss of consciousness
- Nausea and vomiting
- Multi-organ failure – failure of heart, kidney, lungs, brain
Health News
- After Salmonella Cases Double in a Week, Cantaloupe Recall Expanded
- COVID Vaccines Curbed Pandemic-Linked Surge in Preemie Births
- Could a 'Brain Coach' Help Folks at Higher Risk for Alzheimer's?
- Early Promise for Stem Cell Therapy to Curb MS
- Internet Poses No Threat to Mental Health, Major Study Finds
More Health News »
Health Solutions From Our Sponsors
References
Medscape Medical Reference
Complete List
Top What Is Abdominal Wall Reconstruction Related Articles
Abdomen Picture
The abdomen (commonly called the belly) is the body space between the thorax (chest) and pelvis. See a picture of the Abdomen and learn more about the health topic.
Abdominal Pain
Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers. Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination. Treatment for abdominal pain depends upon the cause.
Direct vs. Indirect Hernia
Direct and indirect hernia are both inguinal hernias. Both types of hernias may cause a visible bulge in the groin area. Weakness in the muscle of the abdominal wall causes a direct hernia. A birth defect causes an indirect hernia. Hernias that can't be pushed in need surgery.
gotu kola
Gotu kola is a medicinal herb (Centella asiatica) that has been used in traditional Chinese and Indian Ayurvedic medicine systems to treat circulatory conditions, wound healing, abdominal disorders, and memory enhancement. Gotu kola is used for treating wounds, thick raised scarring (hypertrophic scarring), psoriasis, venous insufficiency, varicose veins, Alzheimer’s disease, Parkinson’s disease, anxiety, depression, insomnia, and others. Common side effects of gotu kola include nausea, gastrointestinal upset, high cholesterol levels, burning, skin rash, itching (pruritus), photosensitivity, allergic contact dermatitis, drowsiness, dizziness, and others.
Hernia (Abdominal Hernia)
A hernia occurs when an organ or piece of tissue protrudes from the space in which it is normally contained. Symptoms of a hernia include pain, nausea, vomiting, bowel obstruction, and fever. Hernias are diagnosed by a physical exam and imaging tests. Some hernias may be held in place with a supportive belt. Other hernias require surgical repair. The prognosis of people who undergo elective hernia repair tends to be good.
Hernia Quiz: Test Your Medical IQ
Exactly what is a hernia and why do we get them? Take this quiz to learn causes, symptoms, treatments and home remedies for this common condition.
How Long Does an Exploratory Laparoscopy Take?
Diagnostic laparoscopy is a surgical procedure done under local anesthesia that evaluates the causes of pain, bleeding, lumps, or diseases in the abdomen. Diagnostic laparoscopy is also called exploratory laparoscopy. Exploratory laparoscopy is used to diagnose and treat abdominal pain, abdominal mass, abdominal infection, fluid in abdomen (ascites), injury to the abdominal organs, liver disease, and cancer staging. Complications include pain, bleeding, infection, headache, dizziness, injury to other organ, and leaking.
How Long Does It Take to Recover from Laparoscopic Inguinal Hernia Surgery?
A laparoscopic inguinal hernia repair is a routine surgery to repair a weakness or perforation in the muscle or tissue in the abdominal cavity. Most people can return to normal activities in two weeks, but may need to avoid heavy lifting.
What Is an Umbilical Hernia Repair Surgery?
A hernia is a protrusion of an internal body part, such as the intestine, through a weak spot in the muscle or the surrounding tissue wall. An umbilical hernia repair is a corrective surgery for a hernia in the navel (umbilicus) region.
What Is Fascial Closure?
Fascial closure is the closure of the inner layers of the abdomen after a major surgery involving an incision on the abdomen. Fascial closure prevents hernia formation. The fascial closure technique is of two types: layered closure and mass closure. Fascial closure is usually indicated for surgery on the abdominal cavity and trauma.
What Is the Omentum?
The omentum ("policeman of the abdomen") is a double layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen. The omentum comprises the greater omentum which is important storage for fat deposits and the lesser omentum which holds the stomach and intestines in place next to the liver and connects them via blood vessels.