Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months. 1. Introduction Abdominal wall defects caused by trauma or surgery are a common surgical problem to solve. Reconstruction of complicated abdominal dehiscence is a challenging condition for both general and plastic surgeons and several techniques have been described. Predisposing factors for lack of skin closure include inadequate local fascial and muscular layers due to prior tissue loss, muscle denervation or vascular insufficiency due to prior irradiation or infection, wound infection, obesity, chronic pulmonary disease, malnutrition, sepsis, anemia, corticosteroid dependency, and/or concurrent malignant process. Biological abdominal mesh is a new possible therapeutic approach in patients with open abdomen that increased mesh abdominal repair indications in patients with abdominal wall defects [1]. In some cases, when abdominal continence has been obtained but a wound dehiscence persists, Negative Pressure Wound Therapy (NPWT) could be a therapeutic option to obtain wound closure [2]. This treatment involves application of topical negative pressure to the open wound. It is an innovative treatment which increases the number of cases that can now be solved [3]. We report a case where we applied NPWT on a biological abdominal mesh in order to reduce