Complex tissue transfer in the management of abdominal wall defects

The concepts of damage control and improved understanding of the pathophysiology of abdominal compartment syndrome have proven to be great advances in trauma care and nontraumatic surgical conditions. Clear recognition of the complications after abdominal wall closure under excess tension has led to the widespread practice of leaving the abdominal cavity. However, these approaches require prolonged open abdomen management and contribute to the increased frequency of abdominal wall defects. In the typical care requiring open abdomen management who are not candidates for early fascial closure, many require a period with a large ventral hernia in which granulated abdominal contents are covered with only a skin graft, necessitating subsequent complex abdominal wall reconstruction. The risk of enterocutaneous fistula may increase as the duration of open abdomen is prolonged and continue even after skin grafting of the granurated open abdominal wound. Although several flap techniques have been demonstrated for abdominal wall reconstruction, the component separation technique, including its modifications and the anterior rectus abdominis sheath turnover flap method of complex tissue transfer can be used in patients with large midline abdominal wall defect. It can be applied not only for later reconstruction also in acute phase.