Complex abdominal wall repair using a combination of porcine dermal matrix and omentum flap in patient with digestive tract fistula: report of a case and review of the literature

Abstract

Purpose: The purpose of this article is to propose an effective approach for giant abdominal wall defects repair in a contaminated field, using a combination of porcine dermal collagen graft (Permacol) and omental interpositional flap.

Case: We report a case of a 41-year-old woman submitted to emergency laparotomy, splenectomy and hepatic haemostasis for massive hemoperitoneum. She developed enteric fistula, cutaneous, muscolar and fascial necrosis leading to evisceration. At the fourth intervention we finally reconstructed abdominal wall defect using a combination of Parmacol and omental flap.

Conclusion: The reconstruction of large, full-thickness, eventually contaminated abdominal wall defects is often a challenging undertaking. Similar difficulties are usually encountered with early abdominal wall closure after damage-control surgery and/or open-abdomen management. In these situations the use of synthetic mesh is contrindicated; adsorbable mesh can be used as temporary solution and some techniques of autologous tissue repair have been suggested. Therefore no ideal operative repair technique or prosthetic material for reconstruction of the fascial defect is currently available in the literature. Recently, the development of biologic meshes has shown successful rates in the management of these parietal wall defects. Also in this patient, porcine dermal collagen mesh combined with omental flap allowed us to reconstruct large abdominal wall defect.