Of all hernia types, large ventral hernias have the most impact on patient quality of life, however they are also the most difficult type of hernia to repair and are associated with high rates of complications. This case series describes repair of large ventral hernias with an ovine reinforced biologic in a complex patient cohort with comorbidities and concomitant procedures.

The author performed bridged repair with an ovine reinforced biologic in 19 consecutive high-risk patients over a 5-year period. In all cases the reinforced biologic was used as an underlay.

Of the 19 patients, six (32%) experienced a surgical site occurrence including infection, seroma, abscess, fistula, bioloma, or bowel obstruction. Three patients (16%) had recurrences with two out of three of the recurrences occurring within 6 months of surgery.

Rates of SSO's and recurrences using ovine reinforced tissue matrix (RTM) were in line with or better than other published studies of bridged repair utilizing biologic or synthetic mesh reinforcement. Ovine RTM's should therefore be considered in complex large ventral hernia repairs.

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Large ventral hernias greatly impact patient quality of life.

Traumatic abdominal wall hernias are rare injuries resulting from blunt abdominal trauma. Traditional approaches have included both open and laparoscopic approaches, with placement of large meshes with giant overlaps. Perhaps the most technically difficult aspect of these repairs is fixating the abdominal wall to the iliac crest. The senior author has developed a method of repair using 2-cm strips of mesh. In this article, we present a description of 4 patients treated with this technique.

• abdominal compartment syndrome
• abdominal decompression
• damage control surgery
• decompressive laparotomy
• intra-abdominal hypertension
• open abdomen

• Biological
• Closure
• Fistula
• Guidelines
• Intra-abdominal infection
• Laparostomy
• Mesh
• Non-trauma
• Nutrition
• Open abdomen
• Pancreatitis
• Peritonitis
• Re-exploration
• Reintervention
• Synthetic
• Technique
• Timing
• Trauma
• Vascular emergencies

• Abdomen/blood supply
• Abdomen/physiopathology
• Abdominal Cavity/blood supply
• Abdominal Cavity/surgery
• Abdominal Wound Closure Techniques/adverse effects
• Abdominal Wound Closure Techniques/standards
• Guidelines as Topic
• Humans
• Intra-Abdominal Hypertension/complications
• Intra-Abdominal Hypertension/prevention & control
• Negative-Pressure Wound Therapy/methods
• Postoperative Complications/prevention & control
• Prophylactic Surgical Procedures/methods
• Prophylactic Surgical Procedures/standards
• Resuscitation/methods

• Body wall defects
• Classification
• Congenital malformation
• Defect repairing
• Reconstruction

• Biological
• Closure
• Fistula
• Laparostomy
• Mesh
• Non-trauma
• Nutrition
• Open abdomen
• Pancreatitis
• Peritonitis
• Re-exploration
• Re-intervention
• Synthetic
• Technique
• Timing
• Vascular emergencies

• Abdominal Wound Closure Techniques/standards
• Abdominal Wound Closure Techniques/trends
• Consensus
• Critical Illness
• Humans
• Lower Body Negative Pressure/methods
• Pancreatitis/surgery

• abdominal wall
• animal model
• biaxial testing
• incisional hernia
• preclinical model
• recurrent hernia

Trauma may cause irreversible tissue damage and loss of function despite current best practice. Healing is dependent both on the nature of the injury and the intrinsic biological capacity of those tissues for healing. Preclinical research has highlighted stem cell therapy as a potential avenue for improving outcomes for injuries with poor healing capacity. Additionally, trauma activates the immune system and alters stem cell behaviour. This paper reviews the current literature on stem cells and its relevance to trauma care. Emphasis is placed on understanding how stem cells respond to trauma and pertinent mechanisms that can be utilised to promote tissue healing. Research involving notable difficulties in trauma care such as fracture non-union, cartilage damage and trauma induced inflammation is discussed further.

• DAMP
• healing
• inflammation
• stem cells
• trauma

• Animals
• Cell Differentiation
• Humans
• Inflammation/etiology
• Multiple Organ Failure/etiology
• Muscles/pathology
• Muscles/physiology
• Neovascularization, Physiologic
• Regeneration
• Stem Cell Research
• Stem Cells/cytology
• Stem Cells/physiology
• Wound Healing/physiology
• Wounds and Injuries/etiology
• Wounds and Injuries/pathology
• Wounds and Injuries/therapy

• Abdominal Wall/surgery
• Abdominoplasty/methods
• Acellular Dermis
• Collagen
• Female
• Humans
• Mammaplasty/methods
• Outcome Assessment, Health Care
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Risk Factors

• Acute component separation
• Acute mesh repair
• Damage control laparotomy
• Delayed primary closure
• Trauma

Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient's physiological condition allows.

• biological mesh
• coding
• synthetic mesh

• biologic
• hernia
• mesh
• xenograft

The use of human acellular dermis (hAD) to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care. This paper describes an investigation of the effects of fluids simulating an open abdomen environment on the biomechanical properties of Epiflex® a cell-free human dermis transplant.

hAD was incubated in Ringers solution, blood, urine, upper gastrointestinal (upper GI) secretion and a peritonitis-like bacterial solution in-vitro for 3 weeks. At day 0, 7, 14 and 21 breaking strength was measured, tensile strength was calculated and standard fluorescence microscopy was performed.

hAD incubated in all five of the five fluids showed a decrease in mean breaking strength at day 21 when compared to day 0. However, upper GI secretion was the only incubation fluid that significantly reduced the mechanical strength of Epiflex after 21days of incubation when compared to incubation in Ringer’s solution.

hAD may be a suitable material for closure of the open abdomen in the absence of upper GI leakage and pancreatic fistulae.

The so-called “burst abdomen” has been described for many years and is a well-known clinical condition, whereas the concept of the “open abdomen” is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of “acute postoperative open abdominal wall” (acute POAW) is presented, which in turn can be divided into “intentional” or planned acute POAW and “unintentional” or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wall-related disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

• Burst abdomen
• Open abdomen
• Evisceration
• Abdominal wall
• Mesh
• Negative pressure wound therapy
• Incisional hernia
• Enteroatmospheric fistula

Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure.

• Abdominal wall defect
• Compartment syndrome
• Inner layer reconstruction
• VAC

To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).

We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear).

In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.

Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.

The online version of this article (doi:10.1007/s00134-013-2906-z) contains supplementary material, which is available to authorized users.

• Acellular dermis
• AlloDerm
• Biological
• Reconstructive

• Abdominal wall reconstruction
• enterocutaneous fistula
• hernia

• Animals
• Biocompatible Materials
• Cosmetic Techniques
• Dermis/metabolism
• Humans
• Plastic Surgery Procedures/methods
• Wound Healing

• Abdominal trauma
• Emergency surgery
• Infection
• Plastic and reconstructive surgery
• Polytrauma