Repair of a postappendectomy massive ventral hernia using tissue expanders
A 41-year-old male patient presented to our emergency department with abdominal pain. Exploratory laparotomy performed through a subumbilical incision showed perforated appendicitis with intraabdominal abscess of 1,500 mL. In addition, there was a large hemangioma occupying 80% of the liver. After surgery he developed intraperitoneal sepsis and in order to prevent abdominal compartment syndrome, he was reoperated and left with "open abdomen". Several open abdomen lavages were performed and his abdominal wall defect was allowed to granulate.\nAfter epithelization of the defect approximately ten months later (), reconstruction of the abdominal wall was planned. Skin incisions were made 2 cm lateral to the defective area. Two rectangular tissue expanders (LS 82 2000, Laboratoires Sebbin, Boissy-l'Aillerie, France) of 2,000 mL volume (230 × 130 × 70 mm) were placed in the subcutaneous pockets created just above the anterior rectus sheath and adjacent to the abdominal wound bilaterally to reconstruct the defect of 23 × 37 cm in size. The ports of the tissue expanders were placed on the thoracic cage region.\nEach of the tissue expanders were inflated with 200 mL of saline at the time of the initial operation. Over the next several weeks, the expanders were gradually inflated to a total volume of 2,350 mL each over a period of four months (). After four months, the patient returned to the operating room for definitive repair of the defect. The expanders were removed () and since the fascial defect was too large to close primarily, utilizing prosthetic mesh (expanded polytetrafluoroethylene; GORE-TEX soft tissue patch) () in conjunction with tissue expanders, the abdominal wall defect was reconstructed. Expanded skin flaps were advanced toward the midline and closed in layers without tension. A more acceptable midline scar was then obtained. Suction drains were placed bilaterally and removed three days later.\nThe postoperative period of the patient was uneventful and he was discharged on the 4th postoperative day. During follow-up for ten months, he showed no signs of mesh infection or extrusion, and did not develop recurrent hernia, ulceration or enteric fistula. The tissue expansion process was well tolerated by the patient ().