Abstract text (incl. references and figure legends)
Case History: A 30-year-old man was admitted to hospital for massive abdominal bleeding after traffic accident. He underwent median laparotomy with right subcostal extension, open abdomen treatment for two months and multiple relaparotomies. The abdomen was closed using a bio A prosthesis and skin grafts because of a significant loss of substance of the right abdominal muscles. (fig 1-2) Clinical Findings: Giant incisional hernia > 25cm wide occupying the entire median incision. Investigation/results: CT scans. Diagnosis: Giant incisional hernia following open abdomen treatment. Therapy and progressions: Two step surgery was performed: first step was the fixing of the inferior fascia and part of the right defect by using two Synecor mesh overlapping (fig 3) with an 18cm residual defect (5 months later). Prolonged medical and negative wound pressure therapy were necessary because of surgical site infection involving the mesh. Second surgery involved the use of Fasciotens Abdomen device (fig 4) which allowed to stretch the upper fascia and reduce the wall defects to 5cm by applying a diagonal-anterior traction (9 months later). The remaining defect was covered using Permacol mesh (fig 5). Comments: in damage control surgery leading to open abdomen treatment incision should be the most conservative as possible and a step-by-step closing strategy should be performed as soon as possible in order to decrease the risk of life threatening complications.1 Fasciotens in our experience avoided the use of a muscle flap for the reconstruction of the abdominal wall and it is an effective tool that enables primary closure of complex hernia with a significant gain in fascia length2 References: 1De Waele J.J, Kaplan M, Sugrue M, et al: How to deal with an open abdomen? Anaesthesiol Intensive Ther 2015; 47:372-8 2 Niebuhr H, Aufenberg T, Dag H, et al: Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study. Front Surg. 2021;7:616669
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