Total abdominal wall reconstruction

E. A. Luce, G. Hyde, S. E. Gottlieb and S. Romm

A patient had full-thickness loss of abdominal wall from clostridial myonecrosis. Initial care consisted of resuscitation, debridement, and transfer to a hyperbaric chamber facility. After control of sepsis, multiple enteric fistulas were managed by enterotomies, gastric and duodenal defunctionalization with closed-loop gastrojejunostomy, gastrostomy, and end jejunostomy. Good nutritional status was maintained with total parenteral nutrition over a three-month period. Total abdominal wall reconstruction was accomplished by rotation of bilateral tensor fascia lata musculocutaneous flaps. Reconstruction was successful as the patient was able to return to an active life.