Abo Alhassan Fawaz Perrin Thomas Bert Marine Delorme Theophile Ortega Deballon Pablo HERNIA Journal INTRODUCTION METHOD RESULTS DISCUSSION CONCLUSION Abdominal Wall Injury AWI ID: 1042261
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1. Managing severe traumatic abdominal-wall injuries, a monocentric experienceAbo-Alhassan Fawaz, Perrin Thomas, Bert Marine, Delorme Theophile, Ortega-Deballon Pablo.HERNIA Journal
2. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSIONAbdominal Wall Injury (AWI)AWI Different severityWeakness areas in abdominal wallInguinal UmbilicalLateral abdominal wallRare, but increasinglySevere (<1% of all trauma)Burst AbdomenRecommendations sparceFew case series reported Biological or biosyntheticKarhof S, Boot R, Simmermacher RKJ, et al (2019) Timing of repair and mesh use in traumatic abdominal wall defects: a systematic review and meta-analysis of current literature. World J Emerg Surg Dennis RW, Marshall A, Deshmukh H, et al (2009) Abdominal wall injuries occurring after blunt trauma: incidence and grading system. The American Journal of Surgery
3. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSIONAbdominal Wall Injury (AWI)Penetrating BluntDennis RW, Marshall A, Deshmukh H, et al (2009) Abdominal wall injuries occurring after blunt trauma: incidence and grading system. The American Journal of Surgery
4. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSION
5. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSION
6. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSION?MethodCase Series2014-2021AWI IV, V, VITreated in CHU Dijon
7. INTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONCaseYearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 1201463Mcrush injuryVprimary suture7 yearsno2201411FRTAVprimary suture7 yearsyes3201520FRTAVmesh 5 yearsno4201729Fstab VImesh 3 yearsyes5201923MRTAVmesh 1 yearno6202085MgunshotVIprimary suture1 yearno7202170MRTAVprimary suture4 monthsno8202133MFallVIprimary sutureNA***NATable 2: Summary of the 8 patients treated in our center* Abdominal wall injury** Road traffic accident*** Not available
8. INTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONYearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 201463Mcrush injuryVprimary suture7 yearsnoStableAssociated Injuries:Pancreatic contusionRight costal fractureEpiploic herniationOperated J1 laparoscopy
9. YearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 201411FRTAVprimary suture7 yearsyesINTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONJ07 yearsStableAssociated injuries:Cecal necrosisRight mesocolic rupRight lat + rectus m.Operated H6Recurrence 6 monthReoperated GORETEXRecurrence 7 years
10. YearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 201520FRTAVmesh 5 yearsnoINTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONStableSeat belt syndromeAssociated Injuries:T12 complete luxationRt abdo muscl ruptureRt colon herniationIleale perforation?Vicryl mesh due to tissue loss
11. YearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 202085MgunshotVIprimary suture1 yearnoINTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONStableAssociated injuries:musculocut tissue lossleft iliac arc fracture Layered fasciomuscular closure
12. YearAgeGenderType of injuryGrade of AWI*Type of repairFollow upRecurrence 202170MRTAVprimary suture4 monthsnoINTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONUnstable after CTAssociated Injuries:Sigmoid perfLeft lat muscle ruptureDamage Control48h – repair + colostomy
13. INTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONNo recommendationsATLSLow threshold to operateStrangulation, occlusion, 30% of severe AWI associated with bowel injuriesDelayed presentation (hematoma)Rathore A, Murherjee I, Kumar P (2013) Traumatic abdominal wall injuries: a review. Minerva Chir 68:221–232 Honaker D, Green J (2014) Blunt traumatic abdominal wall hernias: Associated injuries and optimal timing and method of repair. Journal of Trauma and Acute Care Surgery
14. INTRODUCTIONMETHODCASESDISCUSSIONCONCLUSIONTension free repairLayered closure if possibleEHS – slowly absorbable monofilament “small bite”Biosynthetic mesh repairmesh-mediated fascial traction (MMFT) associated with negative pressure wound therapy (NPWT) Bridging (Inlay)
15. INTRODUCTIONMETHODRESULTSDISCUSSIONCONCLUSION?