Complex Case of Open Abdomen Closure With Mesh Mediated Fascial Traction Technique and Reconstruction of the Abdominal Wall in Case of Loss of Substance

Aim Our aim is to present the clinical case of an Open abdomen delayed closure with Mesh Mediated Fascial Traction (MMFT) and complex abdominal wall reconstruction. Material and Methods We report a case in which was combined the MMFT with a complex abdominal wall reconstruction due to loss of substance. Results A 34 years old male after suicide attempt was submitted to an emergency laparotomy for retroperitoneal hematoma determining colonic perforation and disruption of the insertion of rectus abdominis muscles (RAM) to the pubic bone resulting in a loss of substance in the lower part of the abdomen. A sigmoidectomy, a lateral ileostomy and open abdomen was performed. After 9 days was planned the closure. There was a divarication of RAM of 14 cm in width, loss of substance above the arcuate line, exposure of inguinal ligaments bilaterally and a massive adhesion syndrome of small bowel. The massive soft tissue edema and stiffness of abdominal wall made impossible the closure of the skin. A MMFT technique was used for the medialization of the RAM. 3 cm was gained for each revision, every 48 hours and in 6 procedures the abdomen was closed. For the reconstruction of the lower part of the abdomen a biosynthetic mesh 9 × 15 cm was placed intraperitoneally and over it was implanted a macroporous mesh secured with the onlay mesh placed over the RAM. Conclusions Closure of open abdomen with MMFT technique is useful but availability of materials and expertise are required for complex cases.