Very Long-Term Quality of Life After Following Madrid's Modification of Tar for Complete Bilateral Abdominal Wall Section After a High-Energy Trauma. How Can We Fix It?

Introduction We present the case of a young male transferred to our center after a high-speed car accident with multiple abdominal contusions. An urgent Angio CT scan revealed a grade 2 aortic laceration, colonic perforation with an expansive hematoma in the mesentery, and a complete bilateral section of the entire abdominal musculature. Material and Methods Initially, an aorto-aortic bypass treated the laceration, and a right hemicolectomy with manual anastomosis addressed the colonic perforation. Due to a complete bilateral abdominal wall section with significant active bleeding, packing was done, followed by transfer to the Intensive Care Unit. 48 hours later, a surgical review was performed. A complete left rectus abdominis and anterior aponeurosis section with an intact posterior rectus layer led to a retro-muscular space dissection (Rives Technique). On the right, there was a transverse section of the right rectus muscle, both oblique muscles, and disruption of the anterior aponeurosis and posterior layer, with integrity only of the peritoneum. A transversus abdominal release was done to place a mesh covering the defect. A slow-resorption biosynthetic mesh covered the space created with right TAR and left Rives, with a non-absorbable polypropylene mesh on top. Conclusions Abdominal wall injuries affect approximately one in ten patients presenting to the emergency department following nonpenetrating trauma. These injuries are frequently missed during clinical examination due to the focus on more severe associated injuries. Failure to promptly diagnose these injuries can lead to delayed complications such as giant abdominal wall hernias. Complete muscle section on the right side of the abdominal wall Right TAR MESH placement Before & After the abdominal wall reconstruction