An Horror Movie: A Complex Ventral Hernia After a Severe Case of Necrotising Fasceitis

Abstract Introduction We present a case of a 58-year-old woman with history of severe sepsis after a perinatal abscess. This necrotising fasciitis lead to a partial destruction of the abdominal wall and required multiple surgical debridement (with partial removal of recuts muscle), colostomy and hyperbaric treatment. After controlling the infectious process, we performed a progressive surgical closure with a planned ventral hernia with phasic prosthesis and dermoepidermic graft. Methods This patient had her follow up appointment to prepare for reconstructive surgery with weight loss and biofeedback. She did a CT that demonstrated a ventral hernia (89 × 90 mm) between recuts muscle and transversus. This hernia classified as M2-M5+W3 on the right and L4+W3 on the left. We used adjuvant therapy with botulinum toxin and subcutaneous expansor. Results The reconstruction was performed in two steps. First, we performed a colostomy closure with no complications. After one week we performed an abdominal wall reconstruction with transversus abdominal release. Due to some skin necrosis and risk of infection identified during surgery we decided to differ the closure with a prosthesis with double layer (one reabsorbable and one synthetic) and a dermoepidermic flap. Conclusion Complex abdominal wall hernia are difficult cases to treat due to anatomical changes and infectious complications associated. New materials are being developed that can help to overcome some difficulties that we face.