411 - Staged Abdominal Wall Reconstruction

Staged Abdominal Wall Reconstruction Jeremiah J Maxwell , cst, csfa, rsa MARCH 2018 | The Surgical Technologist | 109 L E A R N I N G O B J E C T I V E S s Discuss the scenarios that may create recurrent complex hernias s Review the anatomy of the anterior abdominal wall s List the considerations taken during the preoperative planning s Recall the procedural steps for the first stage of this surgery s Evaluate the reasons why a soft tissue debridement may be necessary I n addition to many different types of hernias, there also are differ- ing grades of hernia. One of the most challenging clinical scenarios facing the surgical team is when a hernia is present after multiple repairs and/or revisions of repairs. In addition to the surgical challenges with recurrent complex hernias, these scenarios often involve complica- tions where the prosthetic mesh used in the original surgery can harbor a low-grade occult infection that can go years without diagnosis. There are often no perceptible symptoms for the patient other than the vis- ible hernia, possibly some pain or obstructive symptoms associated with the hernia and an overall feeling of malaise. Occult mesh infections can sometimes continue until the severity of the infections grows to a point of skin ulceration and even near evisceration through the ulcerations that can be caused by the infected mesh. The presentation of infected prosthetic mesh within a complex multi-recurrent incisional hernia is It is often assumed by many healthcare providers, that a hernia “is a hernia.” And because of this assumption, caregivers assume that there is little variation between the many types of hernias. In the most basic terminology, the general definition of a hernia of the abdomen is “A weakness or defect in the wall of the perito- neal cavity…(that) eventually push(es) out a pouchlike, serosal lined sac called a hernial sac.” 8