Tissue expansion-assisted closure of massive ventral hernias.

Many multitrauma and severely ill patients requiring multiple laparotomies survive because of advanced critical care and aggressive management, but often these patients face severe challenges on their path to recovery. Prolonged operations and consequential fluid shifts make abdominal closure impossible and even detrimental because of abdominal compartment syndrome, and laparotomy wounds often remain open. As a result, a relative loss of abdominal domain from tissue contraction or actual loss from tumor resection and debridement can occur. Regardless of the cause, abdominal viscera must be contained, usually with an absorbable mesh followed by a split thickness skin graft (STSG). Repair of the resultant ventral hernia is done electively. These large midline hernias pose a great challenge to reconstruction. Primary repair of incisional hernias has a reported recurrence rate between 40% and 46%. Many methods such as primary closure, mesh repair, component separation, tissue expansion, pedicled flap, and free flap have been proposed. Rohrich and colleagues offer an excellent discussion of all available options. We review our experience with large hernia repair by tissue expansion of the remaining abdominal wall tissue.