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Ventral Incisional Hernia Repair with Loss of Domain

This patient was in a motor vehicle collision and suffered significant trauma to the abdomen. Upon conclusion of an exploratory laparatomy, closure of the patient’s abdomen was not possible due to wound severity so the trauma surgeons placed multiple skin grafts directly over his intestines. Years later, the patient suffered an inability to generate intra-abdominal force with physical lifting, going to the bathroom, and/or other activities requiring exertion of the abdominal muscles. This inability to generate intra-abdominal force is known as a “loss of abdominal domain” wherein the abdominal cavity is unable to contain the intestines and other abdominal contents.

Operation Performed: The patient then underwent ventral incisional hernia repair with removal of the skin grafts and abdominal wall closure utilizing the “Components Separation” technique with muscle advancement flaps. Alloderm was then placed on top as an “onlay graft” in order to provide additional support. The following photos are before and six months following the patient’s reconstructive surgery.