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Abdominal Wall Domain Reconstruction After Trauma

Abdominal Wall Domain Reconstruction After Trauma. Castigliano M Bhamidipati, DO PhD MSc Moustafa A Hassan, MD FACS SUNY Upstate Medical University Syracuse, New York. TRAUMA SURGERY. Outside Emergency Department. 56yo ♂ poly trauma Abdominopelvic crush injury

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Abdominal Wall Domain Reconstruction After Trauma

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  1. Abdominal Wall Domain Reconstruction After Trauma Castigliano M Bhamidipati, DO PhD MSc Moustafa A Hassan, MD FACS SUNY Upstate Medical University Syracuse, New York TRAUMA SURGERY

  2. Outside Emergency Department • 56yo ♂ poly trauma • Abdominopelvic crush injury • Crane operated 4000 lbs. magnet and steel shelving • Extricated by co-workers • EMS  ER … Aggressive crystalloid resuscitation • Hemodynamics stabilized  Imaged • Transfer  Tertiary Care Center (55 miles) TRAUMA SURGERY

  3. 4h later … Ground Transfer … Our ER • Hemodynamics stable, GCS 15 • Trauma resuscitation • Intravenous access • Serology and Imaging • Consultant input(s) • Trauma, Orthopedic Trauma, Urology, Vascular, Burns, Hand, Spine TRAUMA SURGERY

  4. Traumatic Obliteration of Hemi-Abdominal Wall(s) TRAUMA SURGERY

  5. Injury Profile Traumatic abdominal ventral hernia Sigmoid colon perforation and/or shear injury Left acetabulum and rami fracture Right sacral alar and iliac wing fracture L2 transverse process fracture Right 12th and left 10th rib fracture Right iliac artery dissection Right pelvic hematoma Anterior and posterior urethral and bladder injury TRAUMA SURGERY

  6. ER  To OR • Damage control laparotomy • Sigmoid colectomy with Discontinuity • Negative pressure dressing abdominal closure • B/L orchiopexy, Supra-pubic catheter placement • Intraop: RLE Ischemia  9mm x 80cm PTA stent • To SICU … Resuscitation and rewarming • Second look 48h later  Washout, continuity and partial abdominal closure TRAUMA SURGERY

  7. Reconstruction … Day 3 • Non-denatured collagen matrix (bovine dermis) • Bio-active, non-inflammatory, regeneration • Rapidly vascularized and incorporated • No rectus abdominis on left above umbilicus • No rectus abdominis on right below umbilicus • Semilunaris to transversus abdominis, internal and external oblique(s) • 25cm x 40cm Xenograft 3–5cm underlay • 1.5–2.0cm distanced fixation sutures TRAUMA SURGERY

  8. Post Operative TRAUMA SURGERY

  9. 8 month follow-up Abdominal hernia reduced / wall reconstructed TRAUMA SURGERY

  10. Discussion / Comments TRAUMA SURGERY

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