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AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital

AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital. W.D. is a 64-year-old woman who presented in 2012 for consideration for colostomy reversal and repair of massive abdominal wall hernia.

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AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital

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  1. AWR Challenging Cases 2013Frederic Eckhauser, M.D.Johns Hopkins Hospital • W.D. is a 64-year-old woman who presented in 2012 for consideration for colostomy reversal and repair of massive abdominal wall hernia. • Past surgical history included partial colectomy, attempted reversal of colostomy with perforation and exploratory laparotomy. • Medical history includes morbid obesity, decreased exercise tolerance and sleep apnea • Clinical exam demonstrated morbid obesity and massive abdominal wall hernia with multiple fenestrations, a right sided colostomy and no evidence of soft tissue infection.

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  5. AWR Challenging Cases 2013 • Operation: • Excision of previously grafted tissue • Creation of extensive bilateral abdomino-fascial flaps (Xiphoid, costal margin, ASIS, pubic symphysis) • Extensive enterolysis • Reversal of colostomy with limited colon resection, hand sewn side-to-side colocolostomy • Primary repair of paracolostomy hernia • 3mm SurgiMend underlay using a silo configuration • Debridement of devitalized skin and subcutaneous tissue with primary skin closure • Application of modified semi-closed VAC negative pressure wound management system

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  9. AWR Challenging Cases 2013 • Outcome – • Baring difficulty with Restless Leg Syndrome, the patient has done extremely well. She denies symptoms associated with her hernia and has begun to diversify her activity. Her incision has healed completely. She has had no complications in either the immediate or protracted post-operative period.

  10. AWR Challenging Cases 2013 • Lessons Learned: - A silo technique on adults with massive defects is a reasonable option for defects which are too large for traditional reconstruction techniques. • Question: • What are the faculty’sthoughts on reconstituting the abdominal wall in patient’s with near complete loss of abdominal domain?

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