Nomenclature

The typical definition of the complex abdominal wall defect would include one or more of the following:

2. Absence of stable skin coverage

3. Recurrence

4. Infected or exposed prosthetic material

5. Compromised abdominal wall soft tissue secondary to co-morbidities, such as irradiation or cortico-steroid dependence

6. Simultaneous visceral complication (eg, enterocuta-neous fistula)

7. A systemically compromised patient (eg, posttrans-plant, concurrent malignancy, immunodeficiency disease) (Steinwald and Mathes, 2001).

Complex abdominal wall defects can occur both acutely and as a delayed consequence of surgery or injury. Acute defects may be the result of trauma, tumor excision, wound dehiscence and evisceration, necrotizing fasciitis, or some other intra-abdominal catastrophe. The acute complex defect may be divided into two types: (1) unstable and (2) stable. Those with unstable abdominal contents are those where urgent surgical intervention is typically required for intraabdominal injury or the acute deterioration of intraabdominal disease (eg, diverticular abscess). An example of an acute complex defect with stable intra-abdominal contents is necrotizing fasciitis. A detailed discussion of the management of these acute defects is more esoteric to the nonsurgeon and will not be discussed further in this chapter.

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