Abdominal Wall Defect


Abdominal Wall Defect

Michael J. Franco & Ida K. Fox
A 55-year-old man with a history of exploratory laparotomy and ventral hernia repair with mesh now presents with recurrence.


  • Large midline abdominal wall hernia consisting of myofascial defect with overlying skin.

  • The rectus abdominis muscles have migrated laterally.

  • There is no evidence of visceral incarceration.



  • Etiology of defect: Congenital, previous surgery, trauma, resection.

  • Duration of defect, management thus far.

  • Nutritional status.

  • History of smoking.

  • Steroids or immunosuppressive medications.

Physical examination

  • Body mass index (BMI): weight (kg)/[height (m)]2.

  • Abdominal wall defect description

    • Location

      • Midline or lateral.

      • Upper, middle, or lower abdomen.

    • Tissue defect

      • Skin and subcutaneous tissue.

      • Myofascial.

      • Full thickness.

    • Size of defect.

    • Condition of surrounding tissues.

  • Preexisting incisions.

  • Pertinent comorbid conditions (diabetes, autoimmune diseases, coronary artery disease, etc).

Pertinent imaging or diagnostic studies

  • Computed tomography of the abdomen with contrast may be helpful to delineate the extent of the defect, the related anatomy, and other issues (e.g., bowel adhesions, abscesses).

  • Pulmonary function testing should be performed if there is preexisting respiratory compromise or suspicion for loss of domain from a large hernia.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Abdominal Wall Defect

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