Warfare-related Complex Abdominal Wall Reconstruction Using a Bioprosthetic Regenerate Template and Negative Pressure Therapy

Warfare-related torso/abdominal wounds are often unique and complex and can pose a significant reconstructive challenge. The objective of this manuscript is to report the unique and successful management of a complex warfare-related abdominal wound. A dermal regenerate template in combination with negative pressure wound therapy was used to reconstitute lateral abdominal wall integrity after radical debridement and control of a necrotizing soft tissue infection of the torso. Adjunctive continuous negative pressure (vacuum assisted closure) therapy was used to provide external coverage and encourage the formation of granulation tissue. With this combination therapy, torso wound size decreased in surface area by 82% and the underlying musculofascial defect decreased by 64%. Neovascularization of a 55-cm(2) acellular dermal graft was achieved as evidenced by surface granulation and complete survival of a partial-thickness skin graft. In our patient with a complex war injury, advanced tissue replacement techniques and negative pressure wound therapy resulted in a decreased abdominal wall defect, a restoration of abdominal wall integrity/domain, and allowed for concurrent surgical treatment of complex intra-abdominal injuries.