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

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of the Navy, the Department of Defense, or the United States Government. We are military service members (or employees of the US Government). This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties. 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.