Abdominal Wall Reconstruction Using De-epithelialized Dermal Flap: A New Technique

BACKGROUND: Although autogenous materials have been used in abdominal wall hernioplasty for a long time, the introduction of prosthetic materials diminished their popularity. However, these materials may be expensive, inappropriate or unavailable. The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias. MATERIALS AND METHODS: A five-year prospective, descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health Institution, from January 2001 to December 2005. RESULTS: Over the five-year period, 37 patients were recruited into the study. There were 11 males and 26 females, giving a male: female ratio of 1: 2.4. The ages ranged from 8 months to 47 years (mean = 12.6 years). The defects consisted of 15 incisional hernias, 12 intermuscular/inferior lumbar hernias, nine healed exomphalos major and two giant umbilical hernias. The size of the hernia defects ranged from 4.5 cm to13cm (mean = 6.4 cm). Three patients had bowel resection and end-to-end anastomosis, in addition to the flap reconstruction. Morbidity was minimal and included skin dimpling in 11 patients, seroma in three, and wound infection in two patients. Neither recurrence of herniation nor mortality was recorded during the period of follow-up, which ranged from three months to 4.5 years (mean = nine months). CONCLUSION: The results suggest that this is a useful technique that can easily be applied in many centers with minimal resources. It is cheap, effective and associated with minimal morbidity.