Incisional Hernia Repair & Abdominal Wall Reconstruction

Incisional hernias can occur after surgery on the abdominal wall. Often a recurrent hernia needs to be repaired differently to prevent the recurrence of the hernia again. Just as important are patient factors that need to be controlled such as weight, protein intake, and cessation of smoking if the patient is a smoker.

If there are multiple hernias of the abdominal wall, it is often advantageous to the surgeons, both general surgeon and plastic and reconstructive surgeon to create adequate and wide exposure of all hernias to allow appropriate reconstruction. The wide exposure can also allow component separation to be performed to facilitate reconstruction of the abdominal wall musculature to create a dynamic abdominal wall.

The wide exposure creates a potential space that must be drained adequately post-operatively with drains. These drains can stay in for approximately 7 days to up to three weeks post-operatively.

Proper protein intake in the post-operative period is important to optimize wound healing.

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Hernia Reconstruction with Component Separation and Tensor Fascia Lata Flap

In order to repair multiple hernias of the abdominal wall, for example midline hernias and hernias related to colostomy or ileostomy procedures a large exposure is needed to properly perform a repair. Often the previous multiple incisions can be incorporated and included into one wound to obviate or prevent complications from wound breakdown.

Further, massive hernias of the abdominal wall may require multiple stages to repair. When repairing hernias, stable soft tissue coverage is important. In patients who have developed a loss of domain because of prior open wounds, a component separation may be employed to recruit more tissue to facilitate closure. Occasionally, in large tumors of the abdominal wall, the plastic and reconstructive surgeon will use the tensor fascia lata muscle from the thigh to close the wound.

The tensor fascia lata is harvested and exposed and then rotated towards the abdomen. The upper border of the abdominal fascia can be closed and the inferior portion can be closed as an underlay with the tensor fascia lata.

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Hernia Repair & Abdominal Wall Reconstruction

Abdominal Wall Reconstruction and Hernia Repair:

It is quite common for patients to have undergone a previous umbilical hernia repair and have a recurrence of their hernia. Also, patients can have a history of a previous surgical operation that results in an abdominal or “incisional” hernia.

Typically, when patients have a hernia that recurs, it is often required to restore the abdominal musculature back to its original anatomic location.

Often when repairing incisional, umbilical or large recurrent hernias, the Plastic & Reconstructive Surgeons work in conjunction with General Surgeons.

The plastic surgeon creates the exposure to allow large exposure to the defect and help prevent and correct any wound problem that may occur secondary to the large exposure. The muscles can then be released, relocated, or repositioned to create a dynamic abdominal wall.

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