Management of Full-Thickness Abdominal Wall Defects Following Tumor Resection

Objectives: Abdominal wall reconstruction continues to evolve with improvement in technique and technology. This study reviews our experience with challenging full thickness (skin, muscle, and fascia) defects following tumor resections often in high-risk patients. Methods: All patients who underwent abdominal wall reconstruction following full thickness tumor resection were included in the series. Data queried included patient demographics, indications, tumor defect, risk factors, type of repair, complications, and recurrence of the hernia. Results: A total of 30 patients underwent reconstruction after full thickness resection of abdominal wall tumors or tumors of intra-abdominal organs involving abdominal wall. The indications included desmoid tumors (n = 6); abdominal wall sarcoma (n = 7); colon cancer invading abdominal wall (n = 10); pancreatic, ovarian, and retroperitoneal sarcoma with abdominal wall invasion (n = 3); and other (n = 4). In all, 17 patients underwent simultaneous resection of one or more intra-abdominal organs. The type of repair included primary closure (+/- components separation), or mesh-assisted closure (+/- primary fascial closure). Acellular dermal matrix was used more commonly in the patients with tumors of gastrointestinal origin. The average follow-up period was 23 months. Postoperative complications developed in 6 patients (20.6%). Incidence of postoperative complications was higher in patients with colon cancer invading the abdominal wall or those with bowel anastomosis or radiation therapy. An abdominal bulge or hernia developed in 4 patients (13.7%); it was higher in patients who did not have mesh reconstruction. Conclusion: Abdominal wall reconstruction after full thickness tumor resection is challenging. It can be performed safely and effectively with attention to surgical technique, patients' risk of infection, and type of mesh. Acellular dermal matrix graft has been a useful addition to minimize morbidity and recurrence in these high-risk patients.