Author Topic: Reconstructive Plastic Surgery Forum - Stomach Lost: Bad Surgery. How To Close?  (Read 4623 times)

Offline DrBermant

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Hi sir
My mom lose her abdomin skin after bad surgery in kuwait private hospital ,The photo will talk better than me to describe the problem .
I need to know the best way to close her abdomin .
Thanx alot

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon and no longer practicing medicine. You are welcome to post the images here to show to others for their comments and advice. You might want to edit out the face for privacy matters.

Setting Priorities
When dealing with major open wounds of the stomach, the best way to close the abdomen depends on so many factors. Coverage of an area with something bringing in blood supply can be great helping marginal surviving stay alive. But flap options requires the defect to be small enough for local resources to manage. Monster size defects can overwhelm available supply making that option unrealistic. Trying to cover the problem with grafts without blood supply requires decent bed for the graft to survive.

Debridement
Dead or infected tissue need to be cleaned up or debridement. Debriding tissue options are many from special solution on gauze that then attaches and the dead skin comes up when the gauze is removed. I have never used them but maggots have a special property of eating only dead tissue leaving living behind. But, then any willing to use them has to get them from a special sterile supply source and then deal with the damn fly they become. The process of cleaning up tissue also depends on if the fascia muscle wall structure remaining intact. Things can get more complicated once the abdominal contents are exposed or if the infection process continues to expand stressing the body further. More typically it involves many small bedside procedures and or trips to the operating room for tissue removal.

Wound Care Centers
There is such an art to this wound care, that it has spawned Wound Care Specialists and Wound Care Centers with special equipment such as total body whirlpools where the water pressure helps with the debridement, not an option once intestine are exposed. Hyperbaric Oxygen Chambers and other equipment make centralizing such facilities.

Reconstructive Plastic Surgery
Once the problem has been stabilized then reconstruction options can be addressed. These are typically a compromise with extremely large wounds.  Goals are getting the issue stabilized, sealing the tissue with skin,  function like being able to get around, then cosmetics. Sadly, the beauty has to take a back seat with life threatening deformity. Goals of abdominal restoration:
Reestablishing the structure to hold the intestines Fascia Muscle Wall
Covering this Fascia with at least skin, but better yet, the combined fat and skin. The latter may not be possible without flap resources. But it is nicer when possible.



You can see what I mean by fascia, skin and fat relationships here on my Anatomy of the Stomach Skin and Belly Button. The page was designed for the belly button tethering discussion, but serves this situation well. The upper part with the fat would be the goal of a more natural feel and look. The thin belly button base area the compromise of grafts on the fascia, a tethered solution.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Reconstructive Plastic Surgery
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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