Abdominal wall reconstruction with Two-step Technique (TST): a prospective study in 20 patients

Recent Advances in Functional Hydrogel for Repair of Abdominal Wall Defects: A Review

The abdominal wall plays a crucial role in safeguarding the internal organs of the body, serving as an essential protective barrier. Defects in the abdominal wall are common due to surgery, infection, or trauma. Complex defects have limited self-healing capacity and require external intervention. Traditional treatments have drawbacks, and biomaterials have not fully achieved the desired outcomes. Hydrogel has emerged as a promising strategy that is extensively studied and applied in promoting tissue regeneration by filling or repairing damaged tissue due to its unique properties. This review summarizes the five prominent properties and advances in using hydrogels to enhance the healing and repair of abdominal wall defects: (a) good biocompatibility with host tissues that reduces adverse reactions and immune responses while supporting cell adhesion migration proliferation; (b) tunable mechanical properties matching those of the abdominal wall that adapt to normal movement deformations while reducing tissue stress, thereby influencing regulating cell behavior tissue regeneration; (c) drug carriers continuously delivering drugs and bioactive molecules to sites optimizing healing processes enhancing tissue regeneration; (d) promotion of cell interactions by simulating hydrated extracellular matrix environments, providing physical support, space, and cues for cell migration, adhesion, and proliferation; (e) easy manipulation and application in surgical procedures, allowing precise placement and close adhesion to the defective abdominal wall, providing mechanical support. Additionally, the advances of hydrogels for repairing defects in the abdominal wall are also mentioned. Finally, an overview is provided on the current obstacles and constraints faced by hydrogels, along with potential prospects in the repair of abdominal wall defects.

Abdominal Wall Reconstruction with the Two-step Technique: Procedure Optimization and Three-year Follow-up in 26 Surgeries

Background:

Complex or recurrent abdominal wall defects may be the result of trauma, infection, tumor resection, or a previous failed attempt at closure, among other causes. This article describes a new surgical technique that better addresses these defects and provides safety and efficacy data from 26 consecutive surgeries with a 3-year follow-up.

Methods:

Prospective study in 18 men and 8 women with serious abdominal wall defects, who were surgically operated on using the two-step technique, which includes a first regenerative and closure step using a vacuum device (vacuum-assisted closure), and a second reconstructive step that does not require the use of any type of surgical mesh. The safety and efficacy results were evaluated through clinical examinations and questionnaires. The severity of patient-experienced pain and both patient and surgeon satisfaction were quantified on a scale from 0 to 10 points. The statistical calculations focused on the mean (m), range (r), and percentage (%).

Results:

The mean complete surface area of the abdominal wall defects was 250.2 cm² (r = 78–770 cm²). The patient and surgeon satisfaction rates at the time of hospital discharge were m = 9.0 (r = 3–10) and m = 9.4 (r = 8–10), respectively. After 3 years, these rates were m = 7.2 (r = 3–10) and m = 9.8 (r = 9–10), respectively. No relevant complications were observed in any stage of the study and no recurrence was observed 3 years later. The main complaint of patients was the presence of hypertrophic scars from the surgical wound (57% of cases).

Conclusion:

The two-step technique is an excellent alternative for the repair of complete abdominal wall defects of up to 800 cm² because it allows serious complications to be avoided, prevents recurrences, and shows high rates of both patient and surgeon satisfaction.