Abstract
We herein present the case of a 61-year-old man with severe obesity who underwent the repair of a post-dissection abdominal aortic aneurysm. Severe intestinal distension and wound dehiscence occurred postoperatively, and open abdominal management for one month did not improve his condition. The exposed bowel loop was scarred and hardened into a large dome protruding from the abdominal wall. As the intestinal tract could not be reinserted into the abdominal cavity, surgical treatment without structural reconstruction of the abdominal wall was performed using a two-stage procedure with a purse-string suture and double vastus lateralis flaps. First, the exposed intestinal surface was made as small and flat as possible using the surrounding subcutaneous dissection and purse-string suturing. For one month, the wound was managed with double-negative-pressure wound therapy using two drain accessories and a cotton filler. Subsequently, bilateral pedicled vastus lateralis flap transfer and split-thickness mesh skin grafting were performed to achieve final wound closure. The postoperative course was uneventful. Two months postoperatively, the wound had almost completely healed, and the patient was transferred to another facility. The surgical method presented herein is considered to be reasonable and useful for achieving safe wound healing in severe cases of open abdomen or massive ventral hernia.
The bowel loop severely prolapsed outside the abdominal cavity and it was scarred and adhered in a dome shape.
