2018 Volume 43 Issue 2 Pages 295-299
Background
The component separation technique (CST) allows reconstruction of large ventral defects, which may be beneficial under contaminated conditions, but the rate of surgical site infection is relatively high. Negative pressure wound therapy (NPWT) potentially offers better wound closure in such conditions.
We present a patient having multiple complex incisional hernias with parastomal hernias who underwent ventral herniorrhaphy with the combined use of CST and NPWT.
Case presentation
This 78-year-old woman had a history of Hartmannʼs operation 5 years previously. She was complicated with median incisional hernia and parastomal hernia. We performed herniorrhaphy with stoma closure simultaneously, with CST and NPWT. After colon anastomosis and simple suture repair of the parastomal hernias, her median abdominal wall defects were assessed as 180mm at upper and 150mm at lower abdomen. Although fascial closure was completed by CST with some tension, dead space remained under the skin and subcutaneous fat layer. Therefore, we combined NPWT on the fascial plane. There was no severe surgical site infection and there was no evidence of hernia recurrence for a year after the operation.
Conclusions
CST followed by NPWT may be an effective alternative for repair of huge and complex incisional hernias, particularly in contaminated conditions.
