Abdominal-wall Reconstruction with Expanded Musculofascial Tissue in a Posttraumatic Defect

An anatomic basis for expansion of the abdominal wall is presented and clinically demonstrated in an adult man with a posttraumatic defect. The patient demonstrates an intact, functional abdominal wall 4 years after the procedure. The procedure provides autogenous, innervated, well-vascularized, contractile tissue for repair of abdominal-wall hernias. Large tissue expanders are placed between the external oblique and internal oblique muscles. A small incision in the posterior rectus sheath is made in order to gain access to the potential space between these muscles. The incision in the posterior rectus sheath is kept small to minimize risk of denervation of the rectus abdominis muscle. Tissue expansion is carried out over several weeks. After removal of the expanders, abundant musculofascial tissue is available for reconstruction of the abdominal wall. The abdominal wall is then reconstructed with innervated, functioning tissue.