[abstract] SALVAGE OF COMPLEX ABDOMINAL WALL RECONSTRUCTION WITH HYPERBARIC OXYGEN THERAPY (HBOT)

Abstract

Background: One of the greatest challenges that even the most experienced surgeons encounter is the need to operate an abdomen that has been entered in multiple occasions. In general the pathology or conditions present bear significant morbidity both inherently and as a consequence of their treatments. Besides the intricacy of the surgical procedures needed for these, there is the complexity of reestablishing the integrity of the abdominal wall as to prevent recurrence and loss of organ function. We review our experience treating complications of these reconstructions with HBOT. Methods: An eight-year (1996 to 2003) retrospective chart review. Seventeen patients met inclusion criteria (multiple surgeries, reconstruction of abdominal wall, ischemia/hypoxia in surgical flaps, and a minimum of 10 HBOTxs.). Number and types of previous surgeries, risk factors, timing and number of HBOT, role of TCOM, and additional surgeries were analyzed. Patients were treated at 2.36 ATA for 90 minutes along with comprehensive wound management. Rigid criteria for success were the development of a healthy tissue bed with functional integrity/ strength and no need for major re-interventions. Results: Success was achieved in 88percent (15/17) of the cases despite exposure of mesh and infection present 76percent of the time. The common denominator was multiple surgeries in 100percent of the cases, median =3 (2-10). Smoking and medical risk factors independently were present 40percent of the time. Average number of HBOTxs was 21 and the timing for institution of therapy ranged from 1 day to 4 months according to referral. TCOM studies predicted accurately severity of hypoxia and clinical evolution. Additional surgeries were minor, performed in 41percent of the cases and consisted mostly of mesh removal. Conclusion: HBOT can effectively support healing and predictably prevent potentially catastrophic outcomes in complex abdominal reconstructive cases in the setting of multiple previous surgeries.