Abdominal wall reconstruction is often required in the setting of major abdominal hernias, typically after surgery. The most common situations that I am asked to help treat include the correction of midline abdominal hernias after previous laparotomy surgery where the normal layers of abdominal muscles have been disrupted and herniation results. In this setting major surgery is often required jointly with general surgery abdominal specialists, often using specialist products that have a high rates of successful hernia treatment but low rates of infection and rejection.
The other significant area that I am asked to assist with is problematically infected meshes where previous synthetic meshes have been used to correct hernias. When these become infected it is often impossible to salvage the reconstruction without removing the mesh altogether. In this situation replacement with acellular dermal matrix products may result in preservation of the abdominal wall integrity and can avoid problematic post-operative infections, which will always be present if synthetic mesh is maintained. Such surgery is a major undertaking and this requires very careful consideration with both the patient and the general surgery teams involved in your care.