Reconstruction of Abdominal Wall Defects Infected with MRSA

J Korean Wound Management Soc > Volume 3(1); 2007 > Article

Original

Journal of the Korean Wound Management Society 2007;3(1): 24-28.

MRSA 균주의 감염을 동반한 복벽결손의 재건

김지연ㆍ은석찬ㆍ허찬영ㆍ백롱민ㆍ장 학ㆍ민경원

서울대학교 의과대학 성형외과학교실

Reconstruction of Abdominal Wall Defects Infected with MRSA

Ji Yeon Kim, Seok Chan Eun, Chan Yeong Heo, Rong Min Beak, Hak Chang, Kyung Won Minn

Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea

Published online: 30 May 2007.

ABSTRACT

The abdominal wall defects originated from tumor resection, trauma or postoperative complication should be repaired with highly vascularized flap for the protection of intraperitoneal viscera, prevention of hernia, and the enhancement of wound healing. Postoperative wound dehiscence is especially susceptible to the nosocomial infection which is poorly controlled with antibiotics. In this study we used highly vascularized rectus muscle flap for the reconstruction of infected abdominal wall defects. From April to July of 2005, rectus muscle flap was applied in 5 patients with postoperative wound dehiscence with culture proven MRSA infection. Dressing and intravenous vancomycin therapy for 2∼3 weeks preceded operation. After debridement of all necrotic and infected tissue including part of rectus muscle, dissection was done in sub-anterior rectus fascial plane and supra-posterior rectus fascial plane bilaterally. Rectus muscle and the anterior rectus fascia were repaired in layers. Posterior rectus fascia was not interrupted. Out-patient follow-up and telephone survey was performed postoperatively. None of the 5 patients did not experience any dehiscence, postoperative hernia, and prolonged abdominal discomfort. There are many surgical techniques published for the reconstruction of abdominal wall defects, but none of these are proven to be exceptionally superior to another. We used local advancement flap of bilateral rectus abdominus muscle under minimal dissection, which has proven to be safe and effective for the control of underlying infection as well as the dynamic support of abdominal wall. (J Korean Wound Care Soc 2007;3:24-28)

Key Words: MRSA, Infected abdominal wall defect, Rectus muscle