Reconstruction of the right side of the abdominal wall due to post-traumatic muscle avulsion.

Abstract

<b>Introduction:</b> Traumatic detachment of the lateral abdominal muscle group from the iliac crest occurs as a result of the acceleration mechanism when the body impacts a seatbelt during a head-on collision of motor vehicles. Due to the rare and variable nature of such defects, a standard treatment protocol has not yet been developed. As a result, the surgical technique and timing of the procedure are always planned individually. The optimal surgical method and type of implant for such cases remain undetermined. Given the anatomical location of the defect, surgical intervention utilizes techniques at the intersection of orthopaedics, reconstructive surgery, and herniology.<br><br><b>Aim:</b> Traumatic separation of the lateral abdominal muscles from the iliac crest, caused by blunt trauma, is a rare and complex injury. This study aims to present a novel surgical technique for managing such defects, focusing on the use of macroporous mesh fixation to the iliac crest with a ProTack stapler (Medtronic, Dublin, Ireland). <br><br><b>Materials and methods:</b> This paper describes the case of a patient with a traumatic detachment of the lateral abdominal muscle group from the iliac crest. The diagnosis was based on physical examination and computed tomography (CT). The surgery was performed 12 months after the initial injury and emergency surgical treatment of abdominal organs. Due to the size of the defect, an open approach was proposed. Adhesions were released, the preperitoneal space was dissected, and a macroporous implant measuring 26 × 28 cm was placed and fixed to the iliac crest using a ProTack stapler (Medtronic, Dublin, Ireland). The lateral abdominal muscles were reattached to the mesh to restore anatomical continuity. <br><br><b>Results:</b> Postoperatively, subcutaneous drainage was maintained for 9 days, and the use of a hernia belt was recommended continuously for 2 weeks, followed by 4 weeks during periods of increased physical activity. The patient was discharged on the third postoperative day. Primary wound healing and a satisfactory functional and aesthetic restoration of the abdominal wall were achieved. During a 12-month follow-up period, no hernia recurrence or other complications were observed. <br><br><b>Conclusions:</b> Traumatic detachment of the lateral abdominal muscle group is an extremely rare and serious medical condition. Randomized studies comparing approaches and surgical methods have not yet been conducted, and no standard treatment protocol has been established. The proposed treatment method, involving implant fixation to the bone using a stapler, appears to be a favorable therapeutic solution. Further experimental studies are needed to optimize the method and establish evidence-based guidelines.