PMC4623546_01
(a) At our initial visit, V.A.C.  system was attached to the front of the abdominal wall defect. (b) When the V.A.C.  system was removed, open abdominal wall remained.
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After ensuring that the sponge was in contact with full thickness of the wound edges, the surrounding skin was coated with benzoin, and suction tubing and adhesive dressing were applied (Figure 1a ). There was scarring over the surface of the visceral edema and his intestine adhered to each other (Figure 1b ).
The abdominal computed tomographic scan at the initial visit. The abdominal wall defect was over 30 cm, and visceral and retroperitoneal edema was clearly seen.
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Visceral and retroperitoneal edema was clearly seen on abdominal CT (Figure 2).
Surgical findings. (a) Bipedicled flaps were designed for both lateral regions. We added the incision to the aponeurosis of external abdominal oblique muscles pursuant to components separation techniques. (b) Completion of surgery. A 1.5x meshed split-thickness skin graft(12/1000 in.) was taken from the anterior surface of both thighs to the defects on the both side of the abdomen. The graft was attached by Reston  Self-Adhering Foam Pads.
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We added the incision to the aponeurosis of external abdominal oblique muscles pursuant to components separation techniques (Figure 3a ). The graft was attached by Reston  Self-Adhering Foam Pads and the operation was completed (Figure 3b ).
(a) Eight days post surgery, exudate was seen from the edge of the graft. (b) Continuous negative-pressure and irrigation treatment was started for the wound. (c) The V.A.C.  system was attached to drain the exudate. (d) After 4 weeks post beginning of the V.A.C.  system, we operated the fistula closure under the flap that became a drainage route. (e) 1 month past from the second operation.
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And 8 days post surgery, when the exudate was seen from the edge of the graft (Figure 4a ), the Reston  Self-Adhering Foam Pads was changed to continuous negative-pressure and irrigation treatment (Figure 4b ). When multi-drug resistant Pseudomonas aeruginosa was not detected in abdominal wound culture, the continuous irrigation device was changed to the V.A.C.  system to drain the exudate (Figure 4c ). After 4 weeks from the start of the V.A.C.  system, the exudate decreased gradually; we operated the fistula closure under the flap and that became a drainage route (Figure 4d ). The fistula disappeared 1 month after the operation (Figure 4e ).
After 8 months from the operation. (a) The left side view. (b) The front view. (c) The right side view.
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He had no trouble with oral intake and bowel movement, though he had to use the abdominal bandage while walking because of the abdominal hernia (Figure 5).