PMC5192031_01
Eventrated and incarcerated abdominal wall hernia. The perforated terminal ileum segment and the perforated hernia sac are visible in the left hand of the surgeon. The ascending and transverse colon as well as a remarkable segment of the terminal ileum were incarcerated and perforated into the hernia sac.
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The peritonitis was caused by the incarcerated and perforated ascending colon and terminal ileum (Fig. 1).
Adequate preparation of the epidermal surface of dermal graft. The epidermis was removed by scalpel. The colour difference between the removed and not yet removed epidermal surface areas (light brown coloured area: removed epidermis, darker yellowish-brown coloured area: not removed epidermis) is clearly visible.
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First the epidermis (Fig. 2) then the subcutaneous adipose tissue was removed from the pannicule (Fig. 3).
The first dermal graft in appropriate position. At least 5 cm overlapping was necessary. The original epidermal surface looked outward. No direct sutures were put into the abdominal wall. The abdominal wall defect was completed by the dermal grafts. The size of the prepared abdominal gap was 223 cm2.
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The dermal graft was fixed to the abdominal wall by interrupted, 2/0 non-absorbable stitches (Fig. 4).
The second dermal graft in appropriate position. The original surface of the prepared dermis faced the abdominal cavity. It was perforated as demonstrated. The perforation of the graft is important for its more intense integration.
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fig0025
The external dermal graft was perforated as it is seen in Fig. 5.