PMC8718503_01
(A) Ischemic lesion on the 8th postoperative day. (B) Two full-thickness skin necrotic foci paramedially on the 22nd postoperative day. (C) View of the abdominal wall after necrectomy on the 22nd postoperative day. (D) View of the abdominal wall after the wound was primarily closed.
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F1
Ischemic lesions of the abdominal wall skin on the right with signs of necrosis along the midline were observed already on day 8 (Figure 1A). During the next 10 days, ischemia progressed, along with the development of another two full-thickness skin necrotic foci paramedially (Figure 1B). Following abdominal wall necrosectomy with a safety margin of healthy tissue and considering an appropriate amount of vital residual abdominal skin, as well as the absence of signs of local tissue infection or mesh infection, primary wound closure was performed in consultation with a plastic surgeon (Figures 1C,D).
(A) Wound dehiscence on the 4th postoperative day after necrectomy with primary closure. (B) Fibrin deposits with zones of the necrotic tissue in the wound. (C) Negative pressure wound therapy delivered in continuous mode with negative pressure maintained at -100 mm Hg was initiated on the 33rd postoperative day. (D) View of the wound 2 weeks after negative pressure wound therapy (NPWT) administration with signs of considerable improvement seen in cavity reduction, decreased wound discharge, and formation of healthy granulation tissue.
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F2
As early as day 4 of the second operation, increased wound discharge and signs of skin wound dehiscence occurred, which required removal of skin sutures (Figures 2A,B). Nephew, Mississauga, Canada) was initiated (Figure 2C). NPWT was delivered in continuous mode with negative pressure maintained at -100 mm Hg. NPWT administration, considerable improvement was recorded in wound cleaning and formation of healthy granulation tissue (Figure 2D). NPWT was continued for the next 2 months, which resulted in further improvement of condition of the patient, along with decreased wound discharge and cavity reduction.
(A) View of the abdomen 3 months after the initial surgery. (B) View of the abdomen 4 months after the initial surgery. (C) View of the abdomen 6 months after the initial surgery. (D) View of the abdomen 10 months after the initial surgery.
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F3
The patient was discharged from the hospital and regular changing of silver-impregnated antimicrobial wound dressing (Aquacel Ag, ConvaTec, Reading, United Kingdom) was continued in ambulatory care that led to complete wound closure in 7 months (Figures 3A-D).