Complex ABDOMINAL WALL REPAIR (AWR) in emergency settings and acute patient management

Abdominal wall surgery has nowadays become a surgical subspecialty in the elective setting. By the way, the real world faces
an increasing amount of abdominal wall reconstruction issues in the emergency setting due to the widespread use of damage control
strategies (including open abdomen) for both traumatic injuries as well as for septic or ischemic abdominal diseases.
The acute critical patient represents a major challenge due to its physiologic derangements and the technical difficulties in managing
local infection, loss of substance or direct damage to the soft tissues.
Moreover, most acute patients still receive their primary cure in nonspecialized contexts, where abdominal wall problems may receive
limited attention due to sub-optimal specific experience together with a perceived “benignity” of the disease, despite its objective impact in
term of disabilities, socio-economic losses and impairment in quality of life.
Abdominal wall reconstruction in the emergency settings requires a mindset shift aimed at preserving patients’ safety in an acute phase
dominated by life-threatening injuries and diseases while preventing significant abdominal wall impairment. Indeed, these patients range
through the whole spectrum from fully active individuals to severely fragile ones who likely would not tolerate an early failure or a delayed
definitive treatment. These patients should have the chance to receive a safe and, ideally, “definitive” reconstruction of the
abdominal wall in the acute phase or, at least, early in the post-acute treatment pathway. New devices and new materials may significantly
contribute in improving reconstruction techniques as well as wide spreading this cultural paradigm shift. Additionally, ongoing
education and training for healthcare professionals in this field are crucial for maintaining a high level of awareness and proficiency in
addressing these challenges.

Gabriele Sganga