Circumferential mesh in abdominal wall reconstruction - Indications, technical notes and case report

The authors describe an original technique of abdominoplasty aiming at correcting ventral muscles, hypotonia, and relaxation, especially in formerly obese patients, pluriparae women, and patients with neuromuscular impairment. The technique encloses regular dermolipectomy, laparocele or hernia reduction (if existing), ventral fascia plication on the midline, and suprafascial application of a purposely built polypropylene mesh. The mesh consists of three continuos segments: two lateral, wider, rectangular segments to be fixed on the ventral area and one central and narrower (like a belt) segment to be inserted posteriorly into the deep subcutaneous tissue above the dorsal muscles and the spine. The vehicle of inserting circumferential mesh includes introducing a smooth, hollow rod through a small lateral skin access. Then, the two lateral segments are extended and criss-crossed over the abdominal muscles and are fixed to the iliac periosteum. This allows the dorsal and ventral muscles to be contained and supported by the mesh during prolonged standing and exercise.