The Biology of Complex Abdominal Wall Defects: Definitions and Causes

Acquired complex abdominal wall defects (CAWD) are those usually developing after severe injuries and their surgical management, and do not heal in a timely manner or fail to heal completely. Full-thickness open abdominal wounds primarily are encountered in patients after acute trauma, infectious processes, or after abdominal catastrophes. Modern surgical experience suggests that biologic and mechanical pathways overlap during normal acute healing of an abdominal wall wound, although a full understanding of the pathophysiology of the healing responses after the surgical procedure remains elusive. Some local and general factors contributing to a poor wound healing and recurrent incisional hernias are well known, with local infection as chief among them. CAWD resulting from damage control surgery and an open abdomen are a real challenge, frequently compounded by an enterocutaneous fistula. The biology of the healing process in this open abdomen approach must be well understood and respected by the surgeon, in order to achieve a successful final outcome.