Introduction:
Open abdomen management (OAM) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OAM remains a formidable task for surgeons. The central goal of OAM is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Techniques such as components separation, mesh-mediated traction, or bridging fascial defect with permanent synthetic mesh, attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this article is to share our experience of the wound closure and reconstruction after open abdomen management, and to evaluating the effect of pre-surgical CT examination for our further reconstructive planning.

Materials and Methods:
We studied retrospectively the consecutive patients with large incisional ventral hernia using component separation technique between January 2012 and June 2018. All the patients had previous open abdomen management and pre-operative CT evaluation before reconstructive surgery. The patients’ demography, diagnosis, surgery methods, surgery timing and associated Laboratory data were recorded.

Results:
There were 18 patients enrolled in the study. All of the 18 patients are male, aged from 20 ~72 y/o (mean age 46.4 ± 17.82). There are various reasons including acute pancreatitis, blunt abdominal trauma, bowel perforation and intra-abdominal bleeding. According to the preoperative CT image, the defect gap between the rectus abdominis muscle edge at the umbilicus level ranged from 6-14 cm (mean: 9.9 ± 2.77). Reconstruction timing ranged from 5 months to 5 years (10 ± 12.5 months in average). Follow-up time was from 1 month to 37 months (10 ± 11. 07 months in average). 17 cases recovered without major complication and discharged within 1 week of time. But minor morbidity included partial skin necrosis in 3 cases and stitch abscess in 2 cases. One patient failed to have repair with component separation and need further negative pressure wound therapy.

Conclusion:
Advantages of the component separation include restoration of functional and structural integrity of the abdominal wall, provision of stable soft tissue coverage, and optimal aesthetic appearance. According to preoperative CT study, the component separation technique could restore abdominal wall functionality for defects up to 14 cm.

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