Subcutaneous Wound Management in Complex, Contaminated Abdominal Wall Reconstruction (AWR) - The "French Fry" Technique.

Abstract

IntroductionPrimary closure of contaminated abdominal wall reconstruction (AWR) wounds carries significant wound complication risks. Vacuum-assisted, delayed primary closure (VADPC) improves outcomes but requires a second anesthetic. The "French fry" technique (FFT) utilizes VA benefits without reoperation. The aim of this study was to evaluate the outcomes of FFT in complex, contaminated AWR.MethodsA single center's open AWRs (CDC class 2-4) managed with FFT were reviewed. Technique: incision is closed except for small gaps to place subcutaneous 1 × 1 × 8cm NPWT foam "French fries" at 5-6 cm intervals under an incisional NPWT (-125 mmHg). FF are removed POD3 at the bedside and precise measurement is taken to assure all FFs are accounted for. Incisional NPWT is continued. Primary outcome included wound complications compared to Carolinas Equation for Determining Associated Risks (CeDAR) predictions.ResultsTwenty-seven AWR patients (BMI 31.6 ± 5.9 kg/m²; 40.7% diabetic; 66.7% recurrent hernias; 100% CDC wound class 2-4; massive defect size 384.2 ± 143.8 cm²) underwent FFT. Biologic mesh was placed in 74.1% of cases; 18.5% of defects were closed primarily. Fascial closure was achieved in 92.6%. CeDAR-predicted wound complication rate was 53.8%. Observed wound complication rate was 25.9%, including infection (14.8%) requiring intervention, with 7.4% requiring reopening of their wounds. There were no mesh infections and no hernia recurrences over average follow-up of 8.2 ± 19.8 months.ConclusionFFT is a practical, single-stage, strategy for contaminated AWR, reducing complications compared to predicted risk.