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Bradley Bengtson, MD • Grand Rapids, Michigan
Revisional hernia repair and abdominoplasty using SERI® Surgical Scaffold for soft tissue support
Operative technique
Step 1: Dr. Bengtson completed the surgical repair of the ventral and periumbilical hernias with 0-Surgilon® braided nylon figure-of-8 sutures, followed immediately by an abdominal wall plication using 0-Surgilon® braided nylon figure-of-8 sutures and a running #1 PDO Quill® knotless tissue-closure device, further reinforcing the hernia repairs. Meticulous hemostasis was maintained throughout the procedure.
Step 2: After the repair was complete, the area was irrigated with triple antibiotic solution: 1 g cefazolin, 80 mg gentamicin, and 50 mL bacitracin in 500-mL lactated Ringer’s solution. To minimize postsurgical pain, 20 mL 1.3% Exparel® (bupivacaine liposome injectable suspension) was diluted in 80 mL normal saline and injected into the fascia and skin margin.
Step 3: To reinforce the abdominoplasty, a 10-cm x 25-cm piece of SERI® Surgical Scaffold was used. Before insertion, SERI® Surgical Scaffold was dipped in a saline and triple-antibiotic solution, and then oriented vertically on the superior-inferior axis as an anterior abdominal wall onlay support. The edges of SERI® Surgical Scaffold were trimmed to follow the abdominal anatomic contours [Figure 1]. Additionally, a small circular opening was cut in the material to expose the umbilicus [Figure 2].
Step 4: The SERI® Surgical Scaffold overlay was tacked with 2-0 synthetic absorbable PDS sutures to anchor the material in place and stabilize the scaffold during tissue ingrowth. The product was then inset on tension with #1 PDO Quill® running sutures around the border, approximately 5 mm to 10 mm from the cut edge [Figure 3].
Figure 1. Edges of SERI® Surgical Scaffold trimmed to follow the abdominal anatomic contours
Figure 2. Circular opening cut in SERI® Surgical Scaffold to expose the umbilicus
Figure 3. SERI® Surgical Scaffold tacked with 2-0 PDS and inset with #1 PDO Quill® running sutures around the border
Step 5: Next, one 15-mm Blake® hubless round silicone drain was inserted in the lower abdomen through a stab incision. 2-0 synthetic absorbable PDS suture was used to close Scarpa’s fascia, followed by 3-0 Monocryl® for the deep dermis, and Monoderm® to close the skin. Steri-Strip® and supportive dressings were applied, with an abdominal binder for additional support.
This Case Review is provided for your information only. As with other surgical and medical decisions, it is the responsibility of surgeons to use sound medical judgment in utilizing the procedures best suited to the needs of each patient and to the skills and experiences of the surgeon. Please refer to the SERI® Surgical Scaffold Instructions for Use for current information.