
Weekly Quiz 14 - Abdominal Wall Recon
Quiz by Miguel Dorante
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A 41-year-old man is being evaluated prior to ventral hernia repair. History includes a traumatic abdominal injury with exposed bowel 4 years ago treated with negative pressure dressings and skin grafting. A separation of components technique will be used. The connection between which of the following layers will most likely remain intact during this procedure?
A 56-year-old man is evaluated for a ventral hernia after undergoing midline laparotomy for diverticulitis. BMI is 38 kg/m2. Physical examination shows midline fascial defect measuring 20 × 15 cm; there is no evidence of infection and skin coverage is stable. Repair with rectus advancement and polypropylene mesh is planned. Placement of mesh between which of the following planes is most likely to decrease this patient’s risk of hernia recurrence?
A 4-year-old boy is scheduled to undergo abdominal wall repair using a component separation technique. He underwent living donor liver transplantation during infancy, at which time the graft was noted to be too large for size. A midline incisional hernia was intentionally made to facilitate organ function after transplantation. Current physical examination shows ventral herniation with marked loss of domain. During abdominal wall repair by component separation, parallel aponeurotomy is most likely to be performed immediately lateral to which of the following anatomical structures?
A 27-year-old woman is evaluated for a recurrent abdominal desmoid tumor. CT scan shows a mass that occupies the full-thickness right musculofascial abdominal wall, involving the rectus abdominis muscle and oblique muscles, including lateral to the semilunar line. Resection is performed. Photographs of the defect are shown. Which of the following is the most appropriate management?

A 43-year-old woman with a history of ovarian cancer is evaluated because of recurrence in the incision and bladder dome. History includes resection, chemotherapy, and radiation therapy. The gynecologic surgeon plans a wide resection of skin, fascia, bilateral lower rectus muscles, and bladder dome resulting in a 10 × 16-cm defect in the central lower abdomen. Which of the following is the most appropriate procedure to achieve abdominal closure?