Simini Boards Cast

Chapter 84 - Part D: Contamination, Infection, and the Dirty Abdomen: Why Perfect Repairs Still Fail

Simini Podcasts Season 1 Episode 61

In this episode of BoardsCast, we stay inside Tobias Chapter 84 – Abdominal Wall Reconstruction and Hernias, focusing on the high-risk abdominal wall:
the contaminated, infected, or downright dirty abdomen.

Even flawless surgical technique can fail if the biology is wrong — and in a contaminated abdomen, biology is working against you. This episode explains why abdominal wall repairs break down, why some closures should never be attempted, and what reconstruction strategies actually succeed.

You’ll learn:

  • The difference between contamination, infection, and septic abdomen
  • Why primary closure often fails even when technically perfect
  • How bacterial load, biofilm, and inflammation sabotage fascia
  • When mesh is contraindicated — and what to use instead
  • Strategies for staged closure, open abdomen management, and vacuum-assisted therapy
  • Why tension and infection multiply each other’s failure risk
  • How boards frame “failed closure in a contaminated field” questions

This episode turns one of the hardest surgical environments into a predictable, manageable decision process.

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