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

In this BoardsCast episode, we complete our exploration of Tobias Chapter 84 – Abdominal Wall Reconstruction and Hernias by focusing on the surgical environment every clinician fears: the contaminated or infected abdomen.

Even the most technically flawless repair can fail when the underlying biology is hostile. This episode explains why contaminated fields undermine tension, sutures, mesh, and muscle — and how surgeons can avoid predictable, preventable disasters.

You’ll learn:

• Why contamination changes the rules of closure
• The biologic cascade that makes fascia incapable of holding sutures
• When mesh becomes dangerous — and when biologic materials can help
• Why infection + tension = guaranteed dehiscence
• How to manage open abdomens, delayed closure, staged reconstruction, and VAC therapy
• What boards expect you to know about closure failure in contaminated fields

If you’ve ever wondered why “perfect” abdominal wall repairs still break down, this episode reveals the real reason: biology > technique in contaminated wounds.

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Listen On:
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Chapters

• 0:00 Introduction: The Abdomen as a Vital Engineering Container
• 1:45 The Strangulation Trap: When Bulges Become Catastrophic
• 3:07 Pathophysiology: Necrosis and the Release of Systemic Toxins
• 4:36 The Critical Decision: Stabilization Before Surgery
• 5:54 Surgical Strategy: The "Un-block" Resection Technique
• 7:22 Reconstruction Materials: Synthetic vs. Biologic Mesh
• 8:58 Managing the "Dirty" Field: Repairs in Hostile Environments
• 10:33 Reperfusion Injury: Preventing the Post-Op Crash
• 12:00 High Yield Nugget Zone: Rules for Successful Wall Reconstruction