207 Management of abdominal wall defects – case series Adrian Pelinaru 1 , Andreea Grosu-Bularda 1 , Carmen Mocanu 1 , Adrian Frunza 1,2 , Razvan Nicolae Teodoreanu 1,2 , Ionut Cosmin Olteanu 3 , Victor Grama 3 , Florin Mihail Iordache 2,3 , Serban Arghir Popescu 1,2 , Ioan Lascar 1,2 Corresponding author: Andreea Grosu-Bularda E-mail: andreeabularda@gmail.com Romanian medical JouRnal – Volume lXVii, no. 2, 2020 ABSTRACT Treating complex abdominal wall defects is challenging for the reconstructive surgeon as there are many possible complications and high reccurence rates. To date, there is no consensus on a definition of complex abdominal wall defects, as the level of complexity can be different from case to case. Thorough knowledge of the etiology of defects and relevant anatomy, adequate management during hospitalization and in postop- erative period are key elements in obtaining optimal functional results. Although the etiology of abdominal wall defects is varied, reconstructive goals are well established, including recovery of structural integrity to ensure visceral coverage and maintenance of intraabdominal pressure, prevention of hernia formation, if possible with an aesthetic pleasant result; long hospitalizations increasing morbidity and costs should be avoided. Choosing the right therapeutic strategy may be very demanding, because there is no standard treating protocol to guide the management of these patients.. We present, through five clinical cases, our experience with managing abdominal wall defects having in mind the general reconstructive priciples and trying to individualize the treatment for each of them. Keywords: abdominal wall defect, reconstruction, risk factors CASE PRESENTATIONS Ref: Ro Med J. 2020;67(2) DOI: 10.37897/RMJ.2020.2.18 BACKGROUND The abdominal wall pathology is really chal- lenging for the reconstructive surgeon as there are many possible complications and high reccurence rates [1]. To date, there is no consensus on a defini- tion of complex abdominal wall defects, as the lev- el of complexity can be different from case to case [2]. The complex abdominal wall defects may vary both in surface and depth, involving different lay- ers of the abdominal wall, from simple skin loss to complicated and infected wounds that lack of via- ble local muscles. Sometimes, the severity is just so high that primary fascial closure is impossible and visceral organs are involved, even with loss of do- main [3]. The most common causes that lead to such defects are abdominal injury (including burn injuries) or politrauma, local infections such as ne- crotizing fasceitis and tumoral resection possibily followed by radiation necrosis [4]. Usually the patients have different clinical pres- entations and the treatment has to be individualized in order to have optimal results. There are different reconstructive options that were studied and im- proved over time and choosing the suitable one has to follow the reconstructive ladder [3,5] (fig. 1). An important concept of abdominal wall recon- struction is optimizing the risk factors in order to lower the risk of wound complications. Currently, Ventral Hernia Working Group grading system is the most used one in order to predict surgical site occurences [6] (fig. 2). Article History: Received: 19 May 2020 Accepted: 5 June 2020 1 Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Clinical Emergency Hospital, Bucharest, Romania 2 „Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania 3 Clinic of General Surgery I, Clinical Emergency Hospital, Bucharest, Romania