A study was conducted to examine if inadequate perfusion of the abdominal wall predisposed to the development of incisional hernias in patients undergoing surgery (midline laparotomy or thoracoabdominal approach) for aortic disease. Thirty-eight patients were selected for the study and they were followed up for 2 years. Preoperative imaging was reviewed to assess vessel patency, contributing to the abdominal wall perfusion. The patency of the superior epigastric artery was assessed at T10 level; that of the inferior epigastric artery at L4 level, while the deep circumflex iliac artery was examined at the level of the anterior superior iliac spine. Lumbar arteries were considered patent if they were seen branching from the aorta. 

Thirteen patients developed incisional hernia. The predictive factors observed were either absence of flow from bilateral superior epigastric arteries or absent flow from ipsilateral superior and inferior epigastric arteries. But, no such correlation was seen for the lumbar or deep circumflex iliac arteries. The authors concluded that absent patency of the abdominal wall vasculature was a new risk factor for development of incisional hernia in patients with aortic disease. Preoperative evaluation of perfusion may help the surgeon to anticipate such a risk and opt for techniques such as prophylactic mesh placement to reduce the risk.

Source: Aicher BO, et al. Hernia. 2021 Apr;25(2):419-425.