Table 1.

Common surgical options for ACS management.

Initial management of ACS
Minimally invasive
Percutaneous aspiration
Colonoscopic decompression of colonic distension
Invasive
Initial or relaparotomy
Open abdomen management (short-term; able to close primarily)
Vacuum assisted closure (proprietary of home-made)
Hook and Loop closure device
Open abdomen management (long-term; unable to close primarily)
Polyglycolic acid mesh and split-thickness skin graft (STSG)
STSG without underlying absorbable mesh
Component separation of parts with biologic mesh underlay (rare)
Fascial relaxing incisions with spanning mesh (prosthetic or biologic)
*Caution: biologic may relax and gap when placed in spanning position
Reconstruction
Component separation of parts with biologic mesh underlay (common)
Primary closure + fascial relaxing incisions + biologic mesh underlay (less common)
Free muscle flap + biologic mesh underlay (rare)