Using sequential fascial closure, Burlew et al. were able to achieve 100% fascial approximation as well as reducing the morbidity of the open abdomen and the cost of complex abdominal reconstruction or biologic mesh insertion [1]. Another important question in the management of patients undergoing DCS or damage control laparotomy (DCL), in particular, is when to use mesh repair and when to use lateral component separation (LCS). To answer this question, Sharrock et al. [2] conducted a systematic review and meta­analysis of studies that compared methods of restoration of fascial continuity when primary closure was not possible fol­lowing DCL for trauma. In their analysis, they included ran­domized controlled trials (RCTs), cohort studies, and case series that reported temporary abdominal closure (TAC) and early definitive closure methods in trauma patients undergoing DCL. After reviewing 26 studies, with mortality, days to fas­cial closure, hospital length of stay, abdominal complications, and delayed ventral herniation as outcomes they concluded that component separation or mesh repair may be valid alter­natives to delayed primary closure following a trauma DCL [2]. Others have used various modifications of VAC [3] to facilitate primary fascial closure and reduce morbidity in patients who had severe abdominal sepsis. Pliakos et al. [3] concluded that sequential fascial closure can begin once abdominal sepsis is controlled. Additionally, Cothren et al. [4] performed a modification of the vacuum-assisted closure (VAC) technique that provided constant fascial tension in order to achieve a higher rate of primary fascial closure and achieved 100% fascial approximation. Other techniques have been described as well [5, 6], to achieve closure.

We have all become acutely aware of the need to close the abdomen as soon as possible. However, if and when one cannot use native tissue to close the defect or they are in need to use reinforcement of the repair with mesh, use of tissue engineer­ing (TE), which aims to create and substitute failing or severely injured organs, by replacing them both anatomically and func­tionally as close as possible or entirely substituting the healthy organ, is in order. TE has contributed more advancements to general and trauma surgery than any other field currently. As general and trauma surgeons or acute care surgeons we are pre­sented daily with large defects of the abdomen as well as other parts of the body that must be sealed off with newly created tissue that eventually will become part of the body and mimic fascia. This tissue has been called “biologic” and is being used to restore the functionality of abdomen. Other clinical indica­tions have emerged also and vary from creating better cosmet­ics results in breast reconstruction, reconstruction after major cranioplasties, facial reconstruction or skin coverage after major burns, or other musculocutaneous defects.

learn more about, and finally create a product that will eventually be cheaper and more effective and will become integrated fully by the scaffold through cellular and fibrovas­cular ingrowth tissue remodeling. Finally, the AWR using biologic mesh has advanced this field significantly; however, the biggest challenging issue that continues to plague abdom­inal wall reconstruction using bioengineered materials is the extraordinary cost that simply renders it impossible to be used in the majority of the countries in the world. Hopefully, what has happened with the expansion of biologic mesh will be followed by other organs as well. My hope is that readers will find inspiration in this book. Even if this book helps to care for one patient alone, the work that so many authors and I have done in this book will be worth the contribution.