Successful Use of OviTex® Bridging Repair in a Super Morbidly Obese Patient With Septic Shock, Perforated Diverticulitis, and Necrotizing Fasciitis of the Abdominal Wall.

Managing abdominal wall defects in contaminated surgical fields is particularly challenging in super morbidly obese patients with severe infection. We report the case of a 49-year-old man (BMI 54, 195 kg) who presented in septic shock with necrotizing fasciitis of the abdominal wall secondary to perforated diverticulitis and colocutaneous fistula. Initial management included exploratory laparotomy, extensive debridement of a 25 × 25 cm abdominal wall abscess, anterior resection left in discontinuity, and temporary abdominal closure with an AbThera™ wound vacuum (Solventum, Saint Paul, MN, USA). Once stabilized, the patient underwent definitive repair with the placement of a 25 × 25 cm inlay OviTex® 2S permanent reinforced tissue matrix (manufactured by TELA Bio, Inc., Malvern, PA, USA), the creation of an end colostomy, and wound vacuum placement. Postoperatively, he recovered steadily, was weaned from ventilatory support, tolerated oral intake, and demonstrated functional colostomy output. He was discharged home with a wound vacuum and returned to full function within two months. At six months, he had stable abdominal wall integrity after skin grafting, with plans for staged colostomy reversal and abdominal wall reconstruction after weight loss. This case highlights the successful use of OviTex® in providing both mechanical strength and biologic integration in a high-risk patient where permanent synthetic mesh was contraindicated and biologic mesh alone would have been inadequate.