Repair of a large recurrent congenital lumbar hernia with free composite anterolateral thigh flap, tensor fascia lata flap, and vastus lateralis flap and meshes: A case report

Free Flap Reconstruction of Abdominal Wall Defects: A Systematic Review and Pooled Analysis

BACKGROUND

Reconstruction of extensive abdominal wall defects poses significant challenges, often requiring free tissue transfer when traditional methods are inadequate. This review examines the past decade's literature on free flaps for abdominal wall reconstruction to guide decision-making.

METHODS

A systematic review following PRISMA guidelines was conducted on July 17, 2024, using PubMed, Cochrane Library, Web of Science, Embase, and Scopus. Studies from 2013 to 2023 involving free flap reconstruction with at least 3 months follow-up were included. Surgical complications and outcomes were analyzed.

RESULTS

Of 2269 articles, 32 met inclusion criteria, involving 104 free flaps. There were no reports of flap loss. The average defect size was 330.0 ± 200.8 cm2. Oncologic resection was the leading indication (57%), with the latissimus dorsi flap used most frequently (36%). The most common recipient vessels were the deep inferior epigastric vessels (66.7%). The most common recipient vessels were the deep inferior epigastric vessels (66.7%). Mesh was used in 53% of cases, predominantly in a sublay position. The majority of reconstructions were immediate (52.9%), followed by delayed (31.8%) and staged (15.3%). Complications included partial flap necrosis (5.8%), surgical site infection (5.8%), and hernia development (4.8%). There were no significant differences in outcomes when stratified by reconstruction timing, flap choice, recipient vessels, or mesh characteristics. Infection as the defect etiology independently predicted surgical site infection (p = 0.03), whereas mesh usage (p = 0.07) and diabetes (p = 0.09) trended toward increased infection risk. Donor site complications were minimal.

CONCLUSION

Free flap reconstruction is safe and effective for large abdominal wall defects, with similar outcomes across flap types. Infection as the initial etiology was the strongest predictor of postoperative infection. Further studies are needed to establish guidelines for patient and flap selection.

Retrospective analysis of 16 cases of lumbar hernia

Background

Through a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition.

Methods

We collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data.

Results

All patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases.

Conclusion

Lumbar hernias are rare and can be safely and effectively treated by open tension-free repair.