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Pogson-Morowitz K, Porras Fimbres D, Barrow BE, Oleck NC, Patel A. Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends. J Clin Med 2024; 13:2876. [PMID: 38792418 PMCID: PMC11122627 DOI: 10.3390/jcm13102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Abdominal wall reconstruction is a common and necessary surgery, two factors that drive innovation. This review article examines recent developments in ventral hernia repair including primary fascial closure, mesh selection between biologic, permanent synthetic, and biosynthetic meshes, component separation, and functional abdominal wall reconstruction from a plastic surgery perspective, exploring the full range of hernia repair's own reconstructive ladder. New materials and techniques are examined to explore the ever-increasing options available to surgeons who work within the sphere of ventral hernia repair and provide updates for evolving trends in the field.
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Affiliation(s)
- Kaylyn Pogson-Morowitz
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC 27710, USA (A.P.)
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Brunetti B, Salzillo R, Tenna S, Petrucci V, Morelli Coppola M, Valeri S, Persichetti P. Abdominal wall reconstruction with the free functional L-shaped latissimus dorsi flap: A case report. Microsurgery 2023; 43:617-621. [PMID: 37226360 DOI: 10.1002/micr.31070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 03/19/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
Extensive tridimensional defects of the abdominal wall are usually addressed with soft tissue flaps combined with meshes. In this scenario, the additional value of dynamic abdominal wall reconstruction with functional flaps has yet to be demonstrated. In this paper the authors describe for the first time a unique case of total abdominal wall reconstruction with the free functional L-shaped latissimus dorsi (LD) flap, designed to increase the surface area of skin flap coverage while minimizing donor site morbidity, highlighting technical tips and long-term outcomes. A 65-year-old patient underwent abdominal wall resection for a dermatofibrosarcoma protuberans, leaving her with a 23 × 15 cm full-thickness defect. After placing a mesh, a myo-cutaneous free LD Flap with an L-shaped configuration was planned. The flap was composed of Paddle A, designed vertically along the anterior margin of the muscle and Paddle B, designed over the inferior aspect of the LD muscle, extending obliquely from the midline and intersecting Paddle A laterally with a 60° angle. End-to-end anastomoses to the deep inferior epigastric artery and vein and thoracodorsal nerve coaptation to a sizeable intercostal nerve were performed. The LD muscle was sutured according to its native tension while the two skin islands allowed an almost complete resurfacing of the abdominal wall defect. Donor site was closed primarily. Post-operative course was uneventful. One year postoperatively, good abdominal contour was observed, with adequate abdominal tone at rest in laying and standing position. Muscle neurotization was confirmed with clinical examination showing voluntary contraction of the transplanted muscle and the patient reported very high functional outcomes at the hernia-related quality-of-life (HerQles) questionnaire. The free L-shaped LD flap represents an innovative solution to reconstruct extensive full-thickness defects of the abdominal wall while reducing donor site morbidity. Flap neurotization should be attempted whenever possible to improve functional outcomes of the procedure.
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Affiliation(s)
- Beniamino Brunetti
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Rosa Salzillo
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Stefania Tenna
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Valeria Petrucci
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Marco Morelli Coppola
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
| | - Sergio Valeri
- Department of Surgery for Soft Tissue Sarcoma, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Persichetti
- Department of Medicine and Surgery, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Rome, Italy
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Abdominal Wall Reconstruction Using Pedicled Antero Lateral Thigh Flap. World J Plast Surg 2022; 11:63-71. [PMID: 36694686 PMCID: PMC9840762 DOI: 10.52547/wjps.11.3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background Reconstructing abdominal wall defects has been a difficult task for surgeons. The abdominal wall defects range from defects of only soft tissue to full thickness defects including all the three layers of the abdomen. Only soft tissue defects are commonly caused by peritonitis and laparotomies, and full thickness defects can occur from en bloc resection of tumours as well as trauma. Treatment options available include component separation, partition technique, flap coverage, and more recently acellular dermal matrix. Methods This retrospective study done between 2016 and 2020 where 20 patients were operated for abdominal wall defect using Pedicled ALT flap in the Department of Plastic and Reconstructive Surgery, Sawai Man Singh Hospital, Jaipur, Rajasthan, India. Results The study consisted of total 20 patients, 14 males and 6 females. Eight patients were post electric burn, 5 patients had suffered trauma, 4 patients underwent resection of abdominal wall tumour and 3 patients were post laparotomy for peritonitis. Mean age of patients was 48 years (range from 36 to 62 years). Mean fascia defect size was 14.2 cm (range 12.2 to 16.4 cm). Mean operative time was 170 minutes (range from 140 minutes to 220 minutes). Postoperative hospital stay ranged from 8 days to 24 days (mean- 12 days). Conclusion Pedicled ALT flap has expanded the armamentarium of plastic surgeons for reconstruction of abdominal wall defects.
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Layer-by-Layer Reconstruction of Abdominal Wall Defect Using Rectus Abdominis Muscle Flap with AlloDerm. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Acartürk TO, Bengür FB. Individually Tailored Approach to Reconstruction of Complex Defects Using Versatility of the Lateral Circumflex Femoral Artery System-Based Pedicled Flaps. J Plast Reconstr Aesthet Surg 2021; 75:199-209. [PMID: 34645586 DOI: 10.1016/j.bjps.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Lateral circumflex femoral artery (LCFA) system is one of the most versatile donor sites in the body. We present our experience with pedicled flaps from the LCFA system, including different components for a wide variety of etiologies and locations. Twenty-three consecutive pedicled flaps were performed on 22 patients (10 females and 12 males; age 4-71 years) between 2007 and 2015 by a single surgeon. Flap size, type, and composition were tailored according to the requirements of the defects, including (1) location; (2) surface area; (3) depth; (4) number of defects; (5) presence of exposed critical structures; (6) presence of exposed foreign bodies; (7) prior use of other options; (8) history of radiation; and (9) other comorbidities. Defect locations were 10 abdominal wall (including groin and pubis), 9 ischio-gluteo-trochanteric and 4 perineal. Defect sizes ranged from 6 × 6 to 30 × 35 cm. Maximum depth of wounds ranged between 7 and 18 cm. The flap sizes ranged from 9 × 6 to 38 × 20 cm. Two flaps were fasciocutaneous perforator, 4 were myocutaneous with "muscle sparing" vastus lateralis, 10 were myocutaneous with "segmental" vastus lateralis, 5 were myocutaneous "tri-muscle," 1 was "tri-muscle," and 1 was rectus femoris only. Donor sites were closed primarily in 20 cases and with split thickness skin grafting in 3 cases. All flaps survived completely without any partial loss or congestion. Pedicled flaps from the LCFA system can be tailored individually for a wide variety of etiologies and locations. Muscles can be harvested and used as "muscle sparing," "segmental," and "tri-muscle" to accommodate the requirements of the defects.
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Affiliation(s)
| | - Fuat Barış Bengür
- University of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA
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Scomacao I, Vijayasekaran A, Fahradyan V, Aliotta R, Drake R, Gurunian R, Djohan R. The Anatomic Feasibility of a Functional Chimeric Flap in Complex Abdominal Wall Reconstruction. Ann Plast Surg 2021; 86:557-561. [PMID: 33939653 DOI: 10.1097/sap.0000000000002490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch. METHODS Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin. RESULTS Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps. CONCLUSIONS This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.
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Affiliation(s)
- Isis Scomacao
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Vahe Fahradyan
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Rachel Aliotta
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Richard Drake
- Department of Anatomic and Laboratory Sciences, Cleveland Clinic Foundation, Cleveland, OH
| | - Raffi Gurunian
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Risal Djohan
- From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Vijayasekaran A, Gibreel W, Carlsen BT, Moran SL, Saint-Cyr M, Bakri K, Sharaf B. Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction: Technical Pearls and Pitfalls. Clin Plast Surg 2020; 47:621-634. [PMID: 32892805 DOI: 10.1016/j.cps.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institution's experience with the PALT flap for locoregional reconstruction.
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Affiliation(s)
- Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Waleed Gibreel
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, MS-01-E443, 2401 South 31st Street, Temple, TX 76508, USA
| | - Karim Bakri
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Basel Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Vranckx JJ. Letter to the editor comments on JPRAS publication "Autologous abdominal wall reconstruction using anterolateral thigh and iliotibial tract flap after extensive tumor resection: A case series study of 50 consecutive cases". J Plast Reconstr Aesthet Surg 2020; 74:223-243. [PMID: 32828697 DOI: 10.1016/j.bjps.2020.05.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jan Jeroen Vranckx
- Department of Plastic and Reconstructive Surgery and Lab of Plastic Surgery and Tissue Engineering Research, KU-Leuven University Hospitals, 49 Herestraat, B-3000 Leuven, Belgium.
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Post-Oncologic Abdominal Wall Reconstruction: Mesh Versus Autologous Tissue. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Resection and Reconstruction of Giant Abdominoscrotal Arteriovenous Malformation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2725. [PMID: 32537371 PMCID: PMC7253270 DOI: 10.1097/gox.0000000000002725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis. Preoperative embolization of the feeding vessels was performed. Three days later, surgical excision of the mass with the affected scrotum, left rectus muscle, sheath, and overlying abdominal skin followed. The testes were dissected from the malformation and preserved along with the right internal pudendal artery. The left thigh skin was advanced to the scrotal remnants and a neoscrotum created. The resulting large abdominal wall defect was reconstructed in layers with a pedicled anterolateral thigh flap, including innervated vastus lateralis muscle, to prevent herniation. Recovery was uneventful, and a 4-year follow-up revealed no significant clinical or radiological recurrence with recovery of flap sensation, retained erectile function, and no herniation. We report this case due to rarity of giant abdominoscrotal arteriovenous malformations and present preoperative embolization, surgical resection, and functional anterolateral thigh flap reconstruction as a valuable treatment option of this life-threatening illness.
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Zhao X, Cao Z, Nie Y, Liu J, Yuan X, Chen J, Shen Y. Retrospective analysis of defect reconstruction after abdominal wall tumor resection in 30 patients. Hernia 2020; 25:375-381. [PMID: 32451791 DOI: 10.1007/s10029-020-02219-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE It is difficult to manage the full-thickness defect that is created by radical resection of an abdominal wall tumor. This report aimed to review our institutional experience with immediate reconstruction using mesh reinforcement after abdominal wall tumor resection. METHODS We retrospectively examined patients who underwent abdominal wall tumor resection with immediate mesh-reinforced reconstruction between April 2014 and November 2018. The patients' records were reviewed to collect data regarding their demographic characteristics, surgical procedures, and complications. RESULTS We identified 30 eligible patients, including 5 who underwent simultaneous resection of affected intra-abdominal organs or tissues. The median size of the resulting abdominal wall defect was 60 cm2 (interquartile range: 32-127.5 cm2) and the median mesh size was 150 cm2 (interquartile range: 150-225 cm2). The median operative time was 85 min (interquartile range: 60-133.8 min), the mean hospital stay was 19.4 ± 9.0 days, and the mean follow-up period was 28.6 ± 16.0 months. The complications included seroma (n = 4), infection (n = 2), massive hematoma (n = 1), and abnormal sensation (n = 3). Tumor recurrence was observed in two patients, and three patients died because of cancer progression. No patient developed a ventral hernia or abdominal bulging. CONCLUSION Immediate mesh-reinforced reconstruction is feasible and effective for patients who require abdominal wall tumor resection.
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Affiliation(s)
- X Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Z Cao
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Y Nie
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - J Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - X Yuan
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
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Kagaya Y, Arikawa M, Higashino T, Miyamoto S. Autologous abdominal wall reconstruction using anterolateral thigh and iliotibial tract flap after extensive tumor resection: A case series study of 50 consecutive cases. J Plast Reconstr Aesthet Surg 2019; 73:638-650. [PMID: 31843388 DOI: 10.1016/j.bjps.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/11/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The utility of anterolateral thigh (ALT) + iliotibial tract (ITT) flaps for the reconstruction of large abdominal wall defects has been reported, especially in cases with huge skin defects, surgical contamination, or a history of radiotherapy. However, previous reports have mainly described short-term results such as flap success rates or incidence of wound complications. The present study reviewed 50 consecutive cases of abdominal wall reconstruction using an ALT+ITT flap after extensive tumor resection and evaluated the durability of this approach (incidence of bulge or hernia) and the factors affecting the results. PATIENTS AND METHODS A detailed retrospective review of 50 consecutive cases was conducted. Computed tomography or magnetic resonance imaging findings were reviewed to assess the incidence of abdominal bulge or hernia. Items extracted as variables from patient records were subjected to univariate and multivariate logistic regression analyses to identify their relationship with postoperative abdominal bulge or hernia. RESULTS Forty-six cases that were followed up for more than six months were analyzed. Twenty-three patients (50.0%) developed abdominal bulge, while none (0%) developed hernia. The multivariate logistic regression analysis revealed that old age and a high body mass index were independently associated with abdominal bulge, while abdominal defect size was not. CONCLUSIONS Abdominal wall reconstruction using an ALT+ITT flap after extensive tumor resection was considered a reasonable option with a low risk of hernia despite a marked incidence of postoperative abdominal bulge; however, the usage of additional material may be considered depending on the situation.
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Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi Chiba, 277-8577, Japan
| | - Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Composite ALT flap for structured reconstruction of the abdominal wall: New insights from long-term outcomes in 14 patients. J Plast Reconstr Aesthet Surg 2019; 72:1700-1738. [PMID: 31300218 DOI: 10.1016/j.bjps.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/19/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
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14
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Aliotta RE, Gatherwright J, Krpata D, Rosenblatt S, Rosen M, Gurunluoglu R. Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life. Hernia 2019; 23:205-215. [PMID: 30798398 DOI: 10.1007/s10029-019-01916-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management. METHODS Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months). RESULTS All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences. CONCLUSION Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.
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Affiliation(s)
- R E Aliotta
- Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - J Gatherwright
- Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - D Krpata
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M Rosen
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - R Gurunluoglu
- Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Sadigh P, Burke J, Nikkhah D, Sammartino C, Puliatti C, Sivaprakasam R, Knowles C. 'Abdominal reanimation' and massive flank hernias: Moving towards a more functional reconstruction. J Plast Reconstr Aesthet Surg 2018; 71:941-943. [PMID: 29426810 DOI: 10.1016/j.bjps.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Parviz Sadigh
- Department of Plastic Reconstructive Surgery, The Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Josh Burke
- National Centre for Bowel Research & Surgical Innovation, London, UK
| | - Dariush Nikkhah
- Department of Plastic Reconstructive Surgery, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Cinzia Sammartino
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Carmelo Puliatti
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Rajesh Sivaprakasam
- Department of Renal Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Charles Knowles
- National Centre for Bowel Research & Surgical Innovation, London, UK
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Vijayasekaran A, Gibreel W, Carlsen BT, Moran SL, Saint-Cyr M, Bakri K, Sharaf B. Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction: Technical Pearls and Pitfalls. Clin Plast Surg 2017; 44:371-384. [PMID: 28340669 DOI: 10.1016/j.cps.2016.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institution's experience with the PALT flap for locoregional reconstruction.
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Affiliation(s)
- Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Waleed Gibreel
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, MS-01-E443, 2401 South 31st Street, Temple, TX 76508, USA
| | - Karim Bakri
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Basel Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Hammer J, Léonard D, Chateau F, Abbes Orabi N, Ciccarelli O, Bachmann R, Remue C, Lengelé B, Kartheuser A. Reconstruction of an abdominal wall defect with biologic mesh after resection of a desmoid tumor in a patient with a Gardner's syndrome. Acta Chir Belg 2017; 117:55-60. [PMID: 27538186 DOI: 10.1080/00015458.2016.1212499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Desmoid tumors are rare proliferative and invasive benign lesions. They can be sporadic, but in most instances, desmoid tumors develop in the context of Gardner's syndrome with principal localization in the abdominal cavity and abdominal wall. CASE-REPORT We report the case of a 24-year-old female presenting Gardner's syndrome with a symptomatic abdominal wall desmoid tumor. Lack of response to medical treatment led to surgical management consisting in a complete resection and parietal reconstruction with a biologic mesh. Postoperative course was uneventful and there was no evidence of recurrence at 12 months of follow-up. DISCUSSION Conventional treatment of abdominal wall desmoid tumors consists in a wide and radical resection. However, complete resection is not always feasible because of difficulty to differentiate the desmoid tumor from adjacent tissues. The surgical approach may require different techniques to repair the parietal defect including prosthetic material such as synthetic or biologic meshes. Biological mesh is an ideal alternative to synthetic graft, mainly in case of infection. CONCLUSION We have encountered a case of a symptomatic growing desmoid tumor of the abdominal wall in a young patient with Gardner's syndrome, successfully treated by complete resection and reconstruction with a biologic mesh to correct the parietal defect.
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Reconstruction of Abdominal Wall Defects Using a Pedicled Anterolateral Thigh Flap including the Vastus Lateralis Muscle: A Report of Two Cases. Case Rep Surg 2017; 2016:8753479. [PMID: 28074168 PMCID: PMC5198147 DOI: 10.1155/2016/8753479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/27/2016] [Indexed: 11/21/2022] Open
Abstract
The purpose of abdominal wall reconstruction is to prevent hernias and protect the abdominal viscera. In cases involving full-thickness defects of the rectus abdominis muscle, the muscle layer should be repaired. We present 2 cases in which full-thickness lower rectus abdominis muscle defects were reconstructed using vastus lateralis-anterolateral thigh flaps. The pedicled vastus lateralis-anterolateral thigh flap provides skin, fascia, and muscle tissue. Furthermore, it has a long neurovascular pedicle and can reach up to the periumbilical area and cover large defects. We consider that this muscle flap is a good option for repairing full-thickness lower abdominal defects.
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Affiliation(s)
- David Ross
- Department of Plastic Surgery, St Thomas' Hospital London and St Marks Hospital, London, UK
| | - Omar Faiz
- St Marks Hospital and Academic Institute & Imperial College, Harrow, London, UK
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