Reconstruction of extensive abdominal wall defect using an eccentric perforator-based pedicled anterolateral thigh flap: a case report

Feasibility of pedicled anterolateral thigh flap with tensor fascia lata and vastus lateralis for difficult abdominal wall closure

PURPOSE

Long-term follow-up for pedicled anterolateral thigh (ALT) flap with vastus lateralis and tensor fascia lata for complex abdominal wall reconstruction is rarely reported. This study aimed to evaluate the feasibility of extended pedicled ALT flap.

METHODS

This retrospective review was conducted at a single medical center between 2011 and 2018. A total of 35 patients with complex abdominal wall defects reconstructed with partition (n = 20) or pedicled ALT flap (n = 15) were enrolled. Data on gender, age, fascial defect size, operation time, hospital days, follow-up duration, and complications were obtained. Mann-Whitney test evaluated the differences in continuous data, and Chi-square test analyzed categorical data.

RESULTS

The partition technique was associated with 10.15 cm (range 8-14 cm) mean defect size, 146 min average operation time, 13.5 hospital days, and 95.42 months of mean follow-up duration. Short- and long-term complications were observed in seven (35%) and six (30%) cases, respectively. The pedicled ALT flap technique was associated with 13.4 cm (range 10.6-16 cm), 342.86 min average operation time, 22.33 hospital days, and 69.4 months of mean follow-up duration. Short- and long-term complications were observed in six (40%) and five (33%) cases, respectively. Significant differences in defect size, operative time, hospital days, and donor-site skin graft loss (p < 0.05) were observed between the groups.

CONCLUSIONS

Extended pedicled ALT flap is a reliable option for complex abdominal wall reconstruction. Compared with the partition technique group, the extended pedicled ALT group had closure of larger fascia defects. However, it was associated with a higher risk of donor-site skin graft loss and longer operative time and hospital days.

Status of wound management in Korea

In spite of a period of intense economic, social, and political hardship following the Korean War, the Republic of Korea has made great strides in economic growth over the past half century, and also remarkable progress in the medical field. However, wound research has been slow to take off in South Korea. Meanwhile, as is the case in many countries in Western Europe and North America, South Korea is seeing a steady increase in its aged population. The growth in the geriatric population has in turn brought on more cases of chronic wounds. Though South Korea only began to recognize the importance of wound management in the early 2000s, it was fortunate enough to have sophisticated related industries, such as biotechnology and information technology, and brilliant, industrious, and eager wound researchers, contributing to rapid development of the field. The country has particular strengths in research for innovative cell-based treatments and products for managing wounds. Notwithstanding government policy ill-equipped to sufficiently support such advancement, better communication between experts and public officials will no doubt bring forth even more achievements in this very promising field. It is in this context that this article aims to summarize current wound management practices, research, training, product development, and government policies regarding wound management in South Korea as of the year 2017.

Early laparotomy and timely reconstruction for patients with abdominal electrical injury: Five Case Reports and Literature Review

INTRODUCTION

High-tension electricity can cause devastating injuries that may result in abdominal wall loss, visceral damage, and sometimes major threat to life. The visceral organ may be exposed after debridement and require flap cover, but the tensile strength of abdominal wall may be lack even if flap transplanted.

METHODS

From April 2007 through May 2015, 5 patients with severe abdominal electrical injury were treated at our hospital. Exploratory laparotomy was performed based on their clinical manifestations and debridement findings of abdominal wall at early stage, and decision regarding technique for reconstruction of abdominal wall was based on an assessment of the location and extent of the defect. Medical records were reviewed for these data.

RESULTS

Clinical evaluation and debridement findings of the abdomen revealed 4 patients with suspicious visceral damage. Laparotomy was performed in 4 cases, and revealed obvious lesion in 3 cases, including segmental necrosis of small intestine, partial necrosis of diaphragm, left liver and gastric wall, and greater omentum. Five patients underwent abdominal wall reconstruction using island retrograde latissimus dorsi myocutaneous flap or free/island composite anterolateral thigh myocutaneous flap. All flaps survived, abdominal bulging occurred in 3 cases after follow-up of 12 to 36 months.

CONCLUSIONS

The clinical manifestations and wound features of abdomen collectively suggest a possible requirement of laparotomy for severe abdominal electrical burns. Retrograde latissimus dorsi myocutaneous flap or composite anterolateral thigh myocutaneous flap is an effective option for reconstruction of abdominal wall loss, the long-term complication of abdominal bulging, however, remains a significant clinical challenge.

Coverage of supraumbilical abdominal wall defects: The tunnelled-pedicled ALT technique

Abdominal wall defects are a challenge for reconstructive surgeons. Although the utility of anterolateral thigh perforator (ALT) flap has been well established for lower abdominal wall reconstruction, pedicled ALT flap is usually not considered for supraumbilical defects in the most recent algorithms. The purpose of this paper is to report the results of a tunneled pedicled ALT flap for reconstruction of supraumbilical defect from a series of patients. From July 2009 to September2014, six patients underwent delayed abdominal wall coverage using pedicled ALT flaps and reinforcement with polypropylene meshes. Defects occurred after surgical complications and abdominal trauma. Flaps were tunneled beneath the rectus femoris and sartorius muscles to increase the pedicle length. The size of the skin islands ranged from 22-29 × 10-14 cm. All flaps survived and the healing of the wounds was successful. Partial dehiscence of donor site occurred in one patient, and small wound dehiscence due to minimal distal necrosis was observed in another patient. No functional problems were reported in donor site, and no complications occurred in 6-68 months of follow-up. The tunneled pedicled ALT flap may provide a reliable alternative method for abdominal wall reconstruction, including supraumbilical defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:119-127, 2017.