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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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Wang D, Zheng S, Qiu X, Fu Y. Immediate Repair With a Self-Gripping Retromuscular Mesh for Abdominal Wall Defect Following Tumor Resection. Surg Innov 2023; 30:50-55. [PMID: 35357985 DOI: 10.1177/15533506221087074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prosthetic repair is always employed after large abdominal wall tumor resection, while chronic pain is one of the mesh-related complications after traumatic fixation. The objective of this research was to evaluate the outcomes of retromuscular repair with self-gripping mesh after abdominal wall tumor resection.Methods: The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with abdominal wall tumor >5 cm in diameter undergoing tumor excision and retromuscular repair with self-gripping mesh. Demographic, operative, early postoperative, and follow-up data were noted. Visual Analog Scale, ranging from 0 (no pain) to 10 (very severe pain), was used to estimate the wound pain.Results: 24 patients were included in this study, and the defect following tumor resection was 26.9±10.0 cm2. There was no tumor recurrence or incisional hernia in median follow-up of 20 months, and the mean VAS score was 0.4. Three had foreign body feeling and no one suffered chronic pain.Conclusions: Immediate repair with a self-gripping retromuscular mesh can be considered as an effective way to treat an abdominal wall defect after resecting an abdominal wall tumor.
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Affiliation(s)
- Dianchen Wang
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shouhua Zheng
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Xinguang Qiu
- Department of Thyroid Surgery, 191599The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, China
| | - Yang Fu
- Department of Hernia and Abdominal Wall Surgery, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Abouzid A, Shetiwy M, Hossam A, Abd Elghaffar M. Abdominal wall reconstruction using Omental Flap with Mesh repair following resection of Aggressive Abdominal Wall Neoplasms. Oncol Res Treat 2022; 45:415-422. [PMID: 35537417 DOI: 10.1159/000524871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resection of large anterior abdominal wall tumors causes a large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point. METHODS Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU) Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic Polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics, operative data including defect size, mesh size, intrabdominal tumor extension and postoperative outcomes and complications. RESULTS Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 mins. The mean size of the abdominal wall defect was 50.78 cm2 (range: 25 - 90 cm2). The meshes used in reconstruction had a mean size of 89.53 cm2 (range: 55 - 130 cm2). The median follow-up period of the patients was 13.5 months (range: 5-54 months). Post-operative complications included infection (n = 4 cases), seroma (n = 2 cases), hematoma (n =1 case) and abnormal sensation (n = 5 cases). Tumor recurrence was reported in two cases and no cases developed incisional hernia during the follow up period. CONCLUSION Immediate use of omental flap with synthetic (PP) mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone.
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Affiliation(s)
- Amr Abouzid
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Amr Hossam
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Abd Elghaffar
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
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Zhao Y, Li Y, Peng X, Yu X, Cheng C, Yu X. Feasibility study of oxidized hyaluronic acid cross-linking acellular bovine pericardium with potential application for abdominal wall repair. Int J Biol Macromol 2021; 184:831-842. [PMID: 34174314 DOI: 10.1016/j.ijbiomac.2021.06.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Bovine pericardium(BP)is one of the biological membranes with extensive application in tissue engineering. To fully investigate the potential clinical applications of this natural biological material, a suitable cross-linking reagent is hopefully adopted for modification. Glutaraldehyde (GA) is a clinically most common synthetic cross-linking reagent. In the study, oxidized hyaluronic acid (AHA) was developed to substitute GA to fix acellular bovine pericardium (ABP) for lower cytotoxicity, aiming to evaluate the feasibility of AHA as a cross-linking reagent and develop AHA-fixed ABP as a biological patch for abdominal wall repair. The AHA with the feeding ratio (1.8:1.0) has an appropriate molecular weight and oxidation degree, almost no cytotoxicity and good cross-linking effect. The critical cross-linking characteristics and cytocompatibility of AHA-fixed ABP were also investigated. The results demonstrated that 2.0% AHA-fixed ABP had the most suitable mechanical properties, thermal stability, resistance to enzymatic degradation and hydrophilicity. Moreover, 2.0% AHA-fixed samples exhibited an excellent cytocompatibility with human peritoneal mesothelial cells (HPMC) and low antigenicity. It also showed a prominent anti-calcification ability required for abdominal wall repair. Our data provided experimental basis for future research on AHA as a new cross-linking reagent and AHA-fixed ABP for abdominal wall repair.
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Affiliation(s)
- Yang Zhao
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Yanjiang Li
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xu Peng
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, PR China
| | - Xiaoshuang Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China.
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Abdominal, perineal, and genital soft tissue reconstruction with pedicled anterolateral thigh perforator flaps. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Pedicled perforator flaps have become a contemporary alternative to muscle flaps for soft tissue reconstruction as they have reduced donor site morbidity, avoid the need for microsurgical transfer, and are versatile and reliable. The anterolateral thigh (ALT) flap was first introduced as a free flap and has since gained popularity as a pedicled flap. Here we review our experience using pedicled ALT flaps for regional soft tissue reconstruction.
Methods
We retrospectively reviewed all patients who underwent loco-regional soft tissue reconstruction using pedicled ALT flaps between March 2014 and October 2018, with the goal of identifying potential applications of pedicled ALT flaps. The following aspects of each case were reviewed: patient demographics, defect location and size, comorbidities such as previous radiotherapy, flap details, clinical follow-up, and postoperative complications.
Results
Our analysis demonstrates the versatility of pedicled ALT flaps in a variety of indications to successfully cover large abdominal, perineal, and genital soft tissue defects. Depending on the patient’s needs to achieve more bulk or stability in the reconstruction, the ALT flap was individually tailored with underlying muscle or fascia. The average follow-up was 7 months (range: 3–13 months).
Conclusions
Pedicled ALT flaps are a valuable reconstructive option for soft tissue defects located within the pedicle’s range, from the lower abdomen to the perianal region. These flaps are usually raised from a non-irradiated donor site and are sufficient for covering extensive soft tissue defects. Three-dimensional reconstruction of the defect using pedicled ALT flaps allows for anatomical function and minor donor sites.
Level of evidence: Level IV, therapeutic study.
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Yang D, Song Z, Lin Y, Dong W, Fu S, Yang J, Zhang P, Gu Y. Prevention of intestinal adhesion and regeneration of abdominal wall tissue with meshes containing an electrostatically spun acellular dermal matrix (ADM)/silk fibroin (SF) fiber composite polypropylene mesh. J Mech Behav Biomed Mater 2020; 112:104087. [PMID: 32980670 DOI: 10.1016/j.jmbbm.2020.104087] [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] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
The repair of abdominal wall defects often requires the use of polypropylene (PP) as the main material. After a PP mesh is implanted in the body, contact with the intestine can cause adhesions between the intestine and the mesh, leading to serious complications such as intestinal fistula. In this study, we used electrostatic spinning technology to coat one side of PP meshes with an electrostatically spun isolating layer of acellular dermal matrix (ADM)/silk fibroin (SF) hybrid material. These meshes were used to repair abdominal wall defects in model rats and were compared with polycaprolactone (PCL) composite polypropylene meshes and PP meshes. The results showed that the adhesion score and area of ADM/SF-PP meshes were smaller than those of PCL-PP and PP meshes. Immunohistochemical assessment revealed that the ADM/SF meshes could effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs. The tissues regenerated on the abdominal side were rich in new blood vessels. Furthermore, the ADM/SF meshes could effectively reduce the expression levels of the inflammation-related factors IL-6 and TNF-α. The expression levels of tissue regeneration-related factors, such as VEGF and PAX-7, were also higher after ADM/SF-PP mesh-mediated repair than after PCL-PP mesh and PP mesh repair. Thus, ADM/SF-PP meshes can effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs and quickly promote regeneration of abdominal surface tissue to prevent and reduce abdominal adhesion and support restoration of the abdominal wall.
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Affiliation(s)
- Dongchao Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhicheng Song
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yongjia Lin
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Wenpei Dong
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shaoju Fu
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Jianjun Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Peihua Zhang
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Zhao XF, Shen YM, Chen J. Multiple recurrent neurofibromas in the abdominal wall: A case report. World J Clin Cases 2020; 8:4223-4227. [PMID: 33024782 PMCID: PMC7520774 DOI: 10.12998/wjcc.v8.i18.4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neurofibroma can be a clinical manifestation of neurofibromatosis, which is a benign neurogenic tumor that occurs sporadically. Neurofibromas in the abdomen usually appear in the retroperitoneal space. Reports on neurofibromas in the abdominal wall are rare, and multiple recurrent neurofibromas in this area have not yet been reported.
CASE SUMMARY This is a case of a 73-year-old man who suffered from multiple recurrent neurofibromas in the abdominal wall for 16 years and received 13 surgical treatments.
CONCLUSION We need to pay due attention to its treatment, and primary surgery should be designed thoroughly.
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Affiliation(s)
- Xue-Fei Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ying-Mo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Jaloux C, Philandrianos C, Mayoly A, Bettex Q, Abellan-Lopez M, Kachouh N, Legré R, Bergel C, Bertrand B, Casanova D. The two-stage free flap strategy: An alternative to reconstruct major oncological surgical defects with noble organ exposure. ANN CHIR PLAST ESTH 2020; 66:320-328. [PMID: 32839049 DOI: 10.1016/j.anplas.2020.08.001] [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: 05/01/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND To minimize the risk of viscera exposure for parietal or calverial reconstruction after tumor removal, we used the two-stage free flap strategy. The flap was transferred a few days before tumor resection and left in a standby position until the second stage. PATIENTS AND METHOD We conducted a retrospective monocentric study. All patients who underwent reconstruction with the two-stage free flap strategy after tumor resection since 2000 were included. RESULTS We performed 14 two-stage flaps (8 for calvaria, 3 for abdomen, and 3 for thorax) on 12 patients. The average skin paddle surface was 318 cm2. The mean operative time was 274min for the first stage and 172min for the second stage. The average time between the two stages was 8.8 days (2 to 24 days). One flap necrosis, one venous thrombosis, and one hematoma were observed after the first stage. Partial skin paddle necrosis (2 flaps) and infections (3 flaps) occurred after the second stage. The mean follow-up was 20 months (6 to 61 months), and two patients had tumor recurrence. CONCLUSIONS The two-stage free flap strategy is another option for major oncological reconstructions, to be safe and reliable some rules must be followed. The flap must contain a large skin paddle to ensure flap autonomization and to allow for complete tight plication of the flap between the two stages, which limits germ colonization. A short delay between the two stages (<12 days) decreases the risk of infection. The presence of a plastic surgeon during the second stage decreases the risk of pedicle trauma.
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Affiliation(s)
- C Jaloux
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Department of hand and limb reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - C Philandrianos
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - A Mayoly
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Department of hand and limb reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Q Bettex
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - M Abellan-Lopez
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - N Kachouh
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Department of hand and limb reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - R Legré
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Department of hand and limb reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - C Bergel
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - B Bertrand
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - D Casanova
- Department of plastic and reconstructive surgery, Conception university hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Medicine faculty, Aix-Marseille university, 27, boulevard Jean-Moulin, 13005 Marseille, France
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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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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lü C. [Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1305-1309. [PMID: 31544444 DOI: 10.7507/1002-1892.201903030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
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11
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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lü C. [Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:712-716. [PMID: 31197998 DOI: 10.7507/1002-1892.201901005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection. Methods Between September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly. Results All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites. Conclusion Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
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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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13
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Spera LJ, Danforth RM, Hadad I. Incisions and reconstruction approaches for large sarcomas. Transl Gastroenterol Hepatol 2018; 3:86. [PMID: 30505973 DOI: 10.21037/tgh.2018.10.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/19/2018] [Indexed: 01/02/2023] Open
Abstract
Large intraabdominal, retroperitoneal, and abdominal wall sarcomas provide unique challenges in treatment due to their variable histology, potential considerable size at the time of diagnosis, and the ability to invade into critical structures. Historically, some of these tumors were considered inoperable if surgical access was limited or the consequential defect was unable to be closed primarily as reconstructive options were limited. Over time, there has been a greater understanding of the abdominal wall anatomy and mechanics, which has resulted in the development of new techniques to allow for sound oncologic resections and viable, durable options for abdominal wall reconstruction. Currently, intra-operative positioning and employment of a variety of abdominal and posterior trunk incisions have made more intraabdominal and retroperitoneal tumors accessible. Primary involvement or direct invasion of tumor into the abdominal wall is no longer prohibitive as utilization of advanced hernia repair techniques along with the application of vascularized tissue transfer have been shown to have the ability to repair large area defects involving multiple quadrants of the abdominal wall. Both local and distant free tissue transfer may be incorporated, depending on the size and location of the area needing reconstruction and what residual structures are remaining surrounding the resection bed. There is an emphasis on selecting the techniques that will be associated with the least amount of morbidity yet will restore and provide the appropriate structure and function necessary for the trunk. This review article summarizes both initial surgical incisional planning for the oncologic resection and a variety of repair options for the abdominal wall spanning the reconstructive ladder.
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Affiliation(s)
- Leigh J Spera
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel M Danforth
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ivan Hadad
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Senghaas A, Kremer T, Schmidt VJ, Harhaus L, Hirche C, Kneser U, Bigdeli AK. Sliding free transverse rectus abdominis myocutaneous flap for closure of a massive abdominal wall defect: A case report. Microsurgery 2018; 39:174-177. [PMID: 29451331 DOI: 10.1002/micr.30309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/25/2017] [Accepted: 02/02/2018] [Indexed: 11/11/2022]
Abstract
Despite considerable advances in reconstructive surgery, massive abdominal wall defects continue to pose a significant surgical challenge. We report the case of a 72-year-old morbidly obese female patient with Clostridium septicum-related gas gangrene of the abdominal wall. After multidisciplinary treatment and multiple extensive debridements, a massive full-thickness defect (40 cm × 35 cm) of the right abdominal wall was present. The abdominal contents were covered with a resorbable mesh to prevent evisceration. Finally, the composite defect was successfully reconstructed through a contralateral extended free transverse rectus abdominis myocutaneus (TRAM) flap (50 cm × 38 cm). An arterio-venous loop to the superficial femoral vessels using the great saphenous vein was necessary to allow the flap to reach the defect. Postoperatively, a minor wound healing disorder of the flap was successfully treated with split skin grafting. Six month after surgery, the patient presented with a completely healed flap coverage area and a small abdominal hernia without the need of further surgical revision. This case illustrates the use of a sliding free TRAM flap for closure of a massive abdominal wall defect.
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Affiliation(s)
- Annika Senghaas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Kremer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Volker J Schmidt
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
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15
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Kim DY, Lee J, Kim JT, Chang HK, Moon SH. Reconstruction of a large full-thickness abdominal wall defect with flow-through-based alt flaps: A case report. Microsurgery 2017; 39:85-90. [DOI: 10.1002/micr.30281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/12/2017] [Accepted: 11/29/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Dong Yeon Kim
- Department of Plastic and Reconstructive Surgery; Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul Korea
| | - Junho Lee
- Department of Plastic and Reconstructive Surgery; Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery; Hanyang University College of Medicine; Seoul Korea
| | - Hye Kyung Chang
- Department of Pediatric Surgery; Kyung Hee University Hospital, Kyung Hee University College of Medicine; Seoul Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery; Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul Korea
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Zhang PH, Liu Z, Ren LC, Zeng JZ, Huang GW, Xiao MZ, Zhou J, Liang PF, Zhang MH, Huang XY. Early laparotomy and timely reconstruction for patients with abdominal electrical injury: Five Case Reports and Literature Review. Medicine (Baltimore) 2017; 96:e7437. [PMID: 28723751 PMCID: PMC5521891 DOI: 10.1097/md.0000000000007437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
| | - Zan Liu
- Department of Burns and Reconstructive Surgery
| | | | | | | | | | - Jie Zhou
- Department of Burns and Reconstructive Surgery
| | | | | | - Xiao-Yuan Huang
- Institute of Burn Research, Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
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Recipient vessels for microsurgical flaps to the abdomen: A systematic review. Microsurgery 2017; 37:707-716. [DOI: 10.1002/micr.30159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/13/2016] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
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