Bilateral anterior abdominal bipedicle flap with permanent prosthesis for the massive abdominal skin-grafted hernia

Covering a large abdominal wall defect using bilateral anterolateral myocutaneous thigh flap: A case report

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A variety of methods for abdominal wall closure have been described.

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Closure of a defect by myocuteous thigh flap is a viable option.

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In this report, bilateral anterolateral myocutaneous thigh flaps has been discussed.

Introduction

Closure of the abdominal wall defect by myocuteous thigh flap is an option. The aim of this paper is to report a case of abdominal wall defect covered by bilateral anterolateral myocutaneous thigh flap.

Case report

A 45-year-old female presented with a large defect in the anterior abdominal wall. It was decided to cover the wound with bilateral anterolateral myocutaneous thigh flap as the defect was so large to be filled with a single flap. Under general anesthesia, a flap was elevated lateral to a line joining mid inguinal point to the lateral epicondyle, the flap was rotated under inguinal skin and sutured to the defect. The procedure was repeated for the contralateral side two weeks later.

Discussion

Lower abdominal wall defects can be reconstructed by the use of the combined technique of sublay technique, intraperitoneal mesh placement, pedicled great omentum flap and rotation skin graft, also tensor fascia lata has been proven to be a safe and versatile flap.

Conclusion

Bilateral anterolateral myocutaneous thigh flap is practical whenever indicated. It is best suited for covering of the lower abdominal defects.

Reconstruction of abdominal wall of a chronically infected postoperative wound with a rectus abdominis myofascial splitting flap

BACKGROUND

If a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect.

METHODS

From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction.

RESULTS

Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery.

CONCLUSIONS

Using a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

Closure of a contained open abdomen using a bipedicled myofascial oblique rectus abdominis flap technique

A contained open abdomen is commonly used during damage control laparotomy and consists of the temporary coverage of the abdomen for protection of the viscera and reduction of intra-abdominal pressure. Definitive closure of a contained open abdomen is technically difficult due to the inability to obtain primary fascial suture. The insertion of a prosthetic mesh can be complicated with enterocutaneous fistula, and other definitive closure techniques need several surgical procedures. We describe a low cost technique that allows definitive closure of large abdominal wall defects avoiding the risk of intestinal fistula.