Repair of a complex abdominal wall defect with anterolateral thigh flap: a good surgical alternative

Abstract

Introduction: Reconstruction of the abdominal wall with major defects usually represents a surgical challenge, especially in cases where the defects are recurrent and have a large size that avoids the use of adjacent tissues for an adequate closure. According to each region the abdomen topography is divided into three regions: upper, middle and lower. Several reconstructive alternatives have been described according to the affected area of the abdomen that include the separation of the muscularis aponeurotic components of the abdominal rectus sheath, the flap of the rectus abdominus muscle with or without cutaneous island, the flap dependent on the dorsal muscle and muscular or musculocutaneous thigh flaps to reconstruct the lower area of the abdomen which is called anterolateral thigh (ALT) flap. The ALT flap has become the best option for large recurrent defects in any of the thirds due to its great versatility. Case report: We present the case of a 50-year-old patient with an abdominal wall defect, loss of domain and exposure of prosthetic material. Patient had a surgical history of open cholecystectomy, necrosectomy due to acute pancreatitis with open abdomen management and attempted repair of the abdominal defect twice with mesh placement. The abdominal wall was reconstructed with an ALT free flap with a fascia lata component with anastomosis to superior epigastric vessels in a successful manner. Nowadays patient remains without evidence of recurrence of the hernia at 1 year follow-up. Discussion/conclusion: The aim of this paper is to illustrate the ALT flap with a fascia lata component anastomosed to the superior epigastric vessels as a good option to reconstruct complex defects of the upper third of the abdomen.

Toxina botulínica a em associação com curativo de pressão negativa no tratamento do abdome aberto agudo pós-operatório não intencional (evisceração)

“…23 Grandes defeitos da parede abdominal são geralmente um desafio cirúrgico, razão pela qual várias alternativas reconstrutivas foram descritas, incluindo separação de componentes, retalhos livres e retalhos pediculados com ou sem colocação de tela. 14,17,26 Há também outros procedimentos complementares, incluindo injeções de toxina botulínica A 17 e pneumoperitônio, no intuito de aumentar o volume da cavidade abdominal no pré-operatório. 16 Nielsen et al 7 demonstraram que especificamente, o defeito fascial horizontal acima de 15 cm pode ser difícil de manejar, pois o fechamento da linha média geralmente é difícil de obter, mesmo após procedimentos de liberação lateral e são técnicas complexas e não isentas de complicações.…”