Lumbar hernias are rare occurrences, with only 300 cases reported in the literature. We present a unique case of a superior lumbar hernia secondary to penetrating trauma to the right flank. We performed a herniorrhaphy using porcine mesh, and provided additional support by mobilizing the external oblique and latissimus dorsi into the defect. At follow up three months after repair, the patient was asymptomatic and exam revealed an intact lumbar abdominal wall with normal contour. Although literature displays a consensus on the need for lumbar hernia repair, specific repair techniques must be tailored to defect etiology, size, location, and contents.
Background
Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity.
Methods
A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed.
Results
A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm2. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11).
Conclusions
This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.
We present the robotic harvest of a pedicled omentum flap for reconstruction of a near-total anterior chest wall defect. The patient was a 68-year-old woman with recurrent secondary chest wall angiosarcoma after previous mastectomy and radiation therapy. She underwent neoadjuvant chemotherapy and radiation, followed by wide radical chest wall resection with a final defect size of 15×35 cm. A one-stage reconstruction was performed with an omentum flap harvested by robotic technique and split-thickness skin grafts from thigh donor sites. The patient healed with minimal complications. Our case supports more widespread application of robotics in plastic and reconstructive surgery.
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