How to Reconstruct an Upper Full-Thickness Abdomen Wall Defect in Austere Environment? Interests of the Pedicled Myofascial Latissimis Dorsi Flap

Abstract

Upper abdominal wall defects secondary to trauma are not amenable to immediate closure in most cases. After a primary coverage, the definitive reconstruction can be done at a later date, using prosthetic mesh or flap. The majority of these complex procedures is, however, not available in the austere environment. The authors report a clinical case of upper full-thickness defects of the abdominal wall secondary to an explosion in Afghanistan. The patient was managed by a French Forward Surgical Team. The defect was immediately reconstructed in a one-stage surgery using a pedicled myofascial latissimus dorsi flap with good functional results. The pedicled latissimus dorsi flap is commonly used for coverage of both extrathoracic and intrathoracic defects. It is, therefore, possible to extend the harvesting of the muscle to the thoracolumbar fascia and the posterior third of the iliac crest. It provides a very large flap to cover an upper full-thickness abdomen wall defect. The harvest technique is simple, short, and largely accessible to a general surgeon. It provides immediate and definitive closure with a short hospital stay, what is clearly adapted in austere environment.

Early laparotomy and timely reconstruction for patients with abdominal electrical injury

“…[24–25] Therefore, one-stage reconstruction with vascularized fascia has been proposed to overcome such disadvantages. [16,20,26] Five patients in our report underwent early flap transplantation with all flap survival, wound primary healing, no recent complications, and short hospitalization period.…”