One-Stage Posttraumatic Bladder Reconstruction and Soft-Tissue Coverage of the Lower Abdomen or Perineum

Abstract

Mutilating injury on pelvis may be complicated by urinary bladder ruptures and soft-tissue avulsion of the lower abdominal wall or perineum. With retraction of the avulsed abdominal wall or perineum, as well as bladder tissue loss secondary to trauma or infection, direct closure the injured bladder often leads to excessive tension, resulting in ischemia and eventual failure of repair. The authors successfully managed 4 patients with such injuries using the pedicled vastus lateralis myocutaneous flap. No major complications occurred and intact bladders were confirmed with cystograms. Three (75%) of them were able to void normally within 1 year. It is concluded that the pedicled vastus lateralis myocutaneous flap is an ideal option for posttraumatic bladder reconstruction and soft-tissue coverage of the lower abdomen or perineum; whereas the undersurface of the muscle serves as a substitute for the missing bladder wall, the remaining part of the muscle, as well as the subcutaneous fat, provide sufficient bulk for dead space obliteration.

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps

“…VRAM flaps recruit tissue from abdominal domain that may already be compromised by the disease process. Finally, functional VL‐MC donor site morbidity, as for the VRAM, is well tolerated …”

Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

“…They concluded that it as an ideal option for post-traumatic bladder reconstruction and soft tissue coverage of the lower abdomen or perineum. [13]…”

Management of urogenital trauma

“…The military trauma surgeon must be aware and look for these injuries. Large muscle mayocutaneous flaps such as the vastus lateralis flap may be successfully used to simultaneously repair the bladder and provide tissue for coverage in devastating injuries involving the bladder and abdominal wall or perineum [23]. The special topic of bladder neck and prostatic injuries associated with pelvic fractures has been recently addressed in the urological literature [24 ] and will be reviewed in the following section concerning urethral trauma.…”