Pedicled omental and split skin graft in the reconstruction of the anterior abdominal wall

Manay, Priyadarshini; Khajanchi, Monty; Prajapati, Ram; Satoskar, R. S.

doi:10.1016/j.ijscr.2013.12.027

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…It is this buttress that forms the third layer (Figure 4) of our reconstruction, and differentiates the omental flap-mesh placement ± primary closure or closure using component separation (a technique already mentioned in literature), from our technique of reconstruction. 4,5 The overlying skin and subcutaneous may either be closed primarily or with the help of a rotation flap (Figure 7).…”

Section: Operative Details Of Our Techniquementioning

confidence: 99%

Reconstruction following full-thickness excision of abdominal wall tumors: A prospective observational study conducted in a tertiary care Government Hospital in Eastern India

Chaturvedi¹,

Chejara²,

Mukherjee³

et al. 2023

Asian J Med Sci

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Background: Reconstruction of abdominal wall defects following full-thickness excision of large tumors (primary or metastatic) has always been a challenge for the treating surgeon. A number of reconstructive techniques have been described in the literature, including different types of meshes, flaps, and component separation techniques (anterior and amp; posterior), with varying results. We conducted a prospective observational study of our three-layer technique of abdominal wall closure at Medical College Hospital, Kolkata, to assess the long-time success of the procedure, especially in terms of hernia rates. Aims and Objectives: Reconstruction of abdominal wall defects following full-thickness excision of large tumors (primary or metastatic) has challenged surgeons for long, with several reconstructive techniques being described, with varying results. We conducted a prospective observational study of our three-layer technique of abdominal wall closure at Medical College Hospital, Kolkata, to assess the long-time success of our procedure, especially in terms of hernia rates. Materials and Methods: Thirteen patients with abdominal wall primary and isolated metastatic tumors were included from January 2017 to January 2022 with follow-up period from 8 to 60 months. Tumors were dermatofibrosarcoma protuberans, sarcomas, desmoid tumors, and two abdominal wall metastases. All patients in our study underwent computed tomography scan, core needle biopsy, and immunohistochemistry for better surgical planning. Results: Eight patients were male and five were female with mean age of 39 years and mean defect size of 10 cm. Polypropylene mesh was used, size varying from 15×15 to 30×30 cm with average operative time of 210 min. Post-operative superficial wound infection in 2 (15%), partial flap necrosis in 1 (7.6%), and tumor recurrence in one patient (7.6%) were seen. Conclusion: For closure of such large abdominal wall defects, our three-layer reconstructive technique has shown good results in terms of zero hernia rates. We recommend our method of closure, where affordability of biological meshes, availability of expensive meshes, accessibility to plastic and reconstructive surgeons or non-acquaintance with complex closure techniques are present.

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Section: Operative Details Of Our Techniquementioning

confidence: 99%

Reconstruction following full-thickness excision of abdominal wall tumors: A prospective observational study conducted in a tertiary care Government Hospital in Eastern India

Chaturvedi¹,

Chejara²,

Mukherjee³

et al. 2023

Asian J Med Sci

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“…They can be designed as a fasciocutaneous, myocutaneous or muscle-only flaps, depending on the defect requirements. Options for reconstruction of the abdominal wall with a regional flap include use of the external oblique muscle [7] , tensor fascia lata myocutaneous (TFL) [8,9] , rectus abdominis myocutaneous, rectus femoris myocutaneous [10] , anterolateral thighfasciocutaneous (ALT) with or without a portion of vastus lateralis muscle [11] , latissimus dorsi muscle or myocutaneous and omental flaps [12] . Each flap has associated advantages and disadvantages which must be taken into consideration when designing the reconstruction [ Table 1].…”

Section: Regional Flap Optionsmentioning

confidence: 99%

“…Descending branch of lateral femoral circumflex artery Myocutaneous Donor site morbidity and limited terminal knee extension Omentum [12] Omentum Entire abdominal wall Right or left gastroepiploic arteries Fat, connective tissue and lymphatics…”

Section: Myocutaneousmentioning

confidence: 99%

Flap reconstruction of the abdominal wall

Patel¹,

Mericli²,

Kapur³

et al. 2020

Plast Aesthet Res

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Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.

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“…Reports of using the omentum alone to cover the abdominal wall defect and then either skin grafting or mobilizing local fasciocutaneous flaps for coverage have been made, but this leaves a hernia defect and inherent risk of evisceration (25). More commonly, the omentum is used along with a synthetic mesh and can be used as coverage alone or as a sandwich technique that splits the omentum and provides peritoneal lining in addition to external coverage of the prosthetic that can then be skin grafted (26,27). Omental flaps build upon a simple bridging mesh and preserve other reconstructive options if needed in the future.…”

Section: Vascularized Tissue Transfer Techniquesmentioning

confidence: 99%

Incisions and reconstruction approaches for large sarcomas

Spera

Danforth

Hadad

2018

Transl. Gastroenterol. Hepatol

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Large intraabdominal, retroperitoneal, and abdominal wall sarcomas provide unique challenges in treatment due to their variable histology, potential considerable size at the time of diagnosis, and the ability to invade into critical structures. Historically, some of these tumors were considered inoperable if surgical access was limited or the consequential defect was unable to be closed primarily as reconstructive options were limited. Over time, there has been a greater understanding of the abdominal wall anatomy and mechanics, which has resulted in the development of new techniques to allow for sound oncologic resections and viable, durable options for abdominal wall reconstruction. Currently, intra-operative positioning and employment of a variety of abdominal and posterior trunk incisions have made more intraabdominal and retroperitoneal tumors accessible. Primary involvement or direct invasion of tumor into the abdominal wall is no longer prohibitive as utilization of advanced hernia repair techniques along with the application of vascularized tissue transfer have been shown to have the ability to repair large area defects involving multiple quadrants of the abdominal wall. Both local and distant free tissue transfer may be incorporated, depending on the size and location of the area needing reconstruction and what residual structures are remaining surrounding the resection bed. There is an emphasis on selecting the techniques that will be associated with the least amount of morbidity yet will restore and provide the appropriate structure and function necessary for the trunk. This review article summarizes both initial surgical incisional planning for the oncologic resection and a variety of repair options for the abdominal wall spanning the reconstructive ladder.

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Pedicled omental and split skin graft in the reconstruction of the anterior abdominal wall

Abstract: The POSSG can be used in reconstruction of abdominal wall defects of any size by general surgeons.

Cited by 6 publications

References 8 publications

Reconstruction following full-thickness excision of abdominal wall tumors: A prospective observational study conducted in a tertiary care Government Hospital in Eastern India

Reconstruction following full-thickness excision of abdominal wall tumors: A prospective observational study conducted in a tertiary care Government Hospital in Eastern India

Flap reconstruction of the abdominal wall

Incisions and reconstruction approaches for large sarcomas

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