Reconstruction of the Abdominal Wall after Oncologic Resection: Defect Classification and Management Strategies

Mericli, Alexander F.; Baumann, Donald P.; Butler, Charles E.

doi:10.1097/prs.0000000000004877

Cited by 39 publications

(33 citation statements)

References 42 publications

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“…In many cases an arteriovenous vein loop is created by anastomosing the saphenous vein to the superficial femoral artery and then transferred to the abdomen to serve as a useful recipient. Healthy soft tissue coverage reduces risk of infection, helps reduce the effect of radiation, increases likelihood of mesh integration and therefore contributes to lower incidence of soft tissue complications and hernia recurrence [47,50].…”

Section: Soft Tissue Coverage Optionsmentioning

confidence: 99%

Refinements and Advancements in Anterior Component Separation

Kapur¹,

Butler²

2019

Hernia Surgery [Working Title]

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This chapter will explore the newest innovations for performing anterior component separation (CS). It will include open CS, perforator sparing CS and minimally invasive component separation (MICS). It will also address the use of various meshes and their plane of inset. It will cover soft tissue management including panniculectomy, quilting sutures and drains. Fascial closure techniques will also be included. The highlight of this chapter will be the description of tips and tricks of performing MICS. We will also touch upon preoperative preparation such as body mass index (BMI) optimization and smoking cessation as well as management of postoperative complications including surgical site infections, skin necrosis and seroma.

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Section: Soft Tissue Coverage Optionsmentioning

confidence: 99%

Refinements and Advancements in Anterior Component Separation

Kapur¹,

Butler²

2019

Hernia Surgery [Working Title]

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“…They divide the abdominal wall into 4 surface area types: type I is located within the 2 semilunar lines in the midcentral abdomen; type II is lateral to the semilunar lines; type III is cephalad to type I to the xiphoid process; and type IV is caudal to type I from the arcuate line to the pubic symphysis. There are additionally 3 depth subtypes: type A is skin and subcutaneous tissue only; type B is musculofascial abdominal wall only; and type C is skin, subcutaneous tissue, and any component of the musculofascial abdominal wall (16).…”

Section: Full Thickness Abdominal Wall Reconstructionmentioning

confidence: 99%

“…Ideally, primary closure is performed if possible with or without component separation as utilized in traditional hernia repairs and abdominal wall reconstruction. The goals of abdominal wall reconstruction are to provide stable soft tissue coverage, restore fascial integrity, prevent hernia, protect abdominal viscera, and restore function if possible (16)(17)(18). These are generally reinforced with a prosthetic mesh to minimize risk of future hernia formation.…”

Section: Primary Closure 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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“…Especially, in cases with abdominal wall defects related to oncologic treatment sequelae, presence of colostomy, and previous abdominal operation and accompanying chronic inflammation could make the reconstruction more difficult. Historically, many options have been introduced and adopted for abdominal soft tissue reconstructions, including external oblique muscle flap, groin flap, tensor fascia lata flaps, and even free flaps from remote places (Mericli, Baumann, & Butler, 2018;Vijayasekaran et al, 2017;Zelken et al, 2016). Among them, a pedicled anterolateral thigh (ALT) flap has served as a valuable option because of its distinct advantages including reliable flap perfusion, ease of harvest, sufficient length of pedicle, and minimal donor site morbidity (Mericli et al, 2018;Vijayasekaran et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Abdominal wall reconstruction using anterolateral thigh flap with microsurgical pedicle lengthening technique: A case report

Kim

Lee

2020

Microsurgery

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Pedicled anterolateral thigh (ALT) flap has been employed for coverage of low abdominal wall defects. However, its use is limited for defects located more on the cranial side because of insufficient pedicle length. We present a case of successful reconstruction of mid‐abdominal wall defect using pedicled ALT flap, overcoming the issue of pedicle length shortage with a microsurgical pedicle lengthening technique. A 75‐year‐old man suffered from a 12 × 8 cm full‐thickness soft tissue defect on his mid‐abdominal wall originated from colon anastomosis site leakage after ileostomy takedown surgery. A pedicled ALT flap was planned for the defect coverage. After we performed debridement to prepare the wound bed, a 14 × 8.5 cm sized ALT flap based on two lateral circumflex femoral artery (LCFA) perforators was elevated. During intramuscular dissection of perforators, we dissected the distal portion of the LCFA descending branch. After full dissection of the pedicle to source vessels, we attempted to transfer the flap, but still the flap had short pedicle. We transected the pedicle just distal to the bifurcating point and reconnected it to the distal end of the dissected descending LCFA branch with microsurgical anastomosis. We passed the flap through a subcutaneous tunnel and conducted smooth flap insetting without any tension on the lengthened pedicle. Postoperatively, the wound healed successfully without complications. The patient was discharged 2 weeks after surgery and followed up at postoperative 3 months without adverse events. A local ALT flap with pedicle lengthened might be a reliable option for reconstruction of supraumbilical abdominal defects.

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Reconstruction of the Abdominal Wall after Oncologic Resection: Defect Classification and Management Strategies

Cited by 39 publications

References 42 publications

Refinements and Advancements in Anterior Component Separation

Refinements and Advancements in Anterior Component Separation

Incisions and reconstruction approaches for large sarcomas

Abdominal wall reconstruction using anterolateral thigh flap with microsurgical pedicle lengthening technique: A case report

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