Reconstruction of complex abdominal wall defects with pedicled anterolateral thigh flap

Öz

Introduction: Traumatic abdominal injuries, surgical wound dehiscence, oncologic resections, transplant related complications or abdominal sepsis related visceral edema and abdominal compartment syndrome can cause enormous abdominal defects Abdominal defects are treated differently according to etiology and chronicity, size and thickness of the defect. ALT flap can be used pedicled or as a free flap for abdominal defect reconstruction. Material and methods: Medical records of 8 patients who underwent pedicled ALT flap reconstruction of abdominal defects between August 2019 and November 2020 were retrospectively reviewed Demographic data, flap size, perforator number, complications, hospital stay, use of alloplastic mesh for fascia repair were recorded. Results: 50% of patients received only 1 reconstructive operations while other 50% received more than one (min:2, max:4) operations. Total flap loss was seen at 12.5%. 25% of patients were lost due to non-flap related complications. Mean (min/max) hospital stay was 33,1 (12/90) days. Conclusion: The pedicled ALT flap is a reliable and reproducible flap for reconstruction of abdominal defects without need for microsurgical vessel anastomosis. It has low donor and recipient site morbidity and potential complications can be easily managed with minor secondary operations.

Anahtar Kelimeler

• anterolateral thigh flap
• abdominal defect
• reconctruction

Kompleks Abdominal Duvar Defektlerinin Pediküllü Anterolateral Uyluk Flebi ile Onarımı

Öz

Giriş: Abdominal defektler etiyolojilerine göre travmatik batın yaralanmaları, cerrahi bölgelerde sütür ayrışmaları, onkolojik rezeksiyonlar, transplant cerrahi sonrası komplikasyonlar veya abdominal kompartman sendromu gibi nedenlerle oluşmaktadır. Abdominal defektler, defektin etiyolojisine ve kronikliğine, boyutuna ve kalınlığına göre farklı şekilde tedavi edilir. ALT flebi abdominal defekt rekonstrüksiyonu hem pediküllü hem serbest flep olarak kullanılabilir. Gereç ve yöntemler: Ağustos 2019 ve Kasım 2020 tarihleri arasında pediküllü ALT flebi ile abdominal defekt rekonstrüksiyonu yapılan 8 hastanın tıbbi kayıtları retrospektif olarak incelendi. Demografik veriler, flep boyutu, perforatör sayısı, komplikasyonlar, hastanede kalış süresi, fasya onarımı için alloplastik meş kullanımı kaydedildi. Bulgular: Hastaların %50'si sadece bir tane rekonstrüktif ameliyat geçirirken, diğer %50'si birden fazla (min:2, maks:4) operasyon geçirdi. Total flep kaybı %12.5 olarak görüldü. Hastaların %25'i flep dışı komplikasyonlar nedeniyle kaybedildi. Ortalama (min/maks) hastanede kalış süresi 33,1 (12/90) gündü. Sonuç: Pediküllü ALT flebi, mikrocerrahi damar anastomozuna ihtiyaç duyulmadan abdominal defektlerin rekonstrüksiyonu için kullanılabilecek güvenilir ve tekrarlanabilir bir fleptir. Verici ve alıcı bölge morbiditesi düşüktür ve olası komplikasyonlar küçük ikincil operasyonlarla kolayca yönetilebilir.

Anahtar Kelimeler

• antrolateral uyluk flebi
• abdominal defekt
• onarım

Kaynakça

1. 1.Alvarez PS, Betancourt AS, Fernández LG. Negative pressure wound ther¬apy with instillation in the septic open abdomen utilizing a modified nega¬tive pressure therapy system. Ann Med Surg (Lond). 2018; 36: 246-51. https://doi.org/10.1016/j.amsu.2018.10.007
2. 2.Stone HH, Fabian TC, Turkleson ML, et al. Management of acute full-thick¬ness losses of the abdominal wall. Ann Surg. 1981; 193(5): 612-8. https://doi.org/10.1097/00000658-198105000-00011
3. 3.Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018; 13:7. https://doi.org/10.1186/s13017-018-0167-4
4. 4.Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984; 37(2): 149-59. https://doi.org.10.1016/0007-1226(84)90002-x.
5. 5.Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002; 109(7): 2219-30. https://doi.org/10.1097/00006534-200206000-00007
6. 6.Perrault D, Kin C, Wan DC, et al. Pelvic/perineal reconstruction: time to consider the anterolateral thigh flap as a first-line option? Plast Reconstr Surg Glob Open. 2020; 8(4):e2733. https://doi.org/10.1097/GOX.0000000000002733
7. 7.Rohrich RJ, Lowe JB, Hackney FL et al. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg. 2000; 105(1): 202-7. https://doi.org/10.1097/00006534-200001000-00036
8. 8.Iida T, Mihara M, Narushima, et al. Dynamic reconstruction of full-thick¬ness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap. Ann Plast Surg. 2013; 70(3): 331-4. https://doi.org/10.1097/SAP.0b013e3182321b64

9. 9.Kim DY, Lee J, Kim JT, et al. Reconstruction of a large full-thickness ab-dominal wall defect with flow-through-based alt flaps: A case report. Mi-crosurgery. 2019; 39(1): 85-90. https://doi.org/10.1002/micr.30281
10. 10.Wong CH, Lin CH, Fu B, et al. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg. 2009; 124(2): 500-9. https://doi.org/10.1097/PRS.0b013e3181addb11
11. 11.Neligan PC, Lannon DA. Versatility of the pedicled anterolateral thigh flap. Clin Plast Surg. 2010; 37(4): 677-81. https://doi.org/10.1016/j.cps.2010.07.001