Poster
# 113
Poster |
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6th Internet World Congress for Biomedical Sciences |
Mª Jesús Martínez González(1), Alejandro Nogueira(2), Olatz Alcelay(3), Francisco Iglesias(4)
(1)(2)(3)(4)Hospital Central de Asturias - OVIEDO. Spain
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[Plastic Surgery] |
Abdominal structures contention after wide oncologic resection demands autologous, aloplastic or both reconstructions.
We present the case of a 40 year-old woman suffering a grade II malignant fibrohistyocitoma in her left abdominal wall, recurrent after 5 local resections. The surgery and evolution will be discussed (1).
The defect, extending from ribs to costal bone under which peritoneum is exposed, is oblitered with homolateral latissimus dorsi microvascularized flap After this, the patient comes up with another recurrence and surgery now leaves a full thickness abdominal wall defect. We employed a PTFE mesh as a support under contralateral latissimus dorsi free flap. The flap failed.
At this time, over PTFE mesh is employed a large pedicled omental flap based on the left gastroepiploic artery ( the larger and more pulsatile right gastroepiploic artery was discarded for previous colecistectomy) and covered with split-thickness meshed grafts.
Figure 1: Full thickness abdominal wall defect extending from 7th rib to iliac bone and crossing midline. PTFE mesh over peritoneum exposed. Harvesting of omental flap for reconstruction.
Figure 2: The pedicle of the flap exits the abdomen through a small hole in PTFE mesh.(1),(2).
Figure 3: Pivot point through abdominal wall opening. This is the only potential weakness point.
Figure 4: Flap over PTFE mesh. It´s a large and highly vascularized flap to accept split thickness meshed grafts.
Figure 5: Aspect of abdominal wall 6 months later. It offers great resistence and support. The skin grafts took completely.
Figure 6: Anterior view.
Figure 7: Lateral view. No herniations for abdominal wall weakness.
The flap was planned when others techniques had failed or were discarded. In this case 5 local resections and 2 microvascularized flaps had been used and few possibilities were left.
Post-op radiotherapy was well tolerated.
One year later the patient wears an excellent functional result without abdominal wall ruptures or recidives ( 2).
Omental flap offers an excellent method for wide abdominal reconstruction due to:
- Great vascularity, large size and low morbidity.
- Good functional result without abdominal wall weakness.
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[Plastic Surgery] |
