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Free Tissue Transfer and Transverse Abdominus Release with Mesh in Complex Abdominal Wall Reconstruction: Preliminary Report
Amir M. Ghaznavi, MD; Rafael A. Couto, MD; Todd A. Baker, MD; Paul Durand, MD; David Krpata, MD; Michael Rosen, MD ; Raffi Gurunluoglu, MD
Cleveland Clinic
2016-01-29
Presenter: Amir M. Ghaznavi
Affidavit:
agreed
Director Name: Risal Djohan
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Autologous tissue transfer is an option in a select group of patients with recalcitrant abdominal wall defects that have severe loss of domain. This reconstructive option allows for complete autologous coverage of alloplastic material when pedicle flaps are not an alternative.
Methods: From 2009-2015, nine patients with complex abdominal wall defects and severe loss of domain were retrospectively reviewed. Patient comorbidities and outcomes were recorded. Inclusion criteria included patients having undergone a transverse abdominus release with mesh, or at least three failed primary or pedicled flap closures. Flaps used included free anterolateral thigh myocutaneous flap and latissimus dorsi myocutaneous flaps.
Results: The mean defect size was 577 cm2 (300-900 cm2). Immediate reconstructions were performed in 67 % of the cases with the femoral artery or the deep inferior epigastric vessels. Thirty-three percent of the time a saphenous vein graft was used to form a temporary arteriovenous shunt when suitable vessels could not be located. Flap complications included pulmonary embolism, hematoma, infection, and venous congestion. All complications were resolved. There was one flap failure. The average length of hospitalization was 18.11 days (7-41 days). Latissimus dorsi based on thoracodorsal artery system was our preferred donor site. A large amount of soft tissue and long pedicle length are available, enabling single-stage autologous reconstruction of the entire anterior abdominal wall.
Conclusions: Free flaps offer the only option for these complex abdominal wall reconstructions. With these techniques, even the most challenging defects can be reconstructed completely with autologous tissue.
