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Abdominal Wall Reconstruction With Free Flaps; An Alternate Approach To An Increasingly Common Problem
Lamaris GA, Durand P, Couto RA, Gurunluoglu R, Gastman R
University program
2016-02-15
Presenter: Lamaris GA
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Ventral incisional hernias represent a common surgical challenge. Despite recent advancements in techniques and the development of synthetic and biologic materials, hernia recurrence rates remain high. Fascial defects lacking adequate overlying soft tissue represent the most complex cases, frequently requiring local or remote flaps for reconstruction.
Method
We performed a retrospective review of all the cases of recalcitrant ventral incisional hernias that were managed using free tissue transfer over the last 5 years. We included patients that were treated with a free muscular/musculocutaneous flap containing vascularized fascia. In all cases we collected information regarding patient demographics, previous attempts at hernia repair, type of flap used as well as outcome.
Results
A total of 7 patients were identified. All patients had an average of five or more prior abdominal operations or attempts at hernia repair. Five patients were treated with an anterolateral thigh flap with vascularized fascia lata used to bridge the fascial defect. Two patients were treated with a free latissimus dorsi muscle flap over a biologic interposition mesh. In all cases, the inferior epigastric artery and vein were appropriate for use as recipient vessels. Albeit minor wound complications, all patients achieved excellent long-term outcomes with no recurrences more than a year post operatively.
Conclusion
Herein we propose an alternate approach to abdominal wall reconstruction in the setting of recurrent ventral incisional hernias. Free flaps provide healthy, well-vascularized, autologous tissue that can restore abdominal wall contour and cover full-thickness defects in a single stage.
