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Patient Reported Outcomes In Complex Abdominal Wall Reconstruction Using Microsurgical Flaps
Aliotta RE, Krpata D, Rosen MJ, Gurunluoglu R.
Cleveland Clinic Plastic Surgery Integrated program
2017-01-17
Presenter: Aliotta, Rachel
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, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Microsurgical flaps are required when a pedicled flap is inadequate in size to provide soft tissue coverage for significant abdominal wall defects. Patient reported outcomes were analyzed using a newly validated 12-question hernia-related quality of life survey (HerQles) to assess abdominal wall function after complex abdominal wall reconstruction (AWR) using mesh/biologics and microsurgical flaps. Patient demographics: 10 consecutive patients, age 34-78 years, mean: 56.4; Female 3, Male 7; BMI 28.0-36.1, mean: 27.35; skin defect area 300-750 cm2, mean: 548 cm2. There were 5 latissimus dorsi, 4 anterolateral thigh, and one combined anterolateral and vastus lateralis flap(s). Inferior epigastric vessels were used as recipient in 8 patients, and 2 patients required an AV loop. Eight patients received concomitant synthetic mesh and posterior components separation with transverse abdominis release, one received anterior components separation and biologic mesh. One patient underwent mesh removal due to infection and had a microsurgical flap only. All flaps survived. Minor wound healing complications occurred in two patients. No new hernia was noted during the follow-up period (average 15.2 months, range: 9-36 mo). Preoperative HerQles score range: 16-33, mean: 22.2, and postoperative HerQles score range: 38-75, mean: 57.9. Baseline HerQles scores were significant compared to those obtained post-operatively with >9 months follow up (p<0.01). Microsurgical flap reconstruction remains a valuable tool for complex AWR with or without mesh repair. In this study the HerQles tool demonstrated significant improvements in various aspects of activities of daily living and patient reported pain in patients undergoing complex AWR with microsurgical flaps.
