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Pregnancy after STSG Abdominal Wall Reconstruction
Wendy Chen, MD, MS; Irene T Ma, MD; Omar Beidas, MD; Hyagriv Simhan, MD; Gisele Hamad, MD; Jeffrey A. Gusenoff, MD
University of Pittsburgh
2018-02-03
Presenter: Wendy Chen
Affidavit:
The abstract was written by the first author and the additional authors were those involved in patient care.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Abdominal wall defects can be challenging to reconstruct. In certain circumstances the reconstructive surgeon may resort to split thickness skin grafting. We report an unusual case of a patient with prior split thickness skin graft (STSG) abdominal wall reconstruction and its impact on pregnancy.
Case Description: A 41-year-old female presented from an outside hospital after a laparoscopic converted to open cholecystectomy with common bile duct exploration. Her post-operative course was complicated by a bile leak with subsequent duodenal and pancreatic fistulas, as well as retroperitoneal abscesses. She eventually required duodenal exclusion and gastrojejunostomy creation, and underwent multiple abdominal explorations that ultimately left her with an open abdomen that was covered with a STSG.
Five years later, she presented with an intra-uterine pregnancy after in vitro fertilization. At 26 weeks of gestation, the patient had developed some ulcerations of the skin graft overlying her bowel. This progressed to full thickness ulceration by 32 weeks of gestation with exposure of the uterus. At this time, the patient was hospitalized and subsequently underwent a C-section at 37 weeks with delivery of a healthy infant.
Discussion: Few cases have been published about pregnancy in the setting of prior abdominal wall reconstruction using a skin graft. Reconstructive surgeons need to be aware that the natural pregnancy course can occur; however, potential complications need to be closely monitored to minimize the risk to mother and baby.
