scholarly journals Management of cavernous abdominal wall defects post radical cystectomy in adult exstrophy complex

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-226076
Author(s):  
Prashant Kumar ◽  
Rishi Nayyar ◽  
Amlesh Seth ◽  
Deepti Gupta
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Bladder Exstrophy ◽  
Rectus Muscle ◽  
Anterolateral Thigh Flap ◽  
Abdominal Wall Defects ◽  
Cloacal Exstrophy ◽  
Local Skin ◽  
Anterolateral Thigh ◽  
Total Reconstruction

The exstrophy–epispadias complex represents a spectrum of genitourinary malformations ranging from simple glanular epispadias to an overwhelming multisystem defect, cloacal exstrophy. Neonatal total reconstruction of bladder exstrophy–epispadias complex is the treatment of choice. An adult patient presenting with untreated exstrophy is very rare. Malignant transformation, commonly adenocarcinoma, in such cases is a known complication due to mucosal metaplasia of urothelium. Management in such cases necessitates a radical surgical procedure that often results in a massive defect in the anterior abdominal wall. Providing a cover for such defects is a challenging task for the reconstructive surgeon. Local skin flaps and wide mobilisation of the rectus muscle are the usually employed techniques for closure of such defects. However, these may be inadequate in extremely large defects such as those encountered in our patients. We, hereby, describe our technique of closure of the abdominal wall defect using a pedicled anterolateral thigh flap.

scholarly journals 1024 The Use of the Pedicled Anterolateral Thigh (ALT) Flap for the Reconstruction of Abdominal Wall Defects in High-Risk Patients: A Case Series and Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Newall ◽  
C Jones ◽  
W Ho ◽  
A Curnier
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Case Series ◽  
Anterolateral Thigh Flap ◽  
Abdominal Wall Defects ◽  
High Risk Patients ◽  
Anterolateral Thigh ◽  
Risk Patients

Abstract Introduction The pedicled anterolateral thigh (ALT) flap is considered as a suitable option in complex abdominal wall reconstruction. Its use as a reconstructive option is infrequent in the literature, and to date, there has been no systematic review evaluating its long-term outcomes. We report our experience with the pedicled anterolateral thigh flap for abdominal wall reconstruction in high-risk patients. Method A prospective database was created for patients with abdominal wall defects treated with pedicled ALT with extended fascia lata flaps between 2014 and 2017. Patient demographics, aetiology, size, location of defect and post-operative results were reviewed. Abdominal defects were classified into the following zones: 1A, upper midline; 1B, lower midline; 2, upper quadrant; 3, lower quadrant. A systematic review of the literature was conducted using PUBMED and EMBASE. Results 4 patients (mean age 59.5 years, range 50-65 years) underwent reconstruction with pedicled ALT flaps. 3 flaps developed partial necrosis secondary to infection; 1 flap required surgical debridement, and 2 were managed conservatively. There was one flap failure, due to avulsion of the pedicle during inset. At mean follow up of 2.75 years (range 1 to 4 years) 3 patients have clinical bulging or herniation. Conclusions Review of the literature demonstrated 52 patients from 17 case series or reports. The overall infection and partial flap loss rates were both 6%. There were no reported flap failures. Our study demonstrates that the pedicled anterolateral thigh flap is an effective flap option for the repair of large defects of the abdominal wall in high-risk patients.

scholarly journals Prenatal ultrasound diagnosis of anterior abdominal wall defects in sub Saharan Africa; simple but often missed

2021 ◽  
Vol 9 (8) ◽  
pp. 2252
Author(s):  
Andrew H. Shitta ◽  
Mercy W. Isichei ◽  
Ezekiel D. Dung ◽  
Solomon D. Peter ◽  
Michael B. Ode ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Abdominal Wall ◽  
Detection Rate ◽  
Anterior Abdominal Wall ◽  
Bladder Exstrophy ◽  
Prune Belly Syndrome ◽  
Abdominal Wall Defects ◽  
Cloacal Exstrophy ◽  
Pentalogy Of Cantrell ◽  
Prune Belly

Background: Congenital anterior abdominal wall defects (AAWD) is a spectrum of abdominal wall defects that includes omphalocele, gastroschisis, bladder exstrophy, cloacal exstrophy, prune belly syndrome and pentalogy of Cantrell. Early Prenatal diagnosis of AAWD provides opportunity for abnormal karyotypes screening and planned delivery in a specialized centre. Ultrasound can detect these defects during pregnancy. This study aims to evaluate the detection rate of AAWD during routine obstetric ultrasonography in our region.Methods: A retrospective study of all patients that presented with AAWD to our centre from January 2008 to July 2020. Data included patient’s age, sex, birth weight, diagnosis, resuscitation time, outcome, maternal age, parity and antenatal ultrasound scan (USS) records. Antenatal USS before 12 weeks only, were excluded. Data analysed using excel.Results: Of the 140 with AAWD, 84.29% had omphalocele, 10% gastroschisis, 2.14% prune belly syndrome and 0.71% each with bladder exstrophy, cloacal exstrophy and pentalogy of Cantrell. There were 123 booked pregnancies. Majority (112) had antenatal care elsewhere while 11 attended our Centre. Ultrasonography of 108 pregnancies scanned at12 weeks or beyond, had 4 confirmed prenatal diagnosis of AAWD. All done in our centre. Mean gestational age at diagnosis was 24weeks. Outcome was rupture1 (25%) and 25% mortality (prenatally diagnosed) and 51.92% mortality for patients with missed diagnosis.Conclusions: Our obstetric ultrasound detection rate of AAWD is very low. There is a need for improvement in training to improve perinatal care of these defects.

scholarly journals Reconstruction of Abdominal Wall Defects Using a Pedicled Anterolateral Thigh Flap including the Vastus Lateralis Muscle: A Report of Two Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Kiyoko Fukui ◽  
Masaki Fujioka ◽  
Satoko Ishiyama
Keyword(s):  
Abdominal Wall ◽  
Vastus Lateralis ◽  
Abdominal Wall Reconstruction ◽  
Rectus Abdominis ◽  
Anterolateral Thigh Flap ◽  
Vastus Lateralis Muscle ◽  
Abdominal Wall Defects ◽  
Full Thickness ◽  
Rectus Abdominis Muscle ◽  
Anterolateral Thigh

The purpose of abdominal wall reconstruction is to prevent hernias and protect the abdominal viscera. In cases involving full-thickness defects of the rectus abdominis muscle, the muscle layer should be repaired. We present 2 cases in which full-thickness lower rectus abdominis muscle defects were reconstructed using vastus lateralis-anterolateral thigh flaps. The pedicled vastus lateralis-anterolateral thigh flap provides skin, fascia, and muscle tissue. Furthermore, it has a long neurovascular pedicle and can reach up to the periumbilical area and cover large defects. We consider that this muscle flap is a good option for repairing full-thickness lower abdominal defects.

scholarly journals Reconstruction of full thickness abdominal wall defect following tumor resection: A case report

2014 ◽  
Vol 142 (5-6) ◽  
pp. 347-350 ◽  
Author(s):  
Predrag Kovacevic ◽  
Asen Velickov ◽  
Danilo Stojiljkovic ◽  
Aleksandra Velickov ◽  
Zoran Ceranic
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Tumor Resection ◽  
Fascia Lata ◽  
Abdominal Wall Defects ◽  
Skin Grafts ◽  
Full Thickness ◽  
Local Skin ◽  
Wall Defect ◽  
Fascia Lata Graft

Introduction. Reconstruction of a full thickness abdominal wall defect is a demanding procedure for general and also for plastic surgeons, requiring vigorous planning and reconstruction of three layers. Case Outline. We present a case of a 70-year-old patient with a huge abdominal wall tumor with 40 years evolution. Surgery was performed under general anesthesia. Full thickness abdominal defect appeared after the tumor resection. Reconstruction followed in the same act. The defect was reconstructed using a combination of techniques, including omental flap, fascia lata graft, local skin flaps and skin grafts. After surgery no major complications were noted, only a partial skin flap loss, which was repaired using partial thickness skin grafts. The final result was described by the patient as very good, without hernia formation. Conclusion. Omenthoplasty, abdominal wall reconstruction in combination with free fascia lata graft and skin grafts can be one of good options for the reconstruction of full thickness abdominal wall defects.

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