Rectus abdominis flap for the treatment of lumbosacral coverage defects.

Authors

DOI:

https://doi.org/10.15417/issn.1852-7434.2018.83.2.785

Keywords:

Rectus abdominis, flap, reconstructive surgery.

Abstract

Introduction: Treatment of soft tissue lumbosacral defects is based on dead space management and defect coverage. The aim of this study is to describe the surgical technique, results and complications of patients who underwent rectus abdominis flap for lumbosacral defects coverage.

Methods: A six-year retrospective review was performed. Demographic characteristics are analyzed. Surgical technique and intra-operative complications are described. Postoperative variables, such as donor site complications, recipient site complications, and flap survival were also reported.

 Results: Five patients met the inclusion criteria (average age, 50 years). Four patients presented sacral tumor diagnosis and one patient had lumbosacral osteomyelitis. Mean follow-up was 20 months. Flap average size was 8 x 13 cm. Intraoperative complications were one pedicle injury (microsurgical repair) and the death of a patient. Regarding postoperative complications, one wound dehiscence was reported. None of the flaps suffered vascular complications and all remained vital throughout follow-up.

Conclusion: Rectus abdominis flap should be considered a valid option in the management of large soft tissue lumbosacral defects. This flap provides sufficient skin volume and muscular tissue. Surgical technique is relatively simple with no need for microsurgical procedure.

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Author Biographies

  • Franco L. De Cicco, Hospital Italiano de Buenos Aires
    Sector de Cirugía de Mano y Miembro Superior. Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi". Hospital Italiano de Buenos Aires.
  • Mariano O. Abrego, Hospital Italiano de Buenos Aires
    Sector de Cirugía de Mano y Miembro Superior. Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi".Hospital Italiano de Buenos Aires.
  • Gerardo L. Gallucci, Hospital Italiano de Buenos Aires
    Sector de Cirugía de Mano y Miembro Superior. Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi". Hospital Italiano de Buenos Aires.
  • Pablo De Carli, Hospital Italiano de Buenos Aires
    Sector de Cirugía de Mano y Miembro Superior. Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi". Hospital Italiano de Buenos Aires.
  • Jorge G. Boretto, Hospital Italiano de Buenos Aires

    Médico de Planta. Sector de Cirugía de Mano y Miembro Superior. Instituto de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi". Hospital Italiano de Buenos Aires.

References

Miles WK, Chang DW, Kroll SS, Miller MJ, Langstein HN, Reece GP, et al. Reconstruction of large sacral defects following total sacrectomy. Plast Reconstr Surg 2000;105(7):2387-94. DOI: https://doi.org/10.1097/00006534-200006000-00012

Maricevich M, Maricevich R, Chim H, Moran SL, Rose PS, Mardini S. Reconstruction following partial and total sacrectomy defects: an analysis of outcomes and complications. J Plast Reconstr Aesthet Surg 2014;67(9):1257-66. DOI: https://doi.org/10.1016/j.bjps.2014.05.001

Holmström H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 1979;13(3):423-7. DOI: https://doi.org/10.3109/02844317909013092

Vaccarezza H. Reconstrucción perineal con colgajo de recto anterior por cáncer de ano localmente avanzado. Una opción para el cirujano colorrectal. Rev Argent Cirug 2016;108(4):208-12.

Chirappapha P, Trikunagonvong N, Prapruttam D, Rongthong S, Lertsithichai P, Sukarayothin T, et al. Donor-site complications and remnant of rectus abdominis muscle status after transverse rectus abdominis myocutaneous flap reconstruction. Plast Reconstr Surg Glob Open 2017;5(6):e1387. DOI: https://doi.org/10.1097/GOX.0000000000001387

Glatt BS, Disa JJ, Mehrara BJ, Pusic AL, Boland P, Cordeiro PG. Reconstruction of extensive partial or total sacrectomy defects with a transabdominal vertical rectus abdominis myocutaneous flap. Ann Plast Surg 2006;56:526-30; discussion 530-1. DOI: https://doi.org/10.1097/01.sap.0000205772.15061.39

Brandi CD, Roche S, Bertone S, Fratantoni ME. No enterocutaneous fistula development in a cohort of 695 patients after incisional hernia repair using intraperitoneal uncoated polypropylene mesh. Hernia 2017;21(1):101-6. DOI: https://doi.org/10.1007/s10029-016-1530-6

Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981;67(2):177-87. DOI: https://doi.org/10.1097/00006534-198167020-00007

Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland JP. The surgical management of sacral chordomas. Spine (Phila Pa 1976) 2009;34(24):2700-4. DOI: https://doi.org/10.1097/BRS.0b013e3181bad11d

Cheong YW, Sulaiman WA, Halim AS. Reconstruction of large sacral defects following tumour resection: a report of two cases. J Orthop Surg 2008;16(3):351-4. DOI: https://doi.org/10.1177/230949900801600317

Petrie N, Branagan G, McGuiness C, McGee S, Fuller C, Chave H. Reconstruction of the perineum following anorectal cancer excision. Int J Colorectal Dis 2009;24:97-104. DOI: https://doi.org/10.1007/s00384-008-0557-2

Nahabedian MY, Dooley W, Singh N, Manson PN. Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg 2002;109:91-101. DOI: https://doi.org/10.1097/00006534-200201000-00016

Kuntscher MV, Mansouri S, Noack N, Hartmann B. Versatility of vertical rectus abdominis musculocutaneous flaps. Microsurgery 2006;26:363-9. DOI: https://doi.org/10.1002/micr.20253

Edsander-Nord A, Jurell G, Wickman M. Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study. Plast Reconstr Surg 1998;102:1508-16. DOI: https://doi.org/10.1097/00006534-199810000-00025

Kim JE, Pang J, Christensen JM, Coon D, Zadnik PL, Wolinsky JP, et al. Soft-tissue reconstruction after total en bloc sacrectomy. J Neurosurg Spine 2015;22(6):571-81. DOI: https://doi.org/10.3171/2014.10.SPINE14114

Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy. Dis Colon Rectum 1998;41:1488-1493. DOI: https://doi.org/10.1007/BF02237294

Weiwei L, Zhifei L, Ang Z, Lin Z, Dan L, Qun Q. Vaginal reconstruction with the muscle-sparing vertical rectus abdominus myocutaneous flap. J Plast Reconstr Aesthet Surg 2009;62:335-40. DOI: https://doi.org/10.1016/j.bjps.2008.06.040

Petit JY, Rietjens M, Ferreira MA, Montrucoli D, Lifrange E, Martinelli P. Abdominal sequelae after pedicled TRAM flap breast reconstruction. Plast Reconstr Surg 1997;99:723-9. DOI: https://doi.org/10.1097/00006534-199703000-00019

Published

2018-05-11

Issue

Section

Clinical Research

How to Cite

Rectus abdominis flap for the treatment of lumbosacral coverage defects. (2018). Revista de la Asociación Argentina de Ortopedia Y Traumatología, 83(2), 76-84. https://doi.org/10.15417/issn.1852-7434.2018.83.2.785