Colgajo de recto anterior del abdomen para el tratamiento de los defectos de cobertura lumbosacros. [Rectus abdominis flap for the treatment of lumbosacral coverage defects.]
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Publicado:
may 11, 2018
Palabras clave:
Rectus abdominis, flap, reconstructive surgery.
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Resumen
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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De Cicco, F. L., Abrego, M. O., Gallucci, G. L., De Carli, P., & Boretto, J. G. (2018). Colgajo de recto anterior del abdomen para el tratamiento de los defectos de cobertura lumbosacros. [Rectus abdominis flap for the treatment of lumbosacral coverage defects.]. 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
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Investigación Clínica
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Citas
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981;67(2):177-87.
9. 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.
10. 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.
11. 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.
12. 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.
13. Kuntscher MV, Mansouri S, Noack N, Hartmann B. Versatility of vertical rectus abdominis musculocutaneous flaps. Microsurgery 2006;26:363-9.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981;67(2):177-87.
9. 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.
10. 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.
11. 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.
12. 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.
13. Kuntscher MV, Mansouri S, Noack N, Hartmann B. Versatility of vertical rectus abdominis musculocutaneous flaps. Microsurgery 2006;26:363-9.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.