TY - JOUR

T1 - Sliding free transverse rectus abdominis myocutaneous flap for closure of a massive abdominal wall defect

T2 - A case report

AU - Senghaas, Annika

AU - Kremer, Thomas

AU - Schmidt, Volker J

AU - Harhaus, Leila

AU - Hirche, Christoph

AU - Kneser, Ulrich

AU - Bigdeli, Amir K

N1 - © 2018 Wiley Periodicals, Inc.

PY - 2019

Y1 - 2019

N2 - Despite considerable advances in reconstructive surgery, massive abdominal wall defects continue to pose a significant surgical challenge. We report the case of a 72-year-old morbidly obese female patient with Clostridium septicum-related gas gangrene of the abdominal wall. After multidisciplinary treatment and multiple extensive debridements, a massive full-thickness defect (40 cm × 35 cm) of the right abdominal wall was present. The abdominal contents were covered with a resorbable mesh to prevent evisceration. Finally, the composite defect was successfully reconstructed through a contralateral extended free transverse rectus abdominis myocutaneus (TRAM) flap (50 cm × 38 cm). An arterio-venous loop to the superficial femoral vessels using the great saphenous vein was necessary to allow the flap to reach the defect. Postoperatively, a minor wound healing disorder of the flap was successfully treated with split skin grafting. Six month after surgery, the patient presented with a completely healed flap coverage area and a small abdominal hernia without the need of further surgical revision. This case illustrates the use of a sliding free TRAM flap for closure of a massive abdominal wall defect.

AB - Despite considerable advances in reconstructive surgery, massive abdominal wall defects continue to pose a significant surgical challenge. We report the case of a 72-year-old morbidly obese female patient with Clostridium septicum-related gas gangrene of the abdominal wall. After multidisciplinary treatment and multiple extensive debridements, a massive full-thickness defect (40 cm × 35 cm) of the right abdominal wall was present. The abdominal contents were covered with a resorbable mesh to prevent evisceration. Finally, the composite defect was successfully reconstructed through a contralateral extended free transverse rectus abdominis myocutaneus (TRAM) flap (50 cm × 38 cm). An arterio-venous loop to the superficial femoral vessels using the great saphenous vein was necessary to allow the flap to reach the defect. Postoperatively, a minor wound healing disorder of the flap was successfully treated with split skin grafting. Six month after surgery, the patient presented with a completely healed flap coverage area and a small abdominal hernia without the need of further surgical revision. This case illustrates the use of a sliding free TRAM flap for closure of a massive abdominal wall defect.

KW - Abdominal Wall/surgery

KW - Aged

KW - Clostridium septicum/isolation & purification

KW - Female

KW - Follow-Up Studies

KW - Gas Gangrene/diagnosis

KW - Humans

KW - Myocutaneous Flap/blood supply

KW - Obesity, Morbid/diagnosis

KW - Plastic Surgery Procedures/methods

KW - Rectus Abdominis/blood supply

KW - Risk Assessment

KW - Severity of Illness Index

KW - Time Factors

KW - Treatment Outcome

KW - Wound Healing/physiology

U2 - 10.1002/micr.30309

DO - 10.1002/micr.30309

M3 - Journal article

C2 - 29451331

VL - 39

SP - 174

EP - 177

JO - International Journal of Microsurgery

JF - International Journal of Microsurgery

SN - 0738-1085

IS - 2

ER -