Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

Background If a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect.

Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction.

Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery.

Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

Keywords

Abdominal wound closure techniques - Wound infection - Rectus abdominis

Publikationsverlauf

Eingereicht: 27. September 2012

Angenommen: 14. Dezember 2012

Artikel online veröffentlicht:
01. Mai 2022

• REFERENCES

• 1 Philbeck Jr TE, Whittington KT, Millsap MH. et al. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage 1999; 45: 41-50
• 2 Abbott DE, Halverson AL, Wayne JD. et al. The oblique rectus abdominal myocutaneous flap for complex pelvic wound reconstruction. Dis Colon Rectum 2008; 51: 1237-1241
• 3 Tobin GR, Pursell SH, Day Jr TG. Refinements in vaginal reconstruction using rectus abdominis flaps. Clin Plast Surg 1990; 17: 705-712
• 4 Izadi K, Ganchi P. Chronic wounds. Clin Plast Surg 2005; 32: 209-222
• 5 Schultz GS, Sibbald RG, Falanga V. et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003; 11 Suppl 1 S1-S28
• 6 Nwomeh BC, Yager DR, Cohen IK. Physiology of the chronic wound. Clin Plast Surg 1998; 25: 341-356
• 7 Sullivan SR, Engrav LH, Anaya DA. et al. Bilateral anterior abdominal bipedicle flap with permanent prosthesis for the massive abdominal skin-grafted hernia. Am J Surg 2007; 193: 651-655
• 8 Morykwas MJ, Argenta LC, Shelton-Brown EI. et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-562
• 9 DeFranzo AJ, Argenta LC, Marks MW. et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 2001; 108: 1184-1191
• 10 Kushimoto S, Yamamoto Y, Aiboshi J. et al. Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management. World J Surg 2007; 31: 2-8
• 11 Beer GM, Schuster A, Seifert B. et al. The normal width of the linea alba in nulliparous women. Clin Anat 2009; 22: 706-711
• 12 Chuo CB, Thomas SS. Absorbable mesh and topical negative pressure therapy for closure of abdominal dehiscence with exposed bowel. J Plast Reconstr Aesthet Surg 2008; 61: 1378-1381
• 13 Dayton MT, Buchele BA, Shirazi SS. et al. Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 1986; 121: 954-960
• 14 Leber GE, Garb JL, Alexander AI. et al. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 1998; 133: 378-382
• 15 Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86: 519-526