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. 2018 Apr;22(2):333-341.
doi: 10.1007/s10029-018-1738-8. Epub 2018 Feb 7.

Abdominal wall reconstruction following resection of large abdominal aggressive neoplasms using tensor fascia lata flap with or without mesh reinforcement

Z Song  1 , D Yang  1 , J Yang  1 , X Nie  1 , J Wu  1 , H Song  1 , Y Gu  2
Affiliations

Abdominal wall reconstruction following resection of large abdominal aggressive neoplasms using tensor fascia lata flap with or without mesh reinforcement

Z Song et al. Hernia. 2018 Apr.

Abstract

Purpose: Abdominal wall defects caused by neoplasms with large extended resection defects remain a challenging problem. Autologous flaps, meshes, and component separation techniques are effective in reconstructing these defects. We retrospectively reviewed and assessed the success of reconstruction using tensor fascia lata flap with or without meshes.

Methods: 18 patients with abdominal wall neoplasms were identified during the period from 2007 to 2016. A retrospective review of office charts and hospital records was performed.

Results: A total of 18 patients received corresponding treatment according to the degree of defects, with a mean age of 53.89 ± 14.56 years old, a mean body mass index (BMI) of 22.89 ± 4.09 kg/m2, and a mean American Society of Anesthesiologist (ASA) score of 2.18 ± 0.75. Operative details included the mean defect size (303.44 ± 175.67 cm2), the mean mesh size (265.92 ± 227.99 cm2), and the mean operative time (382.33 ± 180.38 min). Postoperative wound complications were identified in 7 (39%) patients, including incisional infection, edema and thrombus. Neoplasm recurrence was observed in 2 (13%) primary neoplasms patients. No hernias were present in any patient.

Conclusions: Abdominal wall defects caused by neoplasms should be repaired by autologous flaps combined with or without mesh reinforcement. Most type I defects should be primary sutured; type II or III defects should be repaired well by flaps, with or without mesh; if the incision is infected or contaminated, biological mesh or flaps are the best choice.

Keywords: Abdominal wall defeats; Biomaterial mesh; Synthetic mesh; TFL flap.

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Conflict of interest statement

Conflict of interest

ZCS, DCY, JJY, XN, JGW, HS, YG declares no conflict of interest.

Ethical approval

All the work described in our paper has been carried out in accordance with the code of ethics of the world medical association.

Human and animal rights

Human Experimental Ethical Inspection was approval by ethics committee of Shanghai Ninth People’s Hospital affiliated to shanghai JiaoTong University, School of Medicine

Informed consent

For this type of article informed consent is not required.

Figures

Fig. 1
Fig. 1
The reconstruction of abdominal wall defect (type III) caused by primary abdominal wall neoplasm. a The primary abdominal wall neoplasm in right lumbar with one tube operated in local hospital; b the abdominal wall defect about repaired with biological mesh; c the free tensor fascia lata flap was achieved and preparing to reconstruct the abdominal wall. d Extensive resection abdominal wall neoplasm; e reconstructing the abdominal wall; f HE staining of abdominal wall neoplasm and showed necrotic tumor cells; g immunohistochemical (Ki 67) staining of abdominal wall neoplasm; h CT examination results of abdominal wall neoplasm
Fig. 2
Fig. 2
The reconstruction of abdominal wall defect (type III) caused by secondary abdominal wall neoplasm. a The secondary abdominal wall neoplasm in upper abdominal wall; b the abdominal wall defect was repaired by biological mesh after extensive resection; c the pedicled tensor fascia lata flap was achieved and preparing to reconstruct the abdominal wall. d Extensive resection abdominal wall neoplasm; e reconstructing the abdominal wall with TFL flap 1 month; f HE staining of abdominal wall neoplasm and showed the tumor cells and the invasion of the liver tissue; g immunohistochemical (CK) staining of abdominal wall neoplasm; h CT examination results of abdominal wall neoplasm
Fig. 3
Fig. 3
Surgical treatment proposal of abdominal wall defect
See this image and copyright information in PMC

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