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Case Reports
. 2023 Nov 23;15(11):e49302.
doi: 10.7759/cureus.49302. eCollection 2023 Nov.

Double-Breasted Anterior Rectus Sheath Turnover Flap

Wen Yang Chung  1 , Koh Siang Chai  1 , Daphne Stephen  1 , John Ranjit  2
Affiliations
Case Reports

Double-Breasted Anterior Rectus Sheath Turnover Flap

Wen Yang Chung et al. Cureus. .

Abstract

The management of the open abdomen follows wound management with temporary abdominal closure prior to definitive closure while concurrently managing patient nutrient and fluid losses. This case report describes the successful use of double-breasted anterior rectus sheath turnover (DART) flap for early open abdomen closure to facilitate oncological management. The patient is a 47-year-old female with uterine smooth muscle neoplasm whose laparotomy wound was complicated with abdominal wound dehiscence and intra-abdominal infection. The abdomen could be closed with no fistula formation, iatrogenic bowel perforations, or overlying skin necrosis, and a follow-up showed no hernia occurrence. In conclusion, the DART flap provides a simple and autologous option for early tension-free midline closure of the open abdomen with acceptable intra- and postoperative complications.

Keywords: component separation technique; open abdomen surgery; plastic surgergy; surgical wound management; wound care and reconstructive surgerye.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Intraoperative pictures of the DART flap
(A) Abdominal contents covered with omentum (B) Right anterior rectus sheath raised and turned over (C) Left anterior rectus sheath raised, turned over, and sutured to the medial border of contralateral rectus abdominis muscle (D) Closure of abdominal wound DART, double-breasted anterior rectus sheath turnover
Figure 2
Figure 2. Legend of anatomical structure
Figure 3
Figure 3. Schematic diagram of the DART flap
DART, double-breasted anterior rectus sheath turnover
Figure 4
Figure 4. Two-year postoperative follow-up
See this image and copyright information in PMC

References

    1. The open abdomen, indications, management and definitive closure. Coccolini F, Biffl W, Catena F, et al. World J Emerg Surg. 2015;10:32. - PMC - PubMed
    1. Bogota bag in the treatment of abdominal wound dehiscence. Sukumar N, Shaharin S, Razman J, Jasmi A. https://www.e-mjm.org/2004/v59n2/Treatment_Abdominal_Wound_Dehiscence.pdf. Med J Malaysia. 2004;59:281–283. - PubMed
    1. Cost evaluation of temporary abdominal closure methods in abdominal sepsis patients successfully treated with an open abdomen. Should we take temporary abdominal closure methods at face value? Health economic evaluation. Betancourt AS, Milagros GC, Sibaja P, Fernandez L, Norwood S. Ann Med Surg (Lond) 2020;56:11–16. - PMC - PubMed
    1. Three-year outcome after anterior component separation repair of giant ventral hernias: a retrospective analysis of the original technique without mesh. Kesicioglu T, Yildirim K, Yuruker S, Karabicak I, Koc Z, Erzurumlu K, Malazgirt Z. Asian J Surg. 2022;45:1117–1121. - PubMed
    1. Anterior versus posterior component separation: which is better? Kumar S, Edmunds RW, Dowdy C, Chang YW, King R, Roth JS. Plast Reconstr Surg. 2018;142:47–53. - PubMed

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