Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1734
Peer-review started: October 27, 2020
First decision: December 3, 2020
Revised: December 21, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: March 6, 2021
Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task. An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps, restoration of the abdominal wall integrity, and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia. When treating huge full-thickness defects, composite autologous tissue flaps are a good option for the repair.
This study reported the case of a 43-year-old male patient suffering from full-thickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen. After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels, reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure. The remaining 18 cm × 15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap. The proposed method achieved the functional reconstruction of the abdominal wall.
This approach restored the abdominal wall integrity, maintained certain muscle tension, avoided abdominal hernia, reached satisfactory aesthetic effect, and resulted in no complications in the grafting regions.
Core Tip: The reconstruction of large full-thickness abdominal wall defects is still a challenging task clinically, and it is even more difficult if intestinal damage is combined. Before the intestinal wound healing, it is a great innovation to protect the intestinal tube with heterogeneous acellular dermal matrix and to drain the fluid with vacuum sealing drainage externally, thus avoiding the occurrence of serious infection. Autogenous compound tissue flap is a good choice to reconstruct the abdominal wall defect, restore the integrity of the abdominal wall, maintain the tension of the abdominal wall muscle, and prevent the occurrence of abdominal wall hernia. In this case, an anterolateral thigh flap with tensor fascia lata was used to reconstruct the abdominal wall defect, with good functional and aesthetic results.