Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2010 Apr;125(4):1146-1156. doi: 10.1097/PRS.0b013e3181d18196.
Transposition of well-vascularized flap tissue with or without implantable mesh is often required to repair full-thickness, composite abdominal wall defects. The authors hypothesized that the combination of an inlay of bioprosthetic mesh and a subtotal thigh flap would enable a reliable reconstruction for large, composite abdominal wall defects.
The authors retrospectively reviewed data on patients who underwent repair of large, composite abdominal wall defects with bioprosthetic mesh and free or pedicled subtotal thigh flaps at a major cancer center from 2004 to 2007. Patient, defect, surgical technique, and outcome data were obtained from a prospectively maintained database and medical charts.
Seven patients who received eight subtotal thigh flaps (five pedicled and three free flaps with vein grafts to the femoral vessels) met the study criteria. Indications for reconstruction were tumor resection, enterocutaneous fistula, and abdominal wall osteoradionecrosis. All but one patient received preoperative radiotherapy (mean dose, 54.8 Gy). The musculofascial defect was repaired with a mean of 536.4 cm2 of bioprosthetic mesh. The mean subtotal thigh flap skin paddle size was 514 cm2. Complications included partial flap necrosis in one patient, a cerebrospinal fluid leak in one patient, partial split-thickness skin graft loss in two patients, a focal asymptomatic musculofascial repair-site bulge in one patient, and a hernia (not requiring surgery) in one patient. No bioprosthetic mesh infections, wound dehiscences, bowel obstructions, or seromas occurred (mean follow-up, 27.7 months).
Massive, composite abdominal wall defects can be repaired successfully with relatively minor complications using a combination of bioprosthetic mesh and subtotal thigh flaps.
修复全层复合腹壁缺损通常需要移位血供良好的皮瓣组织，或结合可植入的网片。作者假设，生物假体网片的嵌入式和股前外侧皮瓣的部分游离（带蒂）联合应用，可为大型复合腹壁缺损提供可靠的重建。
作者回顾性分析了 2004 年至 2007 年在一家大型癌症中心，使用生物假体网片和游离或带蒂部分股前外侧皮瓣修复大型复合腹壁缺损的患者数据。通过前瞻性维护的数据库和病历获取患者、缺损、手术技术和结果数据。
7 例患者（8 个股前外侧皮瓣）符合研究标准。重建的适应证为肿瘤切除、肠外瘘和腹壁放射性骨坏死。除 1 例患者外，所有患者均接受术前放疗（平均剂量 54.8 Gy）。使用平均 536.4 cm2的生物假体网片修复肌筋膜缺损。平均股前外侧皮瓣皮瓣大小为 514 cm2。并发症包括 1 例部分皮瓣坏死、1 例脑脊液漏、2 例部分中厚皮片移植失败、1 例肌筋膜修复部位局灶性无症状隆起、1 例疝（无需手术）。无生物假体网片感染、伤口裂开、肠梗阻或血清肿（平均随访 27.7 个月）。
使用生物假体网片和股前外侧皮瓣的联合应用，可以成功修复大型复合腹壁缺损，且并发症相对较少。
