Kagaya Yu, Arikawa Masaki, Kobayashi Eisuke, Kawai Akira, Miyamoto Shimpei
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Division of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2018 Jul 13;6(7):e1819. doi: 10.1097/GOX.0000000000001819. eCollection 2018 Jul.
The surgical management of abdominal wall tumor in women with childbearing potential is a thorny issue. A synthetic mesh is widely used for abdominal wall reconstruction but not necessarily applicable in case of women of childbearing potential because it has been reported to cause severe pain during pregnancy. Autologous reconstruction is usually considered a feasible option for such cases; however, there is no consensus on this approach and almost no evidence to support it. In the present 2 cases, 2 female patients (age, 17 years and 35 years) with abdominal wall desmoid tumor underwent primary radical resection and autologous reconstruction of an abdominal wall defect in the lateral oblique muscle area (defect size, 13 × 5 cm and 8 × 6 cm) using an anterolateral thigh and iliotibial tract flap. The postoperative course was uneventful. Both patients achieved pregnancy and a full-term delivery without complications with the exception of a feeling of mild stretching in the area of the operation. Magnetic resonance imaging and a clinical examination after the delivery revealed no signs of abdominal wall hernia or bulging. Normal pregnancy and full-term delivery could be obtained after abdominal wall resection and autologous reconstruction using an anterolateral thigh + iliotibial tract flap. This reconstructive method is considered to be a versatile option for the management of abdominal wall tumor in women with childbearing potential; however, further evidence should be accumulated on the reconstruction of wider and central abdominal wall defects.
对于有生育潜力的女性腹壁肿瘤的外科治疗是一个棘手的问题。合成补片广泛用于腹壁重建，但对于有生育潜力的女性不一定适用，因为据报道它会在孕期引起剧痛。自体组织重建通常被认为是这类病例的一个可行选择；然而，对于这种方法尚无共识，而且几乎没有证据支持。在本报告的2例病例中，2名患有腹壁硬纤维瘤的女性患者（年龄分别为17岁和35岁）接受了一期根治性切除，并使用股前外侧皮瓣和髂胫束瓣对腹外斜肌区域的腹壁缺损（缺损大小分别为13×5 cm和8×6 cm）进行了自体组织重建。术后过程顺利。两名患者均成功怀孕并足月分娩，除手术区域有轻度牵拉感外无并发症。分娩后磁共振成像和临床检查未发现腹壁疝或膨出迹象。使用股前外侧 + 髂胫束瓣进行腹壁切除和自体组织重建后可实现正常妊娠和足月分娩。这种重建方法被认为是治疗有生育潜力女性腹壁肿瘤的一种通用选择；然而，对于更广泛的中央腹壁缺损重建，应积累更多证据。
