Kumar Prashant, Nayyar Rishi, Seth Amlesh, Gupta Deepti
Urology, AIIMS, New Delhi, India.
Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2019 Jan 14;12(1):bcr-2018-226076. doi: 10.1136/bcr-2018-226076.
The exstrophy-epispadias complex represents a spectrum of genitourinary malformations ranging from simple glanular epispadias to an overwhelming multisystem defect, cloacal exstrophy. Neonatal total reconstruction of bladder exstrophy-epispadias complex is the treatment of choice. An adult patient presenting with untreated exstrophy is very rare. Malignant transformation, commonly adenocarcinoma, in such cases is a known complication due to mucosal metaplasia of urothelium. Management in such cases necessitates a radical surgical procedure that often results in a massive defect in the anterior abdominal wall. Providing a cover for such defects is a challenging task for the reconstructive surgeon. Local skin flaps and wide mobilisation of the rectus muscle are the usually employed techniques for closure of such defects. However, these may be inadequate in extremely large defects such as those encountered in our patients. We, hereby, describe our technique of closure of the abdominal wall defect using a pedicled anterolateral thigh flap.
膀胱外翻-尿道上裂综合征代表了一系列泌尿生殖系统畸形，范围从简单的龟头型尿道上裂到严重的多系统缺陷——泄殖腔外翻。膀胱外翻-尿道上裂综合征的新生儿期全膀胱重建是首选治疗方法。成年患者出现未经治疗的膀胱外翻情况非常罕见。在这种情况下，恶性转化（通常为腺癌）是一种已知的并发症，原因是尿路上皮的黏膜化生。此类病例的治疗需要进行根治性手术，这往往会导致前腹壁出现巨大缺损。为这些缺损提供覆盖物对重建外科医生来说是一项具有挑战性的任务。局部皮瓣和腹直肌的广泛游离是通常用于闭合此类缺损的技术。然而，对于像我们患者所遇到的极大缺损，这些方法可能并不足够。在此，我们描述使用带蒂股前外侧皮瓣闭合腹壁缺损的技术。
