De Luna Gallardo Daniel, Cárdenas Salomon Carlos Michel, Barrera García Gabriel, Posada Torres José Antonio, Poucel Sánchez Medal Fernando
American British Cowdray Medical Center I.A.P., Mexico City, Mexico.
Plast Reconstr Surg Glob Open. 2020 Feb 28;8(2):e2577. doi: 10.1097/GOX.0000000000002577. eCollection 2020 Feb.
The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.
腹壁是一种独特的真皮 - 肌 - 腱结构，被认为是外科手术中的一项挑战。使用阔筋膜张肌（TFL）的肌皮带蒂皮瓣是腹壁修复的一种技术，并且它正成为一种越来越常用的重建手术。这是一种非常合适的手术方法，因为它既能提供半刚性的筋膜层，又能提供足够的皮肤覆盖。我们报告一例61岁男性患者，诊断为膀胱鳞状细胞癌，临床分期为IV期（T4bN1M1），并发回肠 - 直肠 - 尿道皮肤瘘。我们通过旋转双侧带蒂TFL皮瓣重建了腹壁的巨大缺损。治疗方案包括2次外科手术。第一次手术旨在获取并临时固定皮瓣，以使延迟现象发生。三周后，我们通过重新定位双侧TFL皮瓣并放置双层普理灵和再生氧化纤维素网进行腹壁重建。我们为一名晚期肿瘤患者成功实施了姑息手术。结合一项大型肿瘤手术（由肿瘤外科医生完成），我们成功解决了皮肤瘘问题，并显著改善了患者的生活质量。患者出院时无手术相关并发症。术后18个月他一直保持健康，且无腹疝迹象。在特定病例中，双侧TFL皮瓣是原发性或继发性腹壁重建的一种可行选择。当整形外科和重建外科医生面对巨大且复杂的腹壁缺损并伴有明显皮肤覆盖不足时，应考虑这种重建策略。
