Ritz Frederica Jessie Tchoungui, Poumellec Marie Anne, Maertens Alexandra, Sebastianelli Lionel, Camuzard Olivier, Balaguer Thierry, Iannelli Antonio
Reconstructive and Plastic Surgery Service, CHU-Nice, France; Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, PO Box: 5005, Dakar, Senegal.
Reconstructive and Plastic Surgery Service, CHU-Nice, France.
Int J Surg Case Rep. 2021 Apr;81:105707. doi: 10.1016/j.ijscr.2021.105707. Epub 2021 Mar 2.
Trauma injuries and oncologic resection are common aetiologies of complex abdominal wall defect. Reconstruction of abdominal wall is an everlasting question for general, paediatric and reconstructive surgeons. The plethora of techniques, bioprosthetic and engineered tissues offer countless possibilities.
The patient was a 28 years old woman, with past history of untreated giant liver omphalocele, admitted for a suspicious hepatic tumefaction without specific clinical signs. The thoraco abdominopelvic CT scan revealed lung metastasis and a bilobed left hepatic tumour. Pre-operative cytologic findings of mild differentiated hepatocellular carcinoma differed from the post-operative findings of hepatoblastoma. The full-thickness abdominal wall defect after a radical resection was reconstructed with a combined acellular dermal matrix, NPWT and skin graft solution. A total epithelization was obtained after 8 weeks follow-up.
Hepatoblastoma in adult is rare, with no consensus. A radical resection in context of giant untreated omphalocele is an unusual challenge for the surgical team. The pre-operative evaluation, the defect classification and the general conditions of the patient are paramount steps for an appropriate reconstruction. Primary or delayed reconstruction with myocutaneous flap as gold standard, depends on the oncologic management and anticipated post-operative complications. Acellular dermal matrix used for a bridged fascial repair directly on viscera and covered by NPWT, favourited a healthy granulation tissue. The full-thickness defect was then reconstructed with an ADM, NPWT and skin graft instead of an association with the myocutaneous flap. The patient follow-up was emphasized in the hepatoblastoma, but the complications of this reconstruction strategy are unknown. A total epithelization was obtained, the abdominal bulge or hernia is the first complication under surveillance.
Delayed reconstruction after an oncologic large abdominal wall resection has the advantage to manage post-operative complications and prepare alternative solutions. Acellular dermal matrix was not first designed for skin tissue regeneration, some authors as us experimented the conclusion that this matrix could be used for permanent abdominal wall reconstruction.
创伤性损伤和肿瘤切除是复杂腹壁缺损的常见病因。腹壁重建一直是普通外科、小儿外科和重建外科医生面临的问题。大量的技术、生物假体和工程组织提供了无数的可能性。
患者为一名28岁女性，既往有未治疗的巨大肝脏脐膨出病史，因可疑肝脏肿物入院，无特异性临床症状。胸腹部盆腔CT扫描显示肺转移和左肝双叶肿瘤。术前肝细胞癌轻度分化的细胞学检查结果与术后肝母细胞瘤的检查结果不同。根治性切除术后的全层腹壁缺损采用脱细胞真皮基质、负压伤口治疗（NPWT）和植皮相结合的方法进行重建。随访8周后实现了完全上皮化。
成人肝母细胞瘤罕见，尚无共识。在巨大未治疗的脐膨出情况下进行根治性切除对手术团队来说是一项不同寻常的挑战。术前评估、缺损分类和患者的一般情况是进行适当重建的关键步骤。以肌皮瓣作为金标准进行一期或延迟重建，取决于肿瘤治疗方案和预期的术后并发症。用于直接覆盖内脏的桥接筋膜修复的脱细胞真皮基质，并采用NPWT，有利于形成健康的肉芽组织。然后用脱细胞真皮基质、NPWT和植皮重建全层缺损，而不是联合肌皮瓣。肝母细胞瘤患者的随访很重要，但这种重建策略的并发症尚不清楚。实现了完全上皮化，腹部膨出或疝是首要监测的并发症。
肿瘤性大腹壁切除术后延迟重建有利于处理术后并发症并准备替代方案。脱细胞真皮基质并非最初设计用于皮肤组织再生，一些作者（包括我们）通过实验得出结论，这种基质可用于永久性腹壁重建。
