Wang Jun
Department of Burn and Skin Repair Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, Hainan Province, China.
World J Clin Cases. 2021 Mar 6;9(7):1734-1740. doi: 10.12998/wjcc.v9.i7.1734.
Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task. An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps, restoration of the abdominal wall integrity, and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia. When treating huge full-thickness defects, composite autologous tissue flaps are a good option for the repair.
This study reported the case of a 43-year-old male patient suffering from full-thickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen. After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels, reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure. The remaining 18 cm × 15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap. The proposed method achieved the functional reconstruction of the abdominal wall.
This approach restored the abdominal wall integrity, maintained certain muscle tension, avoided abdominal hernia, reached satisfactory aesthetic effect, and resulted in no complications in the grafting regions.
腹部电烧伤清创后巨大全层腹壁缺损的重建修复仍是一项具有临床挑战性的任务。理想的腹壁修复是指用带蒂神经血管肌筋膜瓣重新闭合缺损的腹壁，恢复腹壁完整性，并维持腹壁肌肉张力以防止腹壁疝的发生。在治疗巨大全层缺损时，复合自体组织瓣是修复的良好选择。
本研究报告了一名43岁男性患者的病例，该患者因左上肢和腹部高压烧伤导致全层腹壁缺损，并发多个肠段坏死和十二指肠瘘。腹部电烧伤清创及坏死肠管端端吻合术后，采用脱细胞真皮基质移植和封闭负压引流进行临时腹壁闭合。剩余18 cm×15 cm的全层腹壁缺损采用股前外侧肌和阔筋膜张肌游离瓣联合修复。所提出的方法实现了腹壁的功能重建。
该方法恢复了腹壁完整性，维持了一定的肌肉张力，避免了腹壁疝，达到了满意的美学效果，且移植区域无并发症发生。
