Gupta Ashish Kumar, Gohil Amish Jayantilal, Lamba Shashank
Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, Affiliated to The Tamilnadu Dr M.G.R. Medical University, Chennai, Tamil Nadu, India.
Indian J Urol. 2022 Jan-Mar;38(1):48-52. doi: 10.4103/iju.iju_204_21. Epub 2022 Jan 1.
Bladder exstrophy is an anomaly, which if not treated early in the age, poses a surgical challenge in providing an adequate abdominal wall closure. We report our experience in patients with untreated exstrophy of the bladder, who underwent cystectomy, ileal conduit, and abdominal reconstruction using the anterior rectus sheath turndown flap and paired inguinal skin flaps.
Ten previously unoperated adult patients with exstrophy with epispadias, who underwent surgery at our institute from January 2010 till January 2021, were included in this study to evaluate the adequacy of abdominal wall closure with our technique of retrograde turndown anterior rectus sheath flap with paired inguinal flap, and to document immediate and delayed complications, especially incisional hernia.
The mean follow-up period of the study was 16.5 months. We found that our technique provided adequate local tissue for a sturdy two-layered closure of the lower abdominal wall defect. Out of the ten patients, only one required an additional flap for abdominal wound closure. There were no stoma-related complications or incisional hernia.
Abdominal wall reconstruction, for skin and fascial defects, in such complex cases can be performed by local skin and fascia using a relatively simple, safe, easy, and affordable technique as we have described. Our technique avoids the use of synthetic mesh, thereby reducing the chances of infection in such chronic open wounds.
膀胱外翻是一种先天性畸形，如果在早期未得到治疗，在进行充分的腹壁闭合时会带来手术挑战。我们报告了对未经治疗的膀胱外翻患者的治疗经验，这些患者接受了膀胱切除术、回肠代膀胱术，并使用腹直肌前鞘翻转皮瓣和双侧腹股沟皮瓣进行腹壁重建。
本研究纳入了2010年1月至2021年1月期间在我院接受手术的10例既往未接受过手术的成人膀胱外翻合并尿道上裂患者，以评估我们采用逆行翻转腹直肌前鞘皮瓣联合双侧腹股沟皮瓣技术进行腹壁闭合的充分性，并记录即时和延迟并发症，尤其是切口疝。
本研究的平均随访期为16.5个月。我们发现我们的技术为下腹壁缺损的坚固双层闭合提供了足够的局部组织。10例患者中，只有1例需要额外的皮瓣来闭合腹部伤口。没有造口相关并发症或切口疝。
对于此类复杂病例中的皮肤和筋膜缺损，腹壁重建可采用我们所描述的相对简单、安全、简便且经济的技术，利用局部皮肤和筋膜进行。我们的技术避免了使用合成网片，从而降低了此类慢性开放性伤口感染的几率。
