From the Department of Surgery, UC San Diego School of Medicine, San Diego, CA.
Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA.
Ann Plast Surg. 2022 May 1;88(4 Suppl 4):S320-S324. doi: 10.1097/SAP.0000000000003138.
Tissue expander-assisted component separation can be used to increase the amount of skin, muscle, and fascial components available for repair of congenital abdominal wall defects via a staged approach without the need for flap reconstruction. We present the largest case series to date using a tissue expander-assisted component separation technique for treatment of congenital abdominal wall defects in a pediatric patient population.
A retrospective chart review of 9 patients with large congenital abdominal wall defects not initially amenable to primary repair between 2009 and 2020 was performed. Patients first underwent placement of tissue expanders, followed by removal once they had reached a sufficient expander volume. Component separation, with and without mesh placement, was performed to achieve abdominal wall closure.
The average age of patients at primary repair was 3.2 years (SD ±1.7 years). Eight patients (88.8%) had congenital omphalocele, and 1 patient (11.1%) had gastroschisis; none were amenable to primary repair. The average size of the defects before closure was 87.6 cm2 (SD = 33.6 cm2). Eighteen tissue expanders were placed in 9 patients, 72.2% of which were placed in the plane between the external and internal oblique muscles. Patients were seen in clinic an average of 6.8 times (SD, ±3.3 visits) for volume expansion into the tissue expander, receiving an average of 32.0 mL in each per visit. An average of 4.3 months (SD, ±1.8 months) elapsed between placement and removal of the expanders. At the time of tissue expander removal and abdominal wall closure, the defects ranged from 30 to 132 cm2 (mean, 54 cm2). All defects were successfully repaired using a component separation and bilateral fasciocutaneous flap advancement. Two patients (18.2%) experienced infection of the surgical site and seroma, both of which required debridement. One patient (9.1%) experienced partial thickness skin necrosis that was managed nonsurgically. The overall complication rate was 36.4%.
Omphalocele and gastroschisis can produce abdominal wall defects that are not amenable to primary repair. Staged reconstruction using tissue expander-assisted component separation is a safe and effective method of obtaining adequate local soft tissue to achieve primary closure.
组织扩张器辅助的组件分离术可用于通过分期方法增加皮肤、肌肉和筋膜成分的数量，以修复先天性腹壁缺陷，而无需进行皮瓣重建。我们报告了迄今为止最大的病例系列，使用组织扩张器辅助组件分离技术治疗小儿患者的先天性腹壁缺陷。
对 2009 年至 2020 年间 9 例先天性腹壁缺陷较大且最初无法进行一期修复的患者进行回顾性图表分析。患者首先放置组织扩张器，待达到足够的扩张器体积后再将其取出。进行组件分离，包括放置和不放置网片，以实现腹壁关闭。
初次修复时患者的平均年龄为 3.2 岁（标准差±1.7 岁）。8 例（88.8%）患者为先天性脐膨出，1 例（11.1%）患者为先天性腹裂；均无法进行一期修复。关闭前缺陷的平均大小为 87.6cm2（标准差=33.6cm2）。9 例患者共放置了 18 个组织扩张器，其中 72.2%放置在外层和内层斜肌之间的平面上。患者平均在诊所就诊 6.8 次（标准差，±3.3 次就诊）以进行组织扩张器的容量扩张，每次就诊平均接受 32.0ml。扩张器的放置和取出之间平均间隔 4.3 个月（标准差，±1.8 个月）。在取出扩张器和关闭腹壁时，缺陷范围为 30-132cm2（平均 54cm2）。所有缺陷均采用组件分离和双侧筋膜皮瓣推进术成功修复。2 例（18.2%）患者发生手术部位感染和血清肿，均需清创。1 例（9.1%）患者发生部分厚度皮肤坏死，无需手术治疗。总体并发症发生率为 36.4%。
脐膨出和先天性腹裂可导致腹壁缺陷，无法进行一期修复。使用组织扩张器辅助组件分离的分期重建是一种安全有效的方法，可以获得足够的局部软组织来实现一期关闭。
