Tatekawa Yukihiro, Tsuzuki Yukihiro, Oshiro Kiyotetsu, Fukuzato Yoshimitsu
Department of Pediatric Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa 901-1193, Japan.
J Surg Case Rep. 2024 Apr 24;2024(4):rjae259. doi: 10.1093/jscr/rjae259. eCollection 2024 Apr.
We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision. The composite flaps from each side were reversed in the midline to bring them closer and then sutured; the abdominal wall and skin were then closed. Five months after surgery, the patient had no recurrent incisional hernia and no wound complications.
我们报告了一名患者，其在脐膨出修补术后出现了从剑突到脐部的切口疝。疝逐渐增大至10厘米×10厘米的缺损，在肋弓附着点处腹直肌有明显分离。6岁时，采用成分分离技术闭合了脐部区域的腹壁缺损。对于上腹部区域的肌肉缺损，通过将腹直肌上半部分从肋弓附着点剥离后的皮瓣与通过U形切口制作的腹直肌下半部分筋膜垂直翻转皮瓣缝合在一起，制成复合皮瓣。将两侧的复合皮瓣在中线处翻转使其靠近，然后缝合；接着关闭腹壁和皮肤。术后五个月，患者无切口疝复发，也无伤口并发症。
