Liu Ruoshui, Liang Yimin, Wang Danru, Zhou Renpeng
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Case Rep. 2025 Jul 14;26:e948731. doi: 10.12659/AJCR.948731.
BACKGROUND Depressed abdominal scars resulting from childhood surgical interventions, such as appendectomies, often result in aesthetic and functional impairments due to dermal tissue deficiencies and adhesions to the anterior rectus sheath. Traditional methods, including subcision and fat grafting, have limitations in addressing extensive, adherent scars. This report describes a 22-year-old woman with a post-appendectomy depressed scar and outlines an innovative reconstructive approach involving scar tissue release, abdominal wall reinforcement, bilayered adipofascial flaps, and a W-plasty suturing. CASE REPORT A 22-year-old woman presented to our institution with an 8×2 cm depressed abdominal scar resulting from a childhood appendectomy complicated by postoperative infection. Preoperative imaging confirmed adipose deficiency, muscular disruption, and fibrotic adhesions. Under general anesthesia, the scarred epidermis was completely excised, and adhesions were released. The de-epithelialized scar tissue was anchored to the medial and lateral borders of the released anterior rectus sheath using interrupted sutures for reinforcement. Bilayered adipofascial flaps, comprising Scarpa and Camper fascia, were transposed to restore volumetric deficit, followed by W-plasty closure to minimize tension. Postoperative evaluations at 2 weeks and 1 year revealed no evidence of scar contracture, hypertrophy, or depression recurrence. CONCLUSIONS This report demonstrates that bilayered adipofascial flap reconstruction, combined with tension-distributing sutures, provides an effective solution for complex abdominal scars with deep adhesions and tissue deficiency. The technique overcomes key limitations of conventional approaches - including fat resorption and incomplete adhesion release - to achieve durable functional and aesthetic restoration.
儿童期手术干预（如阑尾切除术）导致的腹部凹陷性瘢痕，常因真皮组织缺损和与腹直肌前鞘粘连而导致美观和功能受损。包括皮下分离术和脂肪移植在内的传统方法，在处理广泛粘连的瘢痕方面存在局限性。本报告描述了一名22岁阑尾切除术后腹部凹陷性瘢痕的女性患者，并概述了一种创新的重建方法，包括瘢痕组织松解、腹壁加强、双层脂肪筋膜瓣和W形缝合。
一名22岁女性因儿童期阑尾切除术后并发感染，出现一条8×2 cm的腹部凹陷性瘢痕，前来我院就诊。术前影像学检查证实存在脂肪缺乏、肌肉中断和纤维化粘连。在全身麻醉下，完全切除瘢痕表皮，松解粘连。将去上皮化的瘢痕组织用间断缝线固定在松解后的腹直肌前鞘的内侧和外侧边缘，以加强腹壁。将包含Scarpa筋膜和Camper筋膜的双层脂肪筋膜瓣移位，以恢复容积缺损，随后进行W形缝合以减少张力。术后2周和1年的评估显示，没有瘢痕挛缩、肥大或凹陷复发的迹象。
本报告表明，双层脂肪筋膜瓣重建结合张力分布缝线，为伴有深部粘连和组织缺损的复杂腹部瘢痕提供了一种有效的解决方案。该技术克服了传统方法的关键局限性，包括脂肪吸收和粘连松解不完全，以实现持久的功能和美观恢复。
