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2 . 2023
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"Weak point" in the application of a full layer anterior abdominal wall flap in thoracic surgery and how to overcome it

Abstract

Aim. To pay attention to a new variant of ventral hernia in thoracic surgical practice and outline a way to prevent it.

Material and methods. An analysis of the treatment of a patient with poststernotomy mediastinitis was carried out. A reconstructive operation using a full-thickness flap from the anterior abdominal wall was complicated afterwards by postoperative ventral hernia, which required repeated hospitalization and surgical intervention.

Results. A minimally invasive operation to eliminate a postoperative ventral hernia led to the recovery of the patient. A good long-term result was noted after 6 months.

Conclusion. A full-thickness flap from the anterior abdominal wall is a good plastic material for eliminating an anterior chest wall defect. The risk of developing postoperative ventral hernia of the anterior abdominal wall may adversely affect the results of treatment of patients with poststernotomy mediastinitis. The use of synthetic materials for preventive strengthening of the anterior abdominal wall after taking a full-thickness flap on the superior epigastric artery will help prevent the development of postoperative ventral hernia. In case of weakness of the anterior abdominal wall, the choice of strengthening it is laparoscopic hernioplasty with a composite plastic implant.

Keywords:poststernotomy mediastinitis; osteomyelitis of the sternum; muscle flaps; chest wall muscle reconstruction; postoperative ventral hernia; laparoscopic hernioplasty

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Medvedchikov-Ardiia M.A., Korymasov E.A., Benyan A.S. “Weak point” in the application of a full layer anterior abdominal wall flap in thoracic surgery and how to overcome it. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (2): 119–24. DOI: https://doi.org/10.33029/2308-1198-2023-11-2-119-124  (in Russian)

References

1.     Sanna S., Brandolini J., Pardolesi A., Argnani D., Mengozzi M., Dell’Amore A., et al. Materials and techniques in chest wall reconstruction: A review. J Vis Surg. 2017; 3: 95. DOI: https://doi.org/10.21037/jovs.2017.06.10  PMID: 29078657; PMCID: PMC5638032.

2.     Seder C.W., Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis. 2016; 8 (suppl 11): S863–71. DOI: https://doi.org/10.21037/jtd.2016.11.07  PMID: 27942408; PMCID: PMC5124596.

3.     Wald O., Islam I., Amit K., Ehud R., Eldad E., Omer O., et al. 11-year experience with Chest Wall resection and reconstruction for primary Chest Wall sarcomas. J Cardiothorac Surg. 2020; 15 (1): 29. DOI: https://doi.org/10.1186/s13019-020-1064-y  PMID: 31992336; PMCID: PMC6988268.

4.     Huang S.C., Chen C.Y., Qiu P., Yan Z.M., Chen W.Z., Liang Z.Z., et al. Reconstruction of complex chest wall defects: A case report. World J Clin Cases. 2022; 10 (11): 3505–10. DOI: https://doi.org/10.12998/wjcc.v10.i11.3505  PMID: 35582050; PMCID: PMC9048570.

5.     Colella S., Brandimarte A., Marra R., Marinari S., D'Incecco A., Di Genesio Pagliuca M., De Vico A., Crisci R., Divisi D. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview. Front Surg. 2022; 9: 976463. DOI: 10.3389/fsurg.2022.976463.

6.     Korymasov E.A., Medvedchikov-Ardiya M.A., Benyan A.S. Combined myo- and omentoplasty of the anterior chest wall. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 131–6. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-131-136  

7.     Chiappetta M., Facciolo F. Sternum reconstruction using titanium plates matched with «sandwich» Gore-Tex meshes. J Vis Surg. 2018; 4: 47. DOI: https://doi.org/10.21037/jovs.2018.02.12 PMID: 29682457; PMCID: PMC5897679.

8.     Baumann D.P., Butler C.E. Component separation improves outcomes in VRAM flap donor sites with excessive fascial tension. Plast Reconstr Surg. 2010; 126 (5): 1573–80. DOI: https://doi.org/10.1097/PRS.0b013e3181ef8d00  

9.     Medvedchikov-Ardiya M.A., Lysov N.A., Korymasov E.A., Benyan A.S. A method for plasty of a chest wall defect with a full-thickness skin-subcutaneous-fascio-muscular flap on the superior epigastric artery. RF patent for the invention No. 2765632. 01.02.2022. Bull. No. 4. (in Russian).

10. Mortada H., AlNojaidi T.F., AlRabah R., Almohammadi Y., AlKhashan R., Aljaaly H. Morbidity of the donor site and complication rates of breast reconstruction with autologous abdominal flaps: A systematic review and meta-analysis. Breast J. 2022; 2022: 7857158. DOI: https://doi.org/10.1155/2022/7857158 PMID: 35847769; PMCID: PMC9249529.

11. Momoh A.O., Colakoglu S., Westvik T.S., Curtis M.S., Yueh J.H., de Blacam C., et al. Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg. 2012; 69 (1): 19–23. DOI: https://doi.org/10.1097/SAP.0b013e318221b578  PMID: 21659842.

12. Schellerer V.S., Bartholomé L., Langheinrich M.C., Grützmann R., Horch R.E., Merkel S., et al. Donor site morbidity of patients receiving vertical rectus abdominis myocutaneous flap for perineal, vaginal or inguinal reconstruction. World J Surg. 2021; 45 (1): 132–40. DOI: https://doi.org/10.1007/s00268-020-05788-5  Epub 2020 Sep 29. PMID: 32995931; PMCID: PMC7752873.

13.                   Espinosa-de-Los-Monteros A., Avendano-Peza H., Novitsky Y.W. Abdominal closure after tram flap breast reconstruction with transversus abdominis muscle release and mesh. Plast Reconstr Surg Glob Open. 2016; 4 (9): e1014. DOI: https://doi.org/10.1097/GOX.0000000000001014  PMID: 27757337; PMCID: PMC5055003.

References

  1. Sanna S., Brandolini J., Pardolesi A., Argnani D., Mengozzi M., Dell’Amore A., et al. Materials and techniques in chest wall reconstruction: A review. J Vis Surg. 2017; 3: 95. DOI: https://doi.org/10.21037/jovs.2017.06.10 PMID: 29078657; PMCID: PMC5638032.
  2. Seder C.W., Rocco G. Chest wall reconstruction after extended resection. J Thorac Dis. 2016; 8 (suppl 11): S863–71. DOI: https://doi.org/10.21037/jtd.2016.11.07 PMID: 27942408; PMCID: PMC5124596.
  3. Wald O., Islam I., Amit K., Ehud R., Eldad E., Omer O., et al. 11-year experience with Chest Wall resection and reconstruction for primary Chest Wall sarcomas. J Cardiothorac Surg. 2020; 15 (1): 29. DOI: https://doi.org/10.1186/s13019-020-1064-y PMID: 31992336; PMCID: PMC6988268.
  4. Huang S.C., Chen C.Y., Qiu P., Yan Z.M., Chen W.Z., Liang Z.Z., et al. Reconstruction of complex chest wall defects: A case report. World J Clin Cases. 2022; 10 (11): 3505–10. DOI: https://doi.org/10.12998/wjcc.v10.i11.3505 PMID: 35582050; PMCID: PMC9048570.
  5. Colella S., Brandimarte A., Marra R., Marinari S., D'Incecco A., Di Genesio Pagliuca M., De Vico A., Crisci R., Divisi D. Chest wall reconstruction in benign and malignant tumors with non-rigid materials: An overview. Front Surg. 2022; 9: 976463. DOI: 10.3389/fsurg.2022.976463.
  6. Korymasov E.A., Medvedchikov-Ardiya M.A., Benyan A.S. Combined myo- and omentoplasty of the anterior chest wall. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 131–6. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-131-136
  7. Chiappetta M., Facciolo F. Sternum reconstruction using titanium plates matched with «sandwich» Gore-Tex meshes. J Vis Surg. 2018; 4: 47. DOI: https://doi.org/10.21037/jovs.2018.02.12 PMID: 29682457; PMCID: PMC5897679.
  8. Baumann D.P., Butler C.E. Component separation improves outcomes in VRAM flap donor sites with excessive fascial tension. Plast Reconstr Surg. 2010; 126 (5): 1573–80. DOI: https://doi.org/10.1097/PRS.0b013e3181ef8d00
  9. Medvedchikov-Ardiya M.A., Lysov N.A., Korymasov E.A., Benyan A.S. A method for plasty of a chest wall defect with a full-thickness skin-subcutaneous-fascio-muscular flap on the superior epigastric artery. RF patent for the invention No. 2765632. 01.02.2022. Bull. No. 4. (in Russian).
  10. Mortada H., AlNojaidi T.F., AlRabah R., Almohammadi Y., AlKhashan R., Aljaaly H. Morbidity of the donor site and complication rates of breast reconstruction with autologous abdominal flaps: A systematic review and meta-analysis. Breast J. 2022; 2022: 7857158. DOI: https://doi.org/10.1155/2022/7857158 PMID: 35847769; PMCID: PMC9249529.
  11. Momoh A.O., Colakoglu S., Westvik T.S., Curtis M.S., Yueh J.H., de Blacam C., et al. Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg. 2012; 69 (1): 19–23. DOI: https://doi.org/10.1097/SAP.0b013e318221b578 PMID: 21659842.
  12. Schellerer V.S., Bartholomé L., Langheinrich M.C., Grützmann R., Horch R.E., Merkel S., et al. Donor site morbidity of patients receiving vertical rectus abdominis myocutaneous flap for perineal, vaginal or inguinal reconstruction. World J Surg. 2021; 45 (1): 132–40. DOI: https://doi.org/10.1007/s00268-020-05788-5 Epub 2020 Sep 29. PMID: 32995931; PMCID: PMC7752873.
  13. Espinosa-de-Los-Monteros A., Avendano-Peza H., Novitsky Y.W. Abdominal closure after tram flap breast reconstruction with transversus abdominis muscle release and mesh. Plast Reconstr Surg Glob Open. 2016; 4 (9): e1014. DOI: https://doi.org/10.1097/GOX.0000000000001014 PMID: 27757337; PMCID: PMC5055003.

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Journals of «GEOTAR-Media»