We report the reconstruction of a complex abdominal-wall defect using expanded skin from pregnancy. Wound closure was achieved using a vertical abdominoplasty.
The use of tissue expansion for the reconstruction of defects in the abdominal wall is well described.
- Carlson G.W
- Elwood E
- Losken A
- Galloway J.R
The role of tissue expansion in abdominal wall reconstruction.
Ann Plast Surg. 2000; 44: 147-153
- Paletta C.E
- Huang D.B
- Dehghan K
- Kelly C
The use of tissue expanders in staged abdominal wall reconstruction.
Ann Plast Surg. 1999; 42: 259-265
3.We report an unusual case of abdominal-wall reconstruction making use of pregnancy as an autologous tissue expander.
- Livingston D.H
- Sharma P.K
- Glantz A.I
Tissue expanders for abdominal wall reconstruction following severe trauma: technical note and case reports.
J Trauma. 1992; 32: 82-86
1. Case report
A 33-year-old woman was admitted with an abdominal-wall desmoid tumour measuring 15 cm×8 cm. After tumour resection, the abdominal-wall defect was closed using a free latissimus dorsi myocutaneous flap over a mesh repair. The flap did not survive and was removed 24 h postoperatively. Twelve days later there was sufficient granulation tissue over the mesh to apply a skin graft and thereby close the wound. She was discharged for outpatient management with an abdominal support.
Seven months after this surgery, she presented to the clinic 2 months pregnant. There was a small discharging wound overlying the distal end of the mesh. It was decided to effect definitive wound closure after delivery using the laxity of the expanded abdominal wall.
Two days after a normal full-term vaginal delivery there was sufficient laxity in the abdominal wall to allow surgical closure using a vertical abdominoplasty (Fig. 1(A) and (B)) . The skin graft and mesh were excised in an ellipse, and the expanded full-thickness abdominal walls were elevated and advanced medially as laterally based flaps (Fig. 1(C)). Her postoperative course was uneventful, and the wound healed without complication. She was discharged after 10 days. Examination at 3 months revealed a stable scar with no evidence of abdominal-wall hernia (Fig. 1(D)). The cosmetic appearance was satisfactory to the patient.
Defects of the abdominal wall greater than 15 cm in size can ideally be closed by tissue expansion after temporary control using a skin graft.
4.The potential for significant tissue gain by using expanders in growing infants was exploited by Zuker et al in 1986 when they described the insertion of intra-abdominal tissue expanders for the reconstruction of major abdominal-wall defects arising from the separation of ischiopagus conjoined twins.
- Argenta L.C
- Marks M.W
- Pasyk K.A
Advances in tissue expansion.
Clin Plast Surg. 1985; 12: 159-171
- Zuker R.M
- Filler R.M
- Lalla R
Intra-abdominal tissue expansion: an adjunct in the separation of conjoined twins.
J Pediatr Surg. 1986; 21: 1198-1200
Pregnancy has all the characteristics of an ideal tissue expander—it is autologous, there is a good blood supply, expansion is gradual and there is no risk of infection or implant extrusion. In this case the symmetrical distribution of the full-thickness tissue expansion aided the closure of a midline abdominal defect. The use of pregnancy as an autologous tissue expander has been reported once before, when a massive ventral hernia was closed after a normal pregnancy.
6.Similarly, in our case the pregnancy provided an ideal solution to a complex reconstructive problem.
- Elwood E.T
- Ingram W.L
- Carlson G.W
Pregnancy as a tissue expander in the repair of a massive ventral hernia.
Ann Plast Surg. 2000; 45: 431-433
This case is a reminder to reconstructive surgeons of the potential advantages of using tissue expansion in abdominal reconstruction.
- The role of tissue expansion in abdominal wall reconstruction.Ann Plast Surg. 2000; 44: 147-153
- The use of tissue expanders in staged abdominal wall reconstruction.Ann Plast Surg. 1999; 42: 259-265
- Tissue expanders for abdominal wall reconstruction following severe trauma: technical note and case reports.J Trauma. 1992; 32: 82-86
- Advances in tissue expansion.Clin Plast Surg. 1985; 12: 159-171
- Intra-abdominal tissue expansion: an adjunct in the separation of conjoined twins.J Pediatr Surg. 1986; 21: 1198-1200
- Pregnancy as a tissue expander in the repair of a massive ventral hernia.Ann Plast Surg. 2000; 45: 431-433
Colin L. Riordan AFRCSI, Registrar
Padraic J. Regan FRCS(Plast), Consultant Plastic and Reconstructive Surgeon
Department of Plastic, Reconstructive and Hand Surgery, University College Hospital, Galway, Ireland
Peter G. Budny FRCS(Plast), Consultant Plastic and Reconstructive Surgeon
Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, UK
Accepted: November 28, 2002
Received: May 22, 2002
© 2003 The British Association of Plastics Surgeons. Published by Elsevier Inc. All rights reserved.