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To bulge or not to bulge: Rectus abdominis functional reconstruction after soft tissue sarcoma resection

Published:November 23, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.051

      ABSTRACT

      Abdominal wall soft tissue sarcomas patients have a high rate of postoperative complications such as fistulas, chronical mesh infection, or functional alterations. In terms of abdominal wall reconstruction, there are many surgical approaches: from the simplest with partial thickness skin grafts to more demanding techniques like free flaps.
      The main goal until now has been to achieve a stable coverage, but functional alterations (coughing, urinating, defecating, exercising, etc.) can affect the patient´s quality of life and it is not possible to prevent it without a dynamic coverage.
      For this reason, it is proposed a cross-innervated gracilis free flap with the iliohypogastric nerve to reconstruct functionally the rectus abdominis muscle in association with two meshes to replace the peritoneum (biological) and the transversalis fascia (polipropilene). Furthermore, apart from providing a stable coverage, it is pretended to restore a symmetrical abdominal wall contraction.
      Three patients with abdominal wall soft tissue sarcomas required unilateral rectus abdominis resection, with an immediate reconstruction with double mesh and a functional musculocutaneous gracilis free flap. At 6 months postoperatively, all patients presented clinically symmetrical abdominal wall contraction. One year postoperatively, a control electromyography (EMG) was performed over the reconstructed area, wherein two patients present active motor gracilis muscle reinnervation, and one could not be confirmed.
      Functional reconstruction is performed to replace anatomically and functionally all the abdominal wall layers. The main reconstructive objectives are to avoid local postoperative complications and to achieve a higher patient satisfaction.

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