Combined serratus anterior and latissimus dorsi myocutaneous flap for obliteration of an irradiated pelvic exenteration defect and simultaneous site for colostomy revision

World Journal of Surgical Oncology

Case Report

Kenji Hayashida¹  Hiroto Saijo¹  Sin Morooka¹  Masaki Fujioka¹  Takashi Nonaka² 

[1] Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Kubara 2, 1001-1856-8562, Ohmura City zip, Japan;Department of Surgery, National Hospital Organization Nagasaki Medical Center, Kubara 2, 1001-1856-8562, Ohmura City zip, Japan;

关键词: Free Flap;    Necrotizing Fasciitis;    Radical Hysterectomy;    Pelvic Cavity;    Abdominal Wall Defect;   

DOI  :  10.1186/1477-7819-12-319

 received in 2013-08-30, accepted in 2014-10-01,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundUsually, several surgical methods are used, with re-suturing, free skin grafting and local flaps, for the reconstruction of wall defects after abdominoperineal resection. However, or larger defects, free flaps have been preferred because they can provide a large area of well-vascularized soft tissue, which is suitable for defect repair. We present the case of a large abdominal wall defect, which was treated with a free combined serratus anterior and latissimus dorsi myocutaneous flap, resulting in a successful outcome.Case presentationA 38-year-old female originally had squamous cell carcinoma of the cervix uteri, and had undergone radical hysterectomy and oophorectomy followed by radiotherapy. She had a recurrence of the cervical cancer after 13 years, and underwent pelvic exenteration. However, the mid-abdominal wound developed dehiscence and an abdominal full-thickness defect communicating with the pelvic cavity. Furthermore, the adhered colon developed necrosis, which drained stools into the pelvic cavity, resulting in chronic peritonitis. During surgery, the empty pelvic cavity was filled with a combined serratus anterior and latissimus dorsi myocutaneous flap to prevent chronic peritonitis, to create a new stoma in the skin paddle of the flap for the necrotic colon, and to separate the pelvic cavity from the drained stools. The patient could walk in the absence of abdominal hernia formation and relapse of infection.ConclusionsA combined serratus anterior and latissimus dorsi myocutaneous free flap was applied to cover the raw surface and reinforce the abdominal wall and to fashion a new colostomy, as well as successfully filling the pelvic cavity with a large muscle body and long vascular pedicle. This is the optimal method for reconstructing severe abdominal wall defects that have many complications.

【 授权许可】

CC BY   
© Fujioka et al.; licensee BioMed Central Ltd. 2014