Background:Reconstruction of the vulva, vagina, and buttocks following cancer ablation is challenging. Restoring the shape, volume, and function is the key to the best reconstruction for these regions. Perineal reconstruction with a free-style flap based on skin perforators from the internal pudenda

The internal pudendal artery perforator flap: free-style pedicle perforator flaps for vulva, vagina, and buttock reconstruction.

Background Reconstruction of the abdominal wall continues to be a challenging problem for plastic surgeons. Transposition of well-vascularized flap tissue is the most effective way to repair composite abdominal wall defects. We retrospectively reviewed the treatment of such patients and assessed the reconstructive technique using combination of an inlay of bioprosthetic materials and a united thigh flap. Methods A retrospective review of patients' records in the department was carried out. In total, 16 patients who underwent immediate abdominal wall reconstruction between 2000 and 2013 were identified. Patients' health status, defect sizes, and surgical technique were obtained from medical charts. Results The immediate reconstruction surgery of the abdominal wall was successful in all patients. One patient with dermatofibrosarcoma protuberans experienced recurrences at the former site. One patient died because of liver metastases at 21 months after surgery. No incisional hernia or infection in this series of patients was observed. Conclusion Full-thickness, giant defects of the complicated abdominal wall can be repaired successfully with relatively minor complications using this reconstructive technique.

Abdominal wall reconstruction using a combination of free tensor fasciae lata and anterolateral thigh myocutaneous flap: a prospective study in 16 patients.

Purpose

Extended and full-thickness abdominal wall defects are commonly reconstructed using free flaps. Published surgical outcomes involving the latissimus dorsi (LD) free flap procedure are limited and are less numerous than those with free flaps involving the thigh. The aim of this report was to describe the immediate and long-term evaluation of complex abdominal wall reconstruction using a LD free flap with mesh.



Patients and Methods

Between 2005 and 2013, nine patients with extended malignant tumors of the abdominal wall underwent surgeries. After the surgical resection, the mean defect size was 385 cm2 (range: 190–650 cm2). Full-thickness abdominal wall reconstruction was performed with a combination of LD free flaps and meshes. The immediate and long-term outcomes were assessed regarding the complications, sustainable strength of the abdominal wall and cancer recurrence.



Results

The meshes measured 927 cm2 in average (range: 500–1036 cm2). Eight Parietex Composite® and 1 Bard Collamend Implant® were used. No donor site complications occurred, and complete LD flap survival was achieved without partial necrosis or thrombosis. One obese patient who received a porcine dermis mesh developed an eventration four days postoperatively and exhibited a limited amount of abdominal skin necrosis around the flap. Two patients died from cancer evolution. After a mean follow-up of 60.4 months (range: 29–94 months), clinical evaluation of the abdomen revealed 2 patients without anomalies, 4 cases of abdominal bulging without functional discomfort and 1 case of major abdominal distension.



Conclusions

Complex abdominal reconstruction with LD free flap and mesh allows extended satisfactory coverage with a low incidence of flap and donor site complications. However, patients should be advised of the significant risk of abdominal bulging. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection

Resume Le lymphome anaplasique a grandes cellules (LAGC) est une pathologie rare, son incidence aux Etats-Unis est de un cas pour 500 000 femmes et de trois pour 100 millions de patientes pour la seule localisation mammaire. Quarante-six cas ont ete recenses dans la litterature. Ils peuvent se developper sur tout type d’implant : expandeur, prothese en silicone et serum physiologique, enveloppe lisse ou texturee. Actuellement, le consensus de traitement comprend la capsulectomie, l’ablation de l’implant, la chimiotherapie et la radiotherapie. Cependant, certains auteurs le classent dans le cadre de pathologie indolente, mais nous pensons que certains cas peuvent echapper a toute therapeutique et deviennent des formes tres agressives. Il est donc important de faire un diagnostic precoce et commencer un traitement en urgence. Sa gravite et la suspicion du caractere iatrogene ont fait du LAGC une obligation d’information des futures porteuses d’implants.

À propos de deux cas de lymphome mammaire sur coque périprothétique : un diagnostic difficile ; une pathologie méconnue

Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management. Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months). All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences. Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.

Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life.

Management of the perineal wound after abdominoperineal resection.

Reconstruction of a full-thickness abdominal wall defect using an anterolateral thigh free flap.

Resume Une nouvelle controverse est recemment apparue sur le lien qui existerait entre les protheses mammaires et l’apparition de lymphome T anaplasique a grandes cellules (LAGC). Afin d’en preciser la nature, nous avons realise une analyse de la litterature reprenant l’ensemble des articles publies entre 1991 et 2011. Nous avons pu identifier 41 cas de LAGC publies. L’âge moyen d’apparition etait de 51 ans avec un intervalle de 108 mois en moyenne entre la pose de l’implant et le diagnostic. Dans plus de 60 % des cas, il s’agissait d’une augmentation mammaire esthetique. Cependant, au terme de l’analyse, aucune des cohortes ou des meta-analyses etudiees n’a pu etablir un lien entre les protheses mammaires et le risque de LAGC. Au terme de cette revue, il semble que le chirurgien peut rassurer la patiente sur la faible incidence des cas rapportes et son caractere indolent, cependant, il doit rester vigilant devant un epanchement periprothetique tardif ou une tumefaction mammaire. La prise en charge chirurgicale apparait indispensable tant dans la demarche diagnostique que therapeutique, en particulier par la caracterisation ALK negatif et CD30 positif de ce lymphome.

Prothèse mammaire et lymphome T anaplasique à grandes cellules : que savons-nous ?

Lambeau perforant libre de cuisse pour reconstruction d’une perte de substance transfixiante de la paroi abdominale☆

Prise en charge des pertes de substance périnéales après amputation abdominopérinéale

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