Post-Oncologic Abdominal Wall Reconstruction: Mesh Versus Autologous Tissue
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PLASTIC SURGERY (M HANASONO & E CHANG, SECTION EDITORS)
Post-Oncologic Abdominal Wall Reconstruction: Mesh Versus Autologous Tissue Reem Karami1
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Fadi Ghieh1
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Amir Ibrahim1
Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review is to summarize and sum up the recent evidence on the topic of abdominal wall reconstruction post oncologic resection, comparing the use of mesh versus autologous reconstruction. Recent Findings Recent findings show a more accepting approach towards more complex reconstructions that aim at a dynamic and robust abdominal wall reconstruction. Musculocutaneous free flaps using the anterolateral thigh flap, with a vastus lateralis, or the latissimus dorsi flap are being used more for replacing musculo-fascial and fullthickness defects to restore abdominal domain. Those autologous reconstructions are best combined with a mesh for robust musculo-fascial layer closure. Different mesh options are available for different cases depending on defect and the contamination status of the wound. Summary Post-oncologic abdominal wall reconstruction is a complex procedure that should be well planned in multidisciplinary teams. The surgical options should be set up on a case-by-case basis weighing the different benefits and risks of autologous, mesh, or combined reconstruction. The
Reem Karami and Fadi Ghieh contributed equally to this work. This article is part of the Topical Collection on Plastic Surgery. & Amir Ibrahim [email protected] Reem Karami [email protected] Fadi Ghieh [email protected] 1
Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
more robust the reconstruction, the less complications encountered, especially with hernia formation rates. Keywords Abdominal wall reconstruction Abdominal wall tumors Oncologic resection Abdominal wall defects
Introduction Oncologic excision an abdominal wall tumor often involves an en bloc resection of the neoplasm, along with a margin of normal tissue, creating a full-thickness defect in the abdominal wall [1]. There is an immediate need for coverage of exposed organs and vital structures in the abdominal cavity [2]. Reconstruction of the abdominal wall is of central importance, frequently necessitating intervention from a Plastic surgeon. The reconstructive surgeon needs to address both soft tissue coverage and abdominal wall support to prevent herniation of the abdominal viscera. Proper preoperative planning is essential. Patient factors such as body habitus, previous abdominal surgeries, medical comorbidities, and previous radiation therapy need to be considered. Defect factors should also be well-thoughtout as defects can differ significantly in complexity. It is vital to assess the size and depth of the defect, its location, and its composition [3]. A thorough understanding of the abdominal wall anatomy and proper surgical planning are essential for a successful recons
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