USE OF THE “VERTICAL RECTUS ABDOMINIS MYOCUTANEOUS FLAP” MODIFIED FOR PELVIC RECONSTRUCTION AFTER TRAUMATIC REMOVAL OF THE HEMIPELVIS
DOI:
https://doi.org/10.53555/eijmhs.v6i1.133Keywords:
Pelvis trauma, pelvis reconstruction, rectus abdominis flap, fasciocutaneous flapsAbstract
Reconstructive surgery in case pelvis defect is a technical challenge. It takes into account the etiology, the general condition of the patient; the location and size of the defect. Pedicled musculocutaneous flaps is necessary in case of deep and large defect. The rectus abdominis flap is frequently used. Our observation demonstrates the difficulties and technical particularities of reconstructing a large traumatic defect. It is a rupture of the hemipelvis following a traffic accident, exposing the peritoneum, part of the bladder and the anal canal. The use of fasciocutaneous flap was doomed to necrosis. Our recourse was the use of the "vertical rectus abdominis myocutaneous flap" (VRAM) by making a technical modification. The muscle was dissected separately from the fascia. This allowed us to spread it out and cover a wider area. Complete cutaneous coverage was provided by using two fasciocutaneous flaps: hypogastric and perineal. Good healing was obtained, and the patient received a prosthesis.
References
. Dodd A.C, Bulka C, Jahangir A, Mir H.R, Obremskey W.T et al. Predictors of 30 day mortality following hip/pelvis fractures. Orthopedics and traumatology : surgery and research 2016 ; 102 : 707-10
. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures : epidemiology and predictors of associate abdominal injuries and outcomes. J Am Coll Surg 2002 ; 195 :1-10
. Ramasamy A, Evans S, Kendrew J.M, Cooper J. The open blast pelvis : teh significant burden of management . J Bone Joint Surg Br 2012 ;94 :829-35
. Bodin F, Brunat-Rodier C. Techniques de reconstruction pelvienne. Encycl Med Chir – techniques chirurgicales – chirurgie plastique, reconstructrice et esthétique 2015 ; 45-685
. Molière S, Dosch J-C, Bierry G. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist. Diagnostic and Interventional Imaging 2016 ; 97, 709—723
. Grotz M.R, Allami M.K, Harwood P et al. Open pelvic fractures : epidemiology, current concepts of management and outcome. Injury 2005 ;36(1) :1-13
. Dente C.J, Feliciano D.V, Rozycki G.S et al. The outcome of open pelvic fractures in the modern rea. Am J Surg 2005 ;190(6) :830-5
. Milton SH. Pedicled skin-flaps: the fallacy of the length: width ratio. Br J Surg 1970;57:502–8.
. Tonetti J. Management of recent unstable fractures of the pelvic ring. An update Conference supported by the Club Bassin Cotyle. (Pelvis-Acetabulum Club). Encycl Med Chir, Orthopaedics & Traumatology: Surgery & Research 2013 ; 99S : 77—86
. Taylor G.I, Corlett R.J, Boyd J.B. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg 1984 ;37 :330-50
. Taylor G.I, Corlett R.J, Boyd J.B. The extend deep inferior epigastric flap : a clinical technique. Plast Reconstr Surg 1983 ;72 :751-65
. Butler C.E, Gündeslioglu A.O, Rodriguez-Bigas M.A. Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects. J Am Coll Surg 2008 ;206 :694-703.
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