Complex abdominal wall reconstruction after oncologic resection in a sequalae of giant omphalocele: A case report. (April 2021)

• Record Type: Journal Article
• Authors: Ritz, Frederica Jessie Tchoungui; Poumellec, Marie Anne; Maertens, Alexandra; Sebastianelli, Lionel; Camuzard, Olivier; Balaguer, Thierry; Iannelli, Antonio
• Is Part Of: International journal of surgery case reports. Volume 81(2021)
• Publication Date: 2021-04
• Subjects: ADM Acellular dermal matrix -- ALD flap autologous latissimus dorsi flap -- ALT flap antero lateral thigh flap -- AWD abdominal wall defect -- BWS Beckwith-Wiedemann syndrome -- CAWD complex abdominal wall defect -- CT scan computed tomography -- GO giant omphalocele -- HIV human immunodeficiency virus -- HBV hepatitis B virus -- HCV hepatitis C virus -- ISOWATS PL (Identification and diagnosis of postoperative fistula, Sepsis and Source Control, Optimization of Nutrition, Providing and Ensuring Wound Care, Redefining the Anatomy and understanding the pathology at hand, Timing of definitive surgery and/or takedown of fistulas, Definitive Surgery and surgical creativity, Postoperative care, Long-term follow-up) -- MDT Multidisciplinary Team -- NPWT Negative Pressure Wound Therapy -- TDAP flap thoraco dorsal artery perforator flap -- TFL flap tensor fascia lata flap -- US ultra sound; Abdominal wall reconstruction -- Hepatoblastoma -- Omphalocele -- Negative Pressure Wound Therapy -- Acellular dermal matrix; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105707
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Giant liver congenital anterior abdominal wall defect untreated in adulthood. Hepatoblastoma in adult. Large full-thickness complex abdominal wall defect after oncologic resection. Surgical experience of the team on the integrity and functional prognostic of the abdominal wall reconstruction. Place of the combined acellular dermal matrix and skin graft as a permanent solution in abdominal wall reconstruction. Abstract: Introduction: Trauma injuries and oncologic resection are common aetiologies of complex abdominal wall defect. Reconstruction of abdominal wall is an everlasting question for general, paediatric and reconstructive surgeons. The plethora of techniques, bioprosthetic and engineered tissues offer countless possibilities. Presentation of case: The patient was a 28 years old woman, with past history of untreated giant liver omphalocele, admitted for a suspicious hepatic tumefaction without specific clinical signs. The thoraco abdominopelvic CT scan revealed lung metastasis and a bilobed left hepatic tumour. Pre-operative cytologic findings of mild differentiated hepatocellular carcinoma differed from the post-operative findings of hepatoblastoma. The full-thickness abdominal wall defect after a radical resection was reconstructed with a combined acellular dermal matrix, NPWT and skin graft solution. A total epithelization was obtained after 8 weeks follow-up. Discussion: Hepatoblastoma in adult is rare, with no consensus. A radical resection in context of giant untreated omphalocele is an unusual challenge for the surgical team. The pre-operative evaluation, the defect classification and the general conditions of the patient are paramount steps for an appropriate reconstruction. Primary or delayed reconstruction with myocutaneous flap as gold standard, depends on the oncologic management and anticipated post-operative complications. Acellular dermal matrix used for a bridged fascial repair directly on viscera and covered by NPWT, favourited a healthy granulation tissue. The full-thickness defect was then reconstructed with an ADM, NPWT and skin graft instead of an association with the myocutaneous flap. The patient follow-up was emphasized in the hepatoblastoma, but the complications of this reconstruction strategy are unknown. A total epithelization was obtained, the abdominal bulge or hernia is the first complication under surveillance. Conclusion: Delayed reconstruction after an oncologic large abdominal wall resection has the advantage to manage post-operative complications and prepare alternative solutions. Acellular dermal matrix was not first designed for skin tissue regeneration, some authors as us experimented the conclusion that this matrix could be used for permanent abdominal wall reconstruction.