Free Tissue Transfer for the Reconstruction of Recurrent Incisional Hernias; an Alternate Approach to an Increasingly Common Problem
Gregory A. Lamaris, MD, PhD, Paul Durand, MD, Rafael A. Couto, MD, Raffi Gurunluoglu, MD, Brian Gastman, MD.
The Cleveland Clinic Foundation, Cleveland, OH, USA.
Ventral incisional hernias represent a common surgical challenge. Fascial defects lacking adequate overlying soft tissue represent the most complex cases, frequently requiring local or remote flaps for reconstruction. We reviewed our experience in the management complex abdominal wall defects using free tissue transfer.
We performed a retrospective review of all recalcitrant ventral incisional hernias managed by free tissue transfer over the last 5 years. In our study we included patients that treated with a free muscular or a musculocutaneous flap containing vascularized fascia. In all identified cases we collected information regarding patient demographics, previous hernia repairs, type of flap used and long term outcome.
A total of 7 patients with recurrent ventral incisional hernias treated with free tissue transfer were identified. All patients had an average of five or more prior abdominal operations or hernia repairs before free flap reconstruction. Five patients were treated with an anterolateral thigh flap with vascularized fascia lata used to bridge the fascial defect. Two patients were treated with a free latissimus dorsi muscle flap over biologic mesh. In all cases, the inferior epigastric artery and vein were used as recipient vessels. Albeit minor wound complications, all patients achieved excellent long-term outcomes with no recurrences more than a year post operatively.
We propose an alternate approach to abdominal wall reconstruction in the setting of recurrent ventral incisional hernias; free flaps provide healthy, well-vascularized, autologous tissue that can restore abdominal wall contour and cover full-thickness defects in a single stage.
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