Lamiaa Bensaida, Samir Elmazouz, Nourredine Gharib, Abdellah Abbassi
DOI: 10.5455/IJMRCR.mc-gregor-flap-reconstruction
How to cite this article:
| Lamiaa Bensaida, Samir Elmazouz, Nourredine Gharib, Abdellah Abbassi. An original reconstruction of a full thickness defect secondary to a parietal invading bladder tumor. Int J Med Rev Case Rep. 2018; 2(1): 1-3. doi:10.5455/IJMRCR.mc-gregor-flap-reconstruction |
What is it about?
Large abdominal wall defects are typically repaired with microsurgical flaps. When microsurgery is not a viable option, two pedicled flaps can be joined together.
Case report:
We present the case of a patient with an invading parietal bladder tumour. At the time, he was 42 years old, married, and childless. He was a low-income small-boat fisherman.
This heavy smoker first complained of lower abdominal pain and hematuria in May 2012. An ultrasound examination disclosed the presence of a large bladder stone. A general surgeon operated on the patient in his small-town hospital in January 2013.
During this initial procedure, the surgeon identified a vesical tumour. A biopsy revealed the presence of an invasive urothelial cancer. At this juncture, the general surgeon referred the patient to the urology department of the university hospital. Seven months later, for social reasons (lack of health insurance and education), the patient presented to our urology department.
At this juncture, a clinical examination revealed a hypogastric mass with an apparent parietal extension measuring 8 cm in diameter. The uroscan revealed a 7x8 cm bladder tumour with localised parietal invasion that was centred on the previous bladder incision. The urology team performed a radical cystoprostatectomy with a monobloc abdominal wall resection. The two-stage latissimus dorsi (LD) free flap "chausson au pommes" was the most logical choice for reconstructing the parietal defect. LD free flap was not performed, however, due to the patient's smoking behaviours and reluctance to undergo a two-stage microsurgery. Due to the transfixing nature and extent of the defect, we chose to combine two pedicled flaps: a McGregor flap and a fascio-cutaneous TFL flap. Epiplooplasty and a non-absorbable membrane were used to cover the neobladder. Two openings were sewn directly onto the synthetic mesh. The histological examination of the resected specimen confirmed the thorough and extensive removal of the tumour.
Three days after surgery, the distal extremity of the fascia lata flap exhibited limited venous stasis. To prevent necrosis and plaque exposure, we performed a minor revision surgery under local anaesthesia: the affected area was excised, and the laxity of the remainder of the flap permitted a direct closure without tension. After four weeks, complete healing was attained. Oncology was referred the patient for adjuvant chemotherapy. The patient has been routinely seen by the oncologist, plastic surgeon, and urologist for the past four years: every two months in the first year, and every six months since. There were no local recurrences or metastases found. We suggested redesigning the flaps to enhance the aesthetic outcome, but the patient declined and was content with the outcome. Even his usual activities (jogging, fishing) were resumed ten months after the intervention and three months after the last chemotherapy session. His primary complaint, however, was the sexual dysfunction caused by the radical cystoprostatectomy.
Key points:
- For the reconstruction of full-thickness sub-umbilical abdominal wall defects in smokers, the combination of the TFL flap and the inguinal flap may be a very attractive option.
- This approach can save lives in humanitarian missions and unplanned emergency reconstructions.
License CC BY-NC-SA 4.0
"A novel approach to the restoration of an abdominal wall defect in adults caused by parietal invasive bladder tumour" is a derivative of "An original reconstruction of a full thickness defect secondary to a parietal invading bladder tumor" by International Journal of Medical Reviews and Case Reports used under CC BY-NC-SA 4.0.
