Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

T Pruimboom,S S Qiu,E Bijkerk,R R W J Van Der Hulst,S O Breukink,I B M Ploegmakers

doi:10.1007/s10029-020-02167-w

T Pruimboom, S S Qiu + Show 4 more

Open Access

https://doi.org/10.1007/s10029-020-02167-w

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Journal: Hernia	Publication Date: Mar 26, 2020
Citations: 2	License type: open-access

Affiliation: Maastricht University

Abstract

PurposeNo previous study reported the use of a fasciocutaneous anterolateral thigh (ALT) flap combined with a biological mesh for abdominal wall reconstruction (AWR) after enterocutaneous fistula (ECF) in a single-staged procedure and the use of Indocyanine Green Angiography (ICGA) intraoperatively. The purpose of this study was to determine the feasibility and safety of this procedure and to examine the added value of ICGA in minimizing postoperative complications.MethodsA single-institution review of a prospectively maintained database was conducted at Maastricht University Medical Center. To evaluate the feasibility and safety of this procedure, early (≤ 30 days) and late (> 30 days) postoperative complications were assessed. ECF recurrence was considered the primary outcome. To examine the added value of ICGA, complications in the ICGA group and the non-ICGA group were compared descriptively.ResultsTen consecutive patients, with a mean age of 66.7 years, underwent a single-staged AWR with fasciocutaneous ALT flaps. Mean follow-up was 17.4 months (4.3–28.2). Two early ECF recurrences were observed. Both restored without the need for reoperation. A lower rate of early complications was observed in the ICGA group compared to the non-ICGA group.ConclusionThe combination of a biological mesh and fasciocutaneous ALT flap is feasible and safe in AWR after ECF repair in a single-staged approach, with an acceptable complication rate in a cohort of complex patients operated in a dedicated center. ECF closure was achieved in all patients. ICGA seems to be of great added value in minimizing postoperative complications during AWR.

Highlights

An enterocutaneous fistula (ECF) is defined as an unnatural communication between the gastrointestinal tract and the skin
A total of ten consecutive patients underwent singlestaged abdominal wall reconstruction (AWR) with a fasciocutaneous Anterolateral thigh (ALT) flap combined with biological mesh after ECF resection
This patient was known with psychiatric complaints that were not related to the abdominal wall reconstruction

Summary

Introduction

An enterocutaneous fistula (ECF) is defined as an unnatural communication between the gastrointestinal tract and the skin. The ALT flap is well described and is found to be a feasible autologous tissue flap for reconstruction of various abdominal defects [11,12,13,14], there is a paucity in the literature concerning ALT flaps in AWR after ECF resection [3, 7, 15,16,17]. Since a biological mesh has the advantage of reconstructing abdominal fascia in a contaminated area and an ALT flap has the advantage of restoring a complex and large abdominal wall defect, the combination of both seems feasible in these complex ECF cases. The combination of a musculocutaneous ALT flap and a biological mesh has recently been reported in a single-staged AWR after ECF resection [3]. This innovative technique allows for real-time imaging of tissue perfusion and aids in performing accurate excision of non-vital tissue intraoperatively [18, 19]

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