Reconstruction of Abdominal Defects After Open Abdomen Treatment Using Propeller Flaps of the Superior and Deep Inferior Epigastric Artery System: Report of Two Cases.

Abstract

Open abdomen treatment (OAT) is associated with significant morbidity and mortality. In cases where primary or delayed fascial closure cannot be achieved, vacuum-assisted wound closure and mesh-mediated fascial traction are indicated, which often result in a planned ventral hernia. If secondary skin closure is not feasible, common treatment of granulated abdominal defects involves split-thickness skin-grafting or healing by secondary intention leading to significant scarring and sometimes mutilating defects. Late enteroatmospheric fistulae may develop as a result of instable scar tissue or insufficient soft tissue coverage. Perforator propeller flaps have been described for reconstruction of soft tissue defects of the abdomen; however, not for OAT-induced abdominal defects. We report two complex cases of OAT-induced abdominal wall defects of 20 × 8 and 22 × 10 cm, which were reconstructed with a propeller flap based on the superior epigastric artery perforator in the first case and the deep inferior epigastric artery perforator in the second case. The flaps were rotated into each of the abdominal defects following the propeller flap concept with primary closure of the donor sites and successful reconstruction of both defects. At 1-year follow-up, both patients developed asymptomatic incisional ventral hernias. Secondary-stage abdominal wall reconstruction was not considered due to satisfaction with the reconstructive result and feared complications. Pedicled perforator flaps designed based on either the superior or deep inferior epigastric artery system are useful reconstructive options for midline abdominal defects without necessity for pedicle lengthening, microsurgical anastomosis, or another donor site beyond the abdomen. In conclusion, soft tissue coverage of OAT-induced abdominal defects in critically ill patients can be achieved with the presented propeller flaps avoiding poor results of skin grafting or secondary intention healing.