Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management

Shigeki Kushimoto, Yasuhiro Yamamoto, Junichi Aiboshi, Futoshi Ogawa, Yuichi Koido, Ryusuke Yoshida, Makato Kawai

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Many patients requiring conventional open abdominal management need a postoperative intermediate period with a large ventral hernia. This situation, in which the granulated abdominal contents are covered only with a skin graft, carry with it a high risk of enterocutaneous fistula, and the patients ultimately require late-stage abdominal wall reconstruction. Early abdominal wall reconstruction in noncandidates for standard fascial closure has received little attention. In this study we used bilateral anterior rectus abdominis sheath turnover flaps for early fascial closure which, to date, has not been evaluated as a technique for early fascial closure. Methods: Eleven trauma and 18 nontrauma cases requiring open abdominal management over a 7-year period were reviewed. Bilateral anterior rectus abdominis sheath turnover flaps were created by longitudinal incisions along the lateral edge of the anterior rectus sheath, which were mobilized medially and approximated. The skin was closed primarily. Results: Twelve nontrauma and eight trauma patients survived. No enteric fistula or abdominal abscess occurred. Anterior rectus sheath turnover flaps were used in nine of the 18 nontrauma and two of the 11 trauma patients, all of whom were unsuitable for standard fascial closure of prolonged visceral edema; the respective mean intervals from initial laparotomy to fascial closure were 9.4 and 18 days. Of the 11 patients with flaps, ten survived without fascial dehiscence or herniation (maximum follow-up: 65 months). Conclusions: Early fascial closure using the anterior rectus abdominis sheath turnover flap may reduce the need for skin grafting and subsequent abdominal wall reconstruction. This approach can be considered as an alternative technique in the early management of patients with open abdomen.

Original languageEnglish
Pages (from-to)2-8
Number of pages7
JournalWorld Journal of Surgery
Volume31
Issue number1
DOIs
Publication statusPublished - 2007 Jan 1
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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