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Upper Abdominal Wall Reconstruction
Clinical Presentation
A 36-year-old White male sustained extensive thermal burn and had excisions and skin graft procedures on his trunk, axilla, and upper extremity. He also developed compartment syndrome and subsequently underwent a decompression procedure for compartment syndrome release. He unfortunately developed a large ventral hernia and previous abdominal wall reconstructions by the general surgery service failed. The plastic surgery service was asked by the primary service to perform a soft tissue coverage to the potential upper abdominal defect with exposed mesh after abdominal wall reconstruction ( Fig. 26.1 ). Because this patient had extensive burns over the trunk and had previously undergone a component separation procedure, there was no abdominal muscle or other flap that could safely be harvested to cover this potential soft tissue defect.
Operative Plan and Special Considerations
In this patient with a significantly large, healed skin graft over his trunk, a good soft tissue coverage to the upper abdomen after a mesh placement for abdominal wall ventral hernia repair was challenging because there was no local or distant flap that could be used for soft tissue reconstruction. A free latissimus dorsi myocutaneous flap could be selected to provide a good and reliable soft tissue coverage for potentially exposed mesh after abdominal wall reconstruction. The right internal mammary vessels at the third or fourth intercostal space could serve as recipient vessels for microvascular anastomoses. The right internal mammary vein is usually larger than the left, but a preoperative duplex scan could be performed to ensure good size and flow of those recipient vessels. The surgeons should anticipate some difficulties for the recipient vessel dissection.
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