Single-stage Abdominoplasty Using Groin Flaps Without Osteotomies: Management of Exstrophy-epispadias Complex - 31/08/18

Doi : 10.1016/j.urology.2018.07.001

Amilcar Martins Giron ^a, Marcos Figueiredo Mello ^a, Ricardo Haidar Berjeaut ^a,^⁎ , Marcos Giannetti Machado ^a, Gabriel Carvalho dos Anjos Silva ^a, Bruno Nicolino Cezarino ^a, Lorena Marçalo Oliveira ^a, Roberto Iglesias Lopes ^a,^b, Francisco Tibor Dénes ^a
^a Divisao de Urologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
^b Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

^⁎Address correspondence to: Ricardo Haidar Berjeaut, M.D., Divisao de Urologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, 7° andar, Urologia, 01414-001 São Paulo, Brazil.Divisao de UrologiaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloAv. Dr. Eneas de Carvalho Aguiar 255, 7° andar, UrologiaSão Paulo01414-001Brazil

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 31 August 2018

Abstract

BACKGROUND AND OBJECTIVE

The optimal treatment for children born with exstrophy-epispadia complex is still a matter of debate.^{1Gearhart JP. Bladder exstrophy: staged reconstruction Curr Opin Urol 1999 ; 9 : 499-506

Cliquez ici pour aller à la section Références, 2Inouye BM, Tourchi A, Di Carlo HN, Young EE, Gearhart JP Modern management of the exstrophy-epispadias complex Surg Res Pract 2014 ; 2014 : 587064

Cliquez ici pour aller à la section Références}^,^{3Mitchell ME. Bladder exstrophy repair: complete primary repair of exstrophy Urology 2005 ; 65 : 5-8

Cliquez ici pour aller à la section Références} We demonstrate the Single-Stage Abdominoplasty using Groin Flap technique to close the abdominal wall of children with classic bladder exstrophy (CBE) without osteotomy neither radical soft tissue mobilization. Advantages over current techniques are less risk of penile tissue loss and avoidance of osteotomies.

MATERIAL AND METHODS

Abdominal wall repair consists in using the hypogastric skin, rectus, and obliquus externus abdominalis muscle fascial flaps. These groin flaps are rotated medially resulting in a very strong abdominal wall support. Groin flaps are made of rectus anterior fascia rotated medially, flipped over, and sutured with Prolene sutures to close the defect. By rotating the fascial flaps medially, complete reinforcement of the abdominal wall to the level of the pubic bone is achieved. This permits abdominal closure maintenance without tension.

Results

Groin flap was applied to 128 patients with CBE referenced from all over the country. Most of these patients returned to their home areas making difficult their follow up. However, we have 44 cases that have regular clinical visits. Mean follow-up was 10.3 ± 4.5 years (2 years 8 months-16 years). Successful closure was achieved in 43 patients (97.7%) as a single procedure; one patient had a complete wound dehiscence and needed another reconstruction (2.2%). Four patients (9.1%) presented abdominal hernias that needed surgical management. When continence is evaluated, we present similar literature rates (60%).^{4Giron AM, Mello MF, Carvalho PA, Moscardi PRM, Lopes RI, Srougi M One-staged reconstruction of bladder exstrophy in male patients: long-term follow-up outcomes Int Braz J Urol 2017 ; 43 : 155-162

Cliquez ici pour aller à la section Références}

Conclusion

Abdominal reconstruction using Groin flaps has advantages over the traditional approaches to CBE. It reduces the surgical steps and facilitates the closure of the abdominal wall without the need of osteotomies and consequent immobilization during the postoperative period. It is feasible at any age and can be also very useful as a salvage technique even after previous failed procedures. Finally, it minimizes the number of surgeries.

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Financial Disclosure: The authors declare that they have no relevant financial interests.