1. Rigshospitalet - University Hospital of Copenhagen
Department of Plastic Surgery, Breast Surgery and Burns Treatment
Department of Orthopaedic Surgery
Abdominal wall reconstruction with Strattice after iliac crest tumour removal
Jógvan S. Øregaard1, Werner Hettwer2 and Barbara Jemec1
1Department of Plastic Surgery, Breast Surgery and Burns Treatment
2Department of Orthopedic Surgery
Background:
Abdominal defects are challenging regarding both morbidity and surgical solutions. Usually large defects are repaired by use of a mesh and possibly a muscular component separation. Synthetic mesh materials have been widely used as have biological materials but the latter are sometimes better suitable, as they can tolerate infection and are incorporated into the host, thereby also making follow-up scans more readily interpretable. Biological materials are of human origin (e.g. Alloderm, FlexHD) or xenografts (Strattice, Permacol, Tutopatch).
Aim/Purpose of study:
To illustrate the potential use of Strattice in abdominal wall reconstruction after a substantial resection of the iliac crest.
MATERIALS AND METHODS:
A 38 year old female with a history of breast cancer was found to have a solitary bone metastasis in the left iliac crest by CT and MRI. Surgery was performed as a joint collaboration by orthopedic and plastic surgeons. The patient underwent resection of the metastasis from the iliac crest as well as removal of the attachment of the abdominal wall musculature to the iliac crest, leaving a 10 x 6 centimeter defect in the abdominal wall with a subsequent potential for herniation. The defect in bone and soft tissue was adequately reconstructed with a Strattice inlay mesh which was sutured to the bone and muscle. Pathology confirmed a metastasis originating from invasive ductal carcinoma.
Findings/results:
When a large section of the iliac crest is resected, successful abdominal wall reconstruction and prevention of herniation can be achieved by the use of an inlay Strattice mesh.
Conclusions: Strattice inlay mesh is an excellent choice for reconstruction of the abdominal wall in cases where bone resection is performed in pelvic region.
Figure 1:
MRI image of the osteolytic metastasis in the left iliac crest
Figure 3:
Strattice as an inlay mesh
Figure 2:
Computer Tomograpy 3D reconstruction showing osteolytic bone metastasis
of the iliac crest
Figure 4:
Postoperative x-ray image of the resected area
References:
- Banyard DA, Bourgeois JM, Widgerow AD, Evans GR. Regenerative biomaterials: a review. Plast Reconstr Surg Jun;135(6): doi: /PRS
- Pinell-White XA, Gruszynski M, Losken A. Ventral Hernia Repair After Bowel Surgery: Does Gastrointestinal Contamination Matter in the Era of Biologic Mesh? Ann Plast Surg. 2014;72(6):S doi: /SAP
- Pascual G, Sotomayor S, Pérez-Lopéz P, Buján J, Bellon JM. Long term behavior of biological prostheses used as abdominal wall substitutes. Histol Histopathol Jan;29(1): Epub 2013 Jul 19.