V09-02: Abdominoplasty without osteotomies using groin flaps to close the abdominal wall defect in the management of exstrophy-epispadias complex
We demonstrate the GROIN FLAP technique to close the abdominal wall of children with exstrophy-epispadia complex without osteotomy and without radical soft tissue mobilization. The advantages over current techniques for complete repair are the small risk of penile tissue loss and the avoidance of osteotomies.
Abdominal wall repair consists in using hypogastric skin and rectus and obliquus externus abdominalis muscle aponeurosis flaps. These groin flaps are rotated to the midline resulting in a very strong abdominal wall support. Groin flaps are made of the rectus anterior aponeuroses rotated medially, flipped over, and sutured with prolene sutures to close the defect. By rotating the facial flaps medially, complete reinforcement of the abdominal wall to the level of the pubic bone is achieved. This permits the abdominal closure maintenance without tension.
During the last 30 years, GROIN FLAP was applied to 128 patients with bladder exstrophy that came 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 (2y8mos-16y). Successful closure was achieved in 43 patients (97.7%) as a single procedure; one patient had complete wound dehiscence and needed another reconstruction (2.2%). Four patients (9.1%) presented abdominal hernias that needed surgical management.
One-staged reconstruction using GROIN FLAPS has advantages over the traditional approaches to bladder exstrophy. 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 rescue technique even after previous failed procedures. Finally, It minimize the number of surgeries.