Masoud Saman1, Sameep Kadakia2, Yadranko Ducic3,4,5. 1. Department of Otolaryngology-Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA. msaman309@gmail.edu. 2. Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary, 310 East 14th ST, 6th Floor, New York, NY, 10003, USA. skadakia@nyee.edu. 3. Otolaryngology and Facial Plastic Surgery, John Peter Smith Health Network, Fort Worth, TX, USA. yducic@sbcglobal.net. 4. Baylor Neuroscience Skull Base Program, Fort Worth, TX, USA. yducic@sbcglobal.net. 5. Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania ave, suite 100, Fort Worth, TX, 76104, USA. yducic@sbcglobal.net.
Abstract
IMPORTANCE: Patients with rectus free flap harvest extending below the arcuate line are predisposed to postoperative hernia formation. As such, many authors have advocated the use of closure adjuncts to increase the integrity of the closure and prevent hernia or abdominal wall bulging. SETTING: Busy level 1 public trauma center in metropolitan Fort Worth, Texas INTERVENTIONS: Following harvest of the rectus free flap, 48 patients underwent primary closure; 24 of these patients had defects extending below the arcuate line. Forty patients were closed with an acellular dermal graft; 22 of these patients had defects extending below the arcuate line. MAIN OUTCOME MEASURE: Postoperative hernia formation and local infection rate were examined in a minimum follow-up period of 1 year. RESULTS: Regardless of closure method, no hernias were observed in the postoperative period. Using an unpaired t test and an alpha value of 0.05, there was no statistically significant difference in the infection rate between the two groups. CONCLUSION: Following rectus abdominis myocutaneous free flap harvest, the use of an acellular dermal graft in abdominal wall closure may not be of any further advantage in the prevention of hernia. LEVEL OF EVIDENCE: Retrospective (Level III).
IMPORTANCE: Patients with rectus free flap harvest extending below the arcuate line are predisposed to postoperative hernia formation. As such, many authors have advocated the use of closure adjuncts to increase the integrity of the closure and prevent hernia or abdominal wall bulging. SETTING: Busy level 1 public trauma center in metropolitan Fort Worth, Texas INTERVENTIONS: Following harvest of the rectus free flap, 48 patients underwent primary closure; 24 of these patients had defects extending below the arcuate line. Forty patients were closed with an acellular dermal graft; 22 of these patients had defects extending below the arcuate line. MAIN OUTCOME MEASURE: Postoperative hernia formation and local infection rate were examined in a minimum follow-up period of 1 year. RESULTS: Regardless of closure method, no hernias were observed in the postoperative period. Using an unpaired t test and an alpha value of 0.05, there was no statistically significant difference in the infection rate between the two groups. CONCLUSION: Following rectus abdominis myocutaneous free flap harvest, the use of an acellular dermal graft in abdominal wall closure may not be of any further advantage in the prevention of hernia. LEVEL OF EVIDENCE: Retrospective (Level III).
Authors: Jean Y Petit; Mario Rietjens; Cristina Garusi; Andrea Giraldo; Francesca De Lorenzi; Piercarlo Rey; Edoardo C Millen; Barbara Pace da Silva; Riccardo Bosco; Omar Youssef Journal: Plast Reconstr Surg Date: 2003-09-15 Impact factor: 4.730