Thomas G W Harris, Chad B Crigger, Visakha Suresh, Ahmad Haffar, Tamir N Sholklapper, Isam W Nasr, John P Gearhart, Robin Yang, Richard J Redett
{"title":"用于膀胱颈闭合后膀胱萎缩的骨盆重建的直肌和擒拿肌肌瓣间接术","authors":"Thomas G W Harris, Chad B Crigger, Visakha Suresh, Ahmad Haffar, Tamir N Sholklapper, Isam W Nasr, John P Gearhart, Robin Yang, Richard J Redett","doi":"10.1097/PRS.0000000000011315","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy and cloacal exstrophy (CE). Patients undergo multiple soft-tissue procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterward for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed.</p><p><strong>Methods: </strong>A retrospective cohort study of patients with exstrophy-epispadias complex who underwent BNC and had a muscle flap was performed. Indication for flap use; surgical technique; and risks for BNC failure, including mucosal violations (MVs), were reviewed. MVs were previous bladder mucosa manipulation for exstrophy closure, repeat closures, and bladder neck reconstruction. Success was defined as BNC without fistula development.</p><p><strong>Results: </strong>Thirty-four patients underwent reconstruction. Indications included fistula prophylaxis during BNC ( n = 13), fistula closure after BNC ( n = 17), fistula prophylaxis after BNC during open cystolithotomy ( n = 1), or fistula closure after open cystolithotomy ( n = 3). A vesicourethral fistula developed most frequently in classic bladder exstrophy (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flaps were used, with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success, and 2 patients with CE required a second flap.</p><p><strong>Conclusions: </strong>The rectus flap is preferred as it covers the anteroinferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs increase the risk of fistula formation and may influence the need for prophylactic flaps.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"1322-1330"},"PeriodicalIF":3.2000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interposing Rectus and Gracilis Muscle Flaps for Pelvic Reconstruction in Bladder Exstrophy after Bladder Neck Closure.\",\"authors\":\"Thomas G W Harris, Chad B Crigger, Visakha Suresh, Ahmad Haffar, Tamir N Sholklapper, Isam W Nasr, John P Gearhart, Robin Yang, Richard J Redett\",\"doi\":\"10.1097/PRS.0000000000011315\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy and cloacal exstrophy (CE). Patients undergo multiple soft-tissue procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterward for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed.</p><p><strong>Methods: </strong>A retrospective cohort study of patients with exstrophy-epispadias complex who underwent BNC and had a muscle flap was performed. Indication for flap use; surgical technique; and risks for BNC failure, including mucosal violations (MVs), were reviewed. MVs were previous bladder mucosa manipulation for exstrophy closure, repeat closures, and bladder neck reconstruction. Success was defined as BNC without fistula development.</p><p><strong>Results: </strong>Thirty-four patients underwent reconstruction. Indications included fistula prophylaxis during BNC ( n = 13), fistula closure after BNC ( n = 17), fistula prophylaxis after BNC during open cystolithotomy ( n = 1), or fistula closure after open cystolithotomy ( n = 3). A vesicourethral fistula developed most frequently in classic bladder exstrophy (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flaps were used, with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success, and 2 patients with CE required a second flap.</p><p><strong>Conclusions: </strong>The rectus flap is preferred as it covers the anteroinferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs increase the risk of fistula formation and may influence the need for prophylactic flaps.</p><p><strong>Clinical question/level of evidence: </strong>Therapeutic, IV.</p>\",\"PeriodicalId\":20128,\"journal\":{\"name\":\"Plastic and reconstructive surgery\",\"volume\":\" \",\"pages\":\"1322-1330\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Plastic and reconstructive surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PRS.0000000000011315\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Plastic and reconstructive surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PRS.0000000000011315","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Interposing Rectus and Gracilis Muscle Flaps for Pelvic Reconstruction in Bladder Exstrophy after Bladder Neck Closure.
Background: The exstrophy-epispadias complex is a spectrum of ventral wall malformations including classic bladder exstrophy and cloacal exstrophy (CE). Patients undergo multiple soft-tissue procedures to achieve urinary continence. If unsuccessful bladder neck closure (BNC) is performed, muscle flaps may be used to reinforce BNC or afterward for fistula reconstruction. In this study, patients reconstructed using a rectus abdominis or gracilis muscle flap were reviewed.
Methods: A retrospective cohort study of patients with exstrophy-epispadias complex who underwent BNC and had a muscle flap was performed. Indication for flap use; surgical technique; and risks for BNC failure, including mucosal violations (MVs), were reviewed. MVs were previous bladder mucosa manipulation for exstrophy closure, repeat closures, and bladder neck reconstruction. Success was defined as BNC without fistula development.
Results: Thirty-four patients underwent reconstruction. Indications included fistula prophylaxis during BNC ( n = 13), fistula closure after BNC ( n = 17), fistula prophylaxis after BNC during open cystolithotomy ( n = 1), or fistula closure after open cystolithotomy ( n = 3). A vesicourethral fistula developed most frequently in classic bladder exstrophy (88.9%) and vesicoperineal fistula in CE (87.5%). Thirty-three rectus flaps and 3 gracilis flaps were used, with success achieved in 97.1% and 66.7%, respectively. All 34 patients achieved success, and 2 patients with CE required a second flap.
Conclusions: The rectus flap is preferred as it covers the anteroinferior bladder and pelvic floor to prevent urethral, cutaneous, and perineal fistula formation. The gracilis flap only reaches the pelvic floor to prevent urethral and perineal fistula development. Increased MVs increase the risk of fistula formation and may influence the need for prophylactic flaps.
Clinical question/level of evidence: Therapeutic, IV.
期刊介绍：
For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis.
Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
