- Email: [email protected]
Is laparoscopic surgery safe after total abdominal wall reconstruction?
Accepted Manuscript Is Laparoscopic Surgery Safe After Total Abdominal Wall Reconstruction? A. Alamri, J. Lee, S. Aldekhayel, K. Shaw, T. Zadeh PII:
S2213-5766(15)00014-7
DOI:
10.1016/j.epsc.2015.01.011
Reference:
EPSC 344
To appear in:
Journal of Pediatric Surgery Case Reports
Received Date: 20 January 2015 Accepted Date: 26 January 2015
Please cite this article as: Alamri A, Lee J, Aldekhayel S, Shaw K, Zadeh T, Is Laparoscopic Surgery Safe After Total Abdominal Wall Reconstruction?, Journal of Pediatric Surgery Case Reports (2015), doi: 10.1016/j.epsc.2015.01.011. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Is Laparoscopic Surgery Safe After Total Abdominal Wall Reconstruction? Alamri A[a], Lee J[a], Aldekhayel S[a], Shaw K[b], Zadeh T[a] [a] Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, Quebec, Canada
Abstract
RI PT
[b] Department of Pediatric Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, Quebec, Canada
Abdominal wall reconstruction is a complex area. Cases vary greatly in terms of cause and location of the defect, the choice of reconstructive option, and the degree of involvement ranging from skin and subcutaneous tissue only, to a total defect
SC
involving muscle and fascia. We present our experience with a total lower abdominal wall reconstruction in a 10 year-old girl who was diagnosed with Ewing’s sarcoma of the pelvis. The mass was resected and reconstructed with a pedicled
M AN U
functional unilateral rectus femoris muscle flap and fascia lata extension in addition to Strattice™ dermal substitute. After 4 weeks, laparoscopic oophoropexy was performed safely by pediatric surgery without any technical difficulty or postoperative complications.
Key words:
AC C
EP
TE D
Lower abdominal wall defect, rectus femoris, Strattice™, laparoscopy, total abdominal wall reconstruction.
ACCEPTED MANUSCRIPT Introduction
Abdominal wall reconstruction is a complex reconstructive procedure with many variables depending on the available blood supply of the abdominal wall, size and location of the defect, depth of the defect, and the available remaining options for
RI PT
coverage ranging from loco-regional to distant flaps. The safety of laparoscopic surgery following total abdominal wall reconstruction is not well recognized or discussed in the literature. The current manuscript explores the safety of
laparoscopic surgery following total abdominal wall reconstruction, and reviews the literature with respect to abdominal
AC C
EP
TE D
M AN U
SC
wall surgery and laparoscopy.
ACCEPTED MANUSCRIPT Case Report
A 10 year-old female was diagnosed with Ewing’s sarcoma of the left superior pubic ramus, left symphysis pubis, and rectus abdominis muscles. She underwent neo-adjuvant chemotherapy followed by wide local excision and immediate
RI PT
reconstruction by orthopedic and plastic surgery teams. The resection resulted in a full thickness lower abdominal wall defect involving skin, subcutaneous tissue, bilateral rectus abdominis muscles, and anterior and posterior rectus sheaths (Figure 1A).
An immediate layered reconstruction was performed. The posterior rectus sheath was reconstructed using dermal
SC
substitute (Strattice™, Figure 1B)[1]. The rectus abdominis muscles were reconstructed with a left rectus femoris pedicled flap with fascia lata extension to reconstruct the anterior rectus sheath (Figure 1C). The rectus femoris muscle was released
M AN U
from its origin and insertion. It was then transposed and the distal aspect of the muscle sutured to the proximal stumps of the rectus abdominis muscles thus simulating the vector of pull; hence, allowing the child to strain post-operatively. A longitudinal skin paddle was included in the flap to allow for monitoring and a tension-free closure. Partial necrosis of the skin paddle ensued which required revisional debridement and primary closure after the swelling had subsided (Figure 2). Four weeks following the abdominal wall reconstruction, the patient underwent laparoscopic oophoropexy by the pediatric surgery team for purposes of ovarian protection against postoperative radiotherapy. Trocars were inserted through
TE D
the usual anatomic landmarks for pelvic laparoscopic procedures, and insufflation to a pressure of 10 mmHg was performed with a good seal. Procedure was without any technical difficulties or complications. Follow up at 25 weeks revealed good
AC C
EP
abdominal contour and tone. Full knee extension without functional limitation was also noted.
ACCEPTED MANUSCRIPT Discussion
Scarce reports regarding the feasibility of laparoscopic surgery following abdominal wall surgery exist in the literature; however none of them examine the safety of such a procedure following total abdominal wall reconstruction.
RI PT
Efthalia et al[2] and Jansen et al[3], reported that laparoscopy is possible and safe after abdominoplasty or a transverse rectus abdominis myocutaneous (TRAM) flap, despite its theoretical contraindications due to alteration in ports placement landmarks and the significant scarring. Other studies detailed the safety and technical details of laparoscopy following abdominoplasty[2,4,5]. Cox et al[6], discussed the combined technique of Rives-Stoppa incisional hernia repair augmented
SC
by laparoscopic component separation in abdominal wall reconstruction. They describe the technique and the outcome over a 14 months period of follow up; however the safety to undergo laparoscopic procedure after reconstruction was not
M AN U
illustrated.
Rectus femoris muscle is a proven versatile choice for abdominal wall or pelvic reconstruction with minimal donor site morbidity[7,8,9]. In our case, total anterior abdominal wall reconstruction was followed 4 weeks later by a laparoscopic procedure, an adequate interval to allow for sufficient healing of the reconstructed abdominal wall. Laparoscopic surgery was performed using the standard settings without any technical difficulties or complications. Although technically demanding, preservation of the original innervation to the rectus femoris muscle during reconstruction is more reliable and
TE D
provides greater and earlier muscle activity and strength when compared to neurotization of the muscle upon transfer [8]. Whether this contributes to the feasibility of safe laparoscopic surgery as early as 4 weeks following reconstruction is unknown and needs further research.
EP
Cicilioni et al[1], published his experience with reinforcing the rectus sheath with Strattice™, a porcine acellular dermal matrix (PADM), after TRAM flap reconstruction of the breast; they concluded that when used in conjunction with
AC C
progressive tension suture closure of the abdominal wall, a dynamic reconstruction of the abdominal wall with resumption of the abdominal wall function is possible. They did not note any abdominal bulging or herniation. In our case, this principle was applied and we found Strattice™ to provide a thick and stiff layer of reconstruction. Furthermore, King et al[10], noticed a rapid revascularization and tissue ingrowth into Strattice™, resulting in improved resistance to infection and rapid integration into the host tissues. Similarly, Huston et al[11] used Strattice™ for chest wall reconstruction and found it to be superior to other products in terms of thickness and strength. Added benefits of Strattice™ include availability of larger sizes (up to 20 x 25 cm) and the ability to be used in contaminated fields without an increased risk of post-operative infection. Although limited evidence exists in the literature, we believe that Strattice™ reinforced our musculofascial flap
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
reconstruction, and likely aided in the success of early laparoscopy following total abdominal wall reconstruction.
ACCEPTED MANUSCRIPT Conclusion:
The use of Strattice™ as an adjunct to abdominal wall flap reconstruction appears to reinforce the strength and aid in the success of early laparoscopy following total abdominal wall reconstruction, however there is limited evidence in the
RI PT
literature supporting this conclusion. To our knowledge, this is the first case of successful laparoscopic surgery reported in the literature following total abdominal reconstruction in a child; in addition, laparoscopic surgery can be performed safely
AC C
EP
TE D
M AN U
SC
as early as 4 weeks post-operatively.
ACCEPTED MANUSCRIPT Figure Legends: Figure 1: Intra-operative images: (A) post resection of Ewing’s sarcoma involving full thickness anterior abdominal wall; (B) posterior rectus sheath reconstruction using porcine acellular dermal matrix; (C) pedicled rectus femoris myocutaneous flap with fascial extension prior to inset.
RI PT
Figure 2: Two weeks postoperative reconstruction following debridement of skin paddle and primary closure.
AC C
EP
TE D
M AN U
SC
Conflict of interest: None
ACCEPTED MANUSCRIPT References
AC C
EP
TE D
M AN U
SC
RI PT
[1] Cicilioni O Jr1, Araujo G, Mimbs N, Cox MD. Initial experience with the use of porcine acellular dermal matrix (Strattice™) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg. 2012 Mar;68(3):265-70. doi: 10.1097/SAP.0b013e31822af89d. [2] Efthalia Tsahalina and Robin Crawford. Laparoscopic surgery following abdominal wall reconstruction: description of a novel method for safe entry. BJOG: An International Journal of Obstetrics & Gynaecology. 22 NOV 2004 DOI: 10.1111/j.1471-0528.2004.00289.x [3] Jansen DA, Murphy MR, Aliabadi-Wahle S, Ferrara JJ. Laparoscopic incisional hernia repair after transverse rectus abdominis myocutaneous flap reconstruction. Plast Reconstr Surg. 1998 Oct;102(5):1623-5. [4] Cassaro S1, Leitman IM. A technique for laparoscopic peritoneal entry after abdominoplasty. J Laparoendosc Adv Surg Tech A. 2013 Dec;23(12):990-1. doi: 10.1089/lap.2013.0462. Epub 2013 Oct 17. [5] Karip B, Altun H, Işcan Y, Bazan M, Celik K, Ozcabı Y, Ağca B, Memişoğlu K. Difficulties of Bariatric Surgery after Abdominoplasty. Case Rep Surg. 2014;2014:620175. Epub 2014 Nov 6. [6] Cox TC, Pearl JP, Ritter EM. Rives-Stoppa incisional hernia repair combined with laparoscopic separation of abdominal wall components: a novel approach to complex abdominal wall closure. Hernia. 2010 Dec;14(6):561-7. doi: 10.1007/s10029-010-0704-x. Epub 2010 Jul 27. [7] M D Flurry; B F Michelotti; K E Moyer. Pedicled rectus femoris flap for coverage of complex open pelvic fractures. Journal of Plastic, Reconstructive & Aesthetic Surgery, v64 n11 (201111): 1490-1494 [8] I Koshima; Y Nanba; T Tutsui. Dynamic Reconstruction of Large Abdominal Defects Using a Free Rectus Femoris Musculocutaneous Flap With Normal Motor Function. ANNALS OF PLASTIC SURGERY, 50, Part 4 (2003): 420-424 [9] MS Matthews Affiliation: Cooper Hospital University Medical Center, Camden, NJ, USA. [email protected]. Abdominal wall reconstruction with an expanded rectus femoris flap. Plastic and reconstructive surgery, 1999 Jul; 104(1): 183-6 [10] King J, Hayes JD, Richmond B. Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice™) with bone anchors and pedicled omental flap coverage: a case report. J Med Case Rep. 2013 Nov 11;7:258. doi: 10.1186/1752-1947-7-258. [11] Huston TL, Taback B, Rohde CH. Chest wall reconstruction with porcine acellular dermal matrix (Strattice™) and a latissimus myocutaneous flap. Am Surg. 2011 Jun;77(6):e115-6. [12] Brunbjerg ME, Juhl AA, Damsgaard TE. Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap. Acta Oncol. 2013 Jun;52(5):1052-4. doi: 10.3109/0284186X.2012.734925. Epub 2012 Oct 24. [13] Mulier KE, Nguyen AH, Delaney JP, Marquez S. Comparison of Permacol™ and Strattice™ for the repair of abdominal wall defects. Hernia. 2011 Jun;15(3):315-9. doi: 10.1007/s10029-010-0777-6. Epub 2011 Jan 15. [14] Bellows CF, Shadduck P, Helton WS, Martindale R, Stouch BC, Fitzgibbons R. early report of a randomized comparative clinical trial of Strattice™ reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias. Hernia. 2014 Apr;18(2):221-30. doi: 10.1007/s10029-013-1076-9. Epub 2013 Mar 31. [15] Patel KM, Albino FP, Nahabedian MY, Bhanot P. Critical Analysis of Strattice™ Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications. Int Surg. 2013 Oct-Dec;98(4):37984. doi: 10.9738/INTSURG-D-13-00053.1. [16] Landim F.M.; Tavares J.M.; Costa M.L.V.; Landim R.M.; Feitosa R.G.F. Complex abdominal wall reconstruction after radiation therapy. A full-thickness defect was repaired with a rectus femoris myofasciocutaneous flap. American Journal of Obstetrics and Gynecology, v200 n1 (2009 01 01): 116.e1-116.e3 [17] Sbitany, Hani M.D.; Koltz, Peter F. M.D.; Girotto, John A. M.D.; Vega, Stephen J. M.D.; Langstein, Howard N. M.D. Assessment of Donor-Site Morbidity following Rectus Femoris Harvest for Infrainguinal Reconstruction. Plastic and reconstructive surgery, 2010 Sep; 126(3): 933-40 [18] Atallah S1, Albert M, Felix O, Izfar S, Debeche-Adams T, Larach S. The technical approach to laparoscopic colectomy in patients who have undergone prior abdominoplasty. Tech Coloproctol. 2013 Feb;17(1):111-6. doi: 10.1007/s10151-0120875-9. Epub 2012 Aug 31. [19] Sue, Gloria R, MA; Narayan, Deepak, MD. Niche Reconstructive Techniques for Complex Abdominal Wall Reconstruction: A Review. The American Surgeon 80.4 (Apr 2014): 327-34.
S2213-5766(15)00014-7
DOI:
10.1016/j.epsc.2015.01.011
Reference:
EPSC 344
To appear in:
Journal of Pediatric Surgery Case Reports
Received Date: 20 January 2015 Accepted Date: 26 January 2015
Please cite this article as: Alamri A, Lee J, Aldekhayel S, Shaw K, Zadeh T, Is Laparoscopic Surgery Safe After Total Abdominal Wall Reconstruction?, Journal of Pediatric Surgery Case Reports (2015), doi: 10.1016/j.epsc.2015.01.011. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Is Laparoscopic Surgery Safe After Total Abdominal Wall Reconstruction? Alamri A[a], Lee J[a], Aldekhayel S[a], Shaw K[b], Zadeh T[a] [a] Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, Quebec, Canada
Abstract
RI PT
[b] Department of Pediatric Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, Quebec, Canada
Abdominal wall reconstruction is a complex area. Cases vary greatly in terms of cause and location of the defect, the choice of reconstructive option, and the degree of involvement ranging from skin and subcutaneous tissue only, to a total defect
SC
involving muscle and fascia. We present our experience with a total lower abdominal wall reconstruction in a 10 year-old girl who was diagnosed with Ewing’s sarcoma of the pelvis. The mass was resected and reconstructed with a pedicled
M AN U
functional unilateral rectus femoris muscle flap and fascia lata extension in addition to Strattice™ dermal substitute. After 4 weeks, laparoscopic oophoropexy was performed safely by pediatric surgery without any technical difficulty or postoperative complications.
Key words:
AC C
EP
TE D
Lower abdominal wall defect, rectus femoris, Strattice™, laparoscopy, total abdominal wall reconstruction.
ACCEPTED MANUSCRIPT Introduction
Abdominal wall reconstruction is a complex reconstructive procedure with many variables depending on the available blood supply of the abdominal wall, size and location of the defect, depth of the defect, and the available remaining options for
RI PT
coverage ranging from loco-regional to distant flaps. The safety of laparoscopic surgery following total abdominal wall reconstruction is not well recognized or discussed in the literature. The current manuscript explores the safety of
laparoscopic surgery following total abdominal wall reconstruction, and reviews the literature with respect to abdominal
AC C
EP
TE D
M AN U
SC
wall surgery and laparoscopy.
ACCEPTED MANUSCRIPT Case Report
A 10 year-old female was diagnosed with Ewing’s sarcoma of the left superior pubic ramus, left symphysis pubis, and rectus abdominis muscles. She underwent neo-adjuvant chemotherapy followed by wide local excision and immediate
RI PT
reconstruction by orthopedic and plastic surgery teams. The resection resulted in a full thickness lower abdominal wall defect involving skin, subcutaneous tissue, bilateral rectus abdominis muscles, and anterior and posterior rectus sheaths (Figure 1A).
An immediate layered reconstruction was performed. The posterior rectus sheath was reconstructed using dermal
SC
substitute (Strattice™, Figure 1B)[1]. The rectus abdominis muscles were reconstructed with a left rectus femoris pedicled flap with fascia lata extension to reconstruct the anterior rectus sheath (Figure 1C). The rectus femoris muscle was released
M AN U
from its origin and insertion. It was then transposed and the distal aspect of the muscle sutured to the proximal stumps of the rectus abdominis muscles thus simulating the vector of pull; hence, allowing the child to strain post-operatively. A longitudinal skin paddle was included in the flap to allow for monitoring and a tension-free closure. Partial necrosis of the skin paddle ensued which required revisional debridement and primary closure after the swelling had subsided (Figure 2). Four weeks following the abdominal wall reconstruction, the patient underwent laparoscopic oophoropexy by the pediatric surgery team for purposes of ovarian protection against postoperative radiotherapy. Trocars were inserted through
TE D
the usual anatomic landmarks for pelvic laparoscopic procedures, and insufflation to a pressure of 10 mmHg was performed with a good seal. Procedure was without any technical difficulties or complications. Follow up at 25 weeks revealed good
AC C
EP
abdominal contour and tone. Full knee extension without functional limitation was also noted.
ACCEPTED MANUSCRIPT Discussion
Scarce reports regarding the feasibility of laparoscopic surgery following abdominal wall surgery exist in the literature; however none of them examine the safety of such a procedure following total abdominal wall reconstruction.
RI PT
Efthalia et al[2] and Jansen et al[3], reported that laparoscopy is possible and safe after abdominoplasty or a transverse rectus abdominis myocutaneous (TRAM) flap, despite its theoretical contraindications due to alteration in ports placement landmarks and the significant scarring. Other studies detailed the safety and technical details of laparoscopy following abdominoplasty[2,4,5]. Cox et al[6], discussed the combined technique of Rives-Stoppa incisional hernia repair augmented
SC
by laparoscopic component separation in abdominal wall reconstruction. They describe the technique and the outcome over a 14 months period of follow up; however the safety to undergo laparoscopic procedure after reconstruction was not
M AN U
illustrated.
Rectus femoris muscle is a proven versatile choice for abdominal wall or pelvic reconstruction with minimal donor site morbidity[7,8,9]. In our case, total anterior abdominal wall reconstruction was followed 4 weeks later by a laparoscopic procedure, an adequate interval to allow for sufficient healing of the reconstructed abdominal wall. Laparoscopic surgery was performed using the standard settings without any technical difficulties or complications. Although technically demanding, preservation of the original innervation to the rectus femoris muscle during reconstruction is more reliable and
TE D
provides greater and earlier muscle activity and strength when compared to neurotization of the muscle upon transfer [8]. Whether this contributes to the feasibility of safe laparoscopic surgery as early as 4 weeks following reconstruction is unknown and needs further research.
EP
Cicilioni et al[1], published his experience with reinforcing the rectus sheath with Strattice™, a porcine acellular dermal matrix (PADM), after TRAM flap reconstruction of the breast; they concluded that when used in conjunction with
AC C
progressive tension suture closure of the abdominal wall, a dynamic reconstruction of the abdominal wall with resumption of the abdominal wall function is possible. They did not note any abdominal bulging or herniation. In our case, this principle was applied and we found Strattice™ to provide a thick and stiff layer of reconstruction. Furthermore, King et al[10], noticed a rapid revascularization and tissue ingrowth into Strattice™, resulting in improved resistance to infection and rapid integration into the host tissues. Similarly, Huston et al[11] used Strattice™ for chest wall reconstruction and found it to be superior to other products in terms of thickness and strength. Added benefits of Strattice™ include availability of larger sizes (up to 20 x 25 cm) and the ability to be used in contaminated fields without an increased risk of post-operative infection. Although limited evidence exists in the literature, we believe that Strattice™ reinforced our musculofascial flap
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
reconstruction, and likely aided in the success of early laparoscopy following total abdominal wall reconstruction.
ACCEPTED MANUSCRIPT Conclusion:
The use of Strattice™ as an adjunct to abdominal wall flap reconstruction appears to reinforce the strength and aid in the success of early laparoscopy following total abdominal wall reconstruction, however there is limited evidence in the
RI PT
literature supporting this conclusion. To our knowledge, this is the first case of successful laparoscopic surgery reported in the literature following total abdominal reconstruction in a child; in addition, laparoscopic surgery can be performed safely
AC C
EP
TE D
M AN U
SC
as early as 4 weeks post-operatively.
ACCEPTED MANUSCRIPT Figure Legends: Figure 1: Intra-operative images: (A) post resection of Ewing’s sarcoma involving full thickness anterior abdominal wall; (B) posterior rectus sheath reconstruction using porcine acellular dermal matrix; (C) pedicled rectus femoris myocutaneous flap with fascial extension prior to inset.
RI PT
Figure 2: Two weeks postoperative reconstruction following debridement of skin paddle and primary closure.
AC C
EP
TE D
M AN U
SC
Conflict of interest: None
ACCEPTED MANUSCRIPT References
AC C
EP
TE D
M AN U
SC
RI PT
[1] Cicilioni O Jr1, Araujo G, Mimbs N, Cox MD. Initial experience with the use of porcine acellular dermal matrix (Strattice™) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction. Ann Plast Surg. 2012 Mar;68(3):265-70. doi: 10.1097/SAP.0b013e31822af89d. [2] Efthalia Tsahalina and Robin Crawford. Laparoscopic surgery following abdominal wall reconstruction: description of a novel method for safe entry. BJOG: An International Journal of Obstetrics & Gynaecology. 22 NOV 2004 DOI: 10.1111/j.1471-0528.2004.00289.x [3] Jansen DA, Murphy MR, Aliabadi-Wahle S, Ferrara JJ. Laparoscopic incisional hernia repair after transverse rectus abdominis myocutaneous flap reconstruction. Plast Reconstr Surg. 1998 Oct;102(5):1623-5. [4] Cassaro S1, Leitman IM. A technique for laparoscopic peritoneal entry after abdominoplasty. J Laparoendosc Adv Surg Tech A. 2013 Dec;23(12):990-1. doi: 10.1089/lap.2013.0462. Epub 2013 Oct 17. [5] Karip B, Altun H, Işcan Y, Bazan M, Celik K, Ozcabı Y, Ağca B, Memişoğlu K. Difficulties of Bariatric Surgery after Abdominoplasty. Case Rep Surg. 2014;2014:620175. Epub 2014 Nov 6. [6] Cox TC, Pearl JP, Ritter EM. Rives-Stoppa incisional hernia repair combined with laparoscopic separation of abdominal wall components: a novel approach to complex abdominal wall closure. Hernia. 2010 Dec;14(6):561-7. doi: 10.1007/s10029-010-0704-x. Epub 2010 Jul 27. [7] M D Flurry; B F Michelotti; K E Moyer. Pedicled rectus femoris flap for coverage of complex open pelvic fractures. Journal of Plastic, Reconstructive & Aesthetic Surgery, v64 n11 (201111): 1490-1494 [8] I Koshima; Y Nanba; T Tutsui. Dynamic Reconstruction of Large Abdominal Defects Using a Free Rectus Femoris Musculocutaneous Flap With Normal Motor Function. ANNALS OF PLASTIC SURGERY, 50, Part 4 (2003): 420-424 [9] MS Matthews Affiliation: Cooper Hospital University Medical Center, Camden, NJ, USA. [email protected]. Abdominal wall reconstruction with an expanded rectus femoris flap. Plastic and reconstructive surgery, 1999 Jul; 104(1): 183-6 [10] King J, Hayes JD, Richmond B. Repair of giant subcostal hernia using porcine acellular dermal matrix (Strattice™) with bone anchors and pedicled omental flap coverage: a case report. J Med Case Rep. 2013 Nov 11;7:258. doi: 10.1186/1752-1947-7-258. [11] Huston TL, Taback B, Rohde CH. Chest wall reconstruction with porcine acellular dermal matrix (Strattice™) and a latissimus myocutaneous flap. Am Surg. 2011 Jun;77(6):e115-6. [12] Brunbjerg ME, Juhl AA, Damsgaard TE. Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap. Acta Oncol. 2013 Jun;52(5):1052-4. doi: 10.3109/0284186X.2012.734925. Epub 2012 Oct 24. [13] Mulier KE, Nguyen AH, Delaney JP, Marquez S. Comparison of Permacol™ and Strattice™ for the repair of abdominal wall defects. Hernia. 2011 Jun;15(3):315-9. doi: 10.1007/s10029-010-0777-6. Epub 2011 Jan 15. [14] Bellows CF, Shadduck P, Helton WS, Martindale R, Stouch BC, Fitzgibbons R. early report of a randomized comparative clinical trial of Strattice™ reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias. Hernia. 2014 Apr;18(2):221-30. doi: 10.1007/s10029-013-1076-9. Epub 2013 Mar 31. [15] Patel KM, Albino FP, Nahabedian MY, Bhanot P. Critical Analysis of Strattice™ Performance in Complex Abdominal Wall Reconstruction: Intermediate–Risk Patients and Early Complications. Int Surg. 2013 Oct-Dec;98(4):37984. doi: 10.9738/INTSURG-D-13-00053.1. [16] Landim F.M.; Tavares J.M.; Costa M.L.V.; Landim R.M.; Feitosa R.G.F. Complex abdominal wall reconstruction after radiation therapy. A full-thickness defect was repaired with a rectus femoris myofasciocutaneous flap. American Journal of Obstetrics and Gynecology, v200 n1 (2009 01 01): 116.e1-116.e3 [17] Sbitany, Hani M.D.; Koltz, Peter F. M.D.; Girotto, John A. M.D.; Vega, Stephen J. M.D.; Langstein, Howard N. M.D. Assessment of Donor-Site Morbidity following Rectus Femoris Harvest for Infrainguinal Reconstruction. Plastic and reconstructive surgery, 2010 Sep; 126(3): 933-40 [18] Atallah S1, Albert M, Felix O, Izfar S, Debeche-Adams T, Larach S. The technical approach to laparoscopic colectomy in patients who have undergone prior abdominoplasty. Tech Coloproctol. 2013 Feb;17(1):111-6. doi: 10.1007/s10151-0120875-9. Epub 2012 Aug 31. [19] Sue, Gloria R, MA; Narayan, Deepak, MD. Niche Reconstructive Techniques for Complex Abdominal Wall Reconstruction: A Review. The American Surgeon 80.4 (Apr 2014): 327-34.