Abdominoplasty of cloacal exstrophy: application of reconstructive methods to recurrent and primary cases
Takahiro Matsui1, Susam Park, Tomohiro Shiraishi
1Department of Plastic Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. ta.matsui@scchr.jp
Insights
This study demonstrates successful abdominal wall reconstruction for cloacal exstrophy using muscle fascia flaps. The technique prevented relapse of bladder exstrophy and abdominal defects in both primary and recurrent cases.
Area of Science:
- Pediatric Surgery
- Reconstructive Surgery
- Urology
Background:
- Cloacal exstrophy presents significant surgical challenges, often involving large abdominal wall defects and pubic bone diastasis.
- Primary closure at birth can be insufficient, leading to potential relapse of bladder exstrophy and abdominal defects.
Observation:
- Abdominal wall reconstruction was performed using rectus abdominis and external oblique muscle fascia flaps.
- Reinforcement of bilateral rectus abdominis muscles was utilized in two cases.
- Procedures were performed on one recurrent case (7 months old) and one primary case (2 days old).
Findings:
- Successful closure of the abdominal wall was achieved in both patients.
- No relapse of bladder exstrophy or abdominal defects occurred post-operatively.
- Patients are currently undergoing rehabilitation.
Implications:
- Thorough abdominal wall repair, utilizing plastic surgery techniques, is crucial for managing cloacal exstrophy.
- Early and comprehensive surgical intervention shortly after birth is recommended.
- This reconstructive approach offers a promising solution for preventing long-term complications.
Background:
Surgical repair of cloacal exstrophy is still challenging. At birth, patients undergo bladder closure, colostomy, and osteotomy of the pubic bone (if necessary, when the interpubic range is wide and cannot be brought together with the hands). This abdominal defect is closed primarily by urologists or pediatric surgeons, if possible, but the patient may experience a relapse of bladder exstrophy and an abdominal defect. Abdominal reconstruction was performed for a series of recurrent and primary (preventive) cases.
Methods:
Abdominal wall reconstruction was performed using the rectus abdominis and external oblique muscle fascia flaps, and reinforcement of the bilateral rectus abdominis muscles in 2 cases of cloacal exstrophy patients. One was a recurrent case treated at 7 months old, and the other was done primarily at 2 days after birth.
Results:
The closure of the abdominal wall was successful and no relapse of bladder exstrophy or abdominal defect has occurred. These patients are now undergoing rehabilitation.
Conclusion:
Cloacal exstrophy usually has many serious complications. The abdominal-wall defect is often large and accompanied by a wide detachment of the pubic bone. Even if the simple closure of abdominal wall is possible at birth, it is usually insufficient. Abdominal-wall repair must be done thoroughly, soon after birth, and plastic surgery techniques should be used.
