Dynamic abdominoplasty for the treatment of prune belly syndrome

The deficient abdominal wall musculature associated with prune belly syndrome often results in numerous functional disabilities, including diminished cough, impaired bladder and bowel function, and poor posture and balance. Traditional abdominoplasties focus on static fascial excisions or plications. The authors sought to assess their preliminary experience with a new abdominoplasty technique that incorporates standard fascial tightening with bilateral pedicled rectus femoris muscle transfers.

This case series review included all patients treated with prune belly syndrome at the authors' center. Physical presentation, operative procedures, hospitalization, complications, and postoperative functional status were assessed, and a systematic analysis of published surgical series was performed.

Over a 16-year period, the authors treated 13 patients with prune belly syndrome. All underwent standard "vest over pants" fascial plications, with 11 of 13 undergoing additional rectus femoris muscle transpositions at a mean age of 4 years (range, 12 months to 13 years). Hospitalization averaged 9.3 days, and the average follow-up was over 1.5 years. The authors identified three minor complications (chylous leak, fungal urinary tract infection, and partial umbilical necrosis), yielding a complication rate similar to those identified in our systematic analysis of published standard abdominoplasties. Postoperatively, all transposed muscles were palpably functional, one patient was successfully weaned off a ventilator, and all demonstrated improvements with balance and ambulation.

The authors' preliminary review suggests that this new procedure, which supplements the standard prune belly abdominoplasty with bilateral rectus femoris transposition flaps, is not associated with substantially higher complication rates yet does appear to have the potential to provide functional improvements.