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Pediatric patient with a complex Abdominal Wall defect reconstructed with sandwich omental flap. A case report
Daniel Odhiambo Otieno1, Janan Malik1, Benjamin Wabwire2
1Department of Plastic, Reconstructive and Aesthetic Surgery University of Nairobi School of Medicine, Nairobi, Kenya.
Insights
This case study highlights the challenges of treating pediatric low-grade fibromyxoid sarcoma (LGFMS). Reconstruction of complex abdominal wall defects using an omental flap, mesh, and skin graft was successful, but recurrence remains a concern.
Area of Science:
- Oncology
- Surgical Reconstruction
- Pediatric Sarcoma
Background:
- Low-grade fibromyxoid sarcoma (LGFMS) is a rare, indolent soft tissue malignancy with a propensity for late recurrence and metastasis.
- Pediatric LGFMS typically presents in subcutaneous tissues, contrasting with adult deep soft tissue presentations.
- Management of LGFMS requires a multidisciplinary team approach, with wide local excision as the primary treatment.
Observation:
- A 9-year-old male patient with recurrent LGFMS presented with a complex abdominal wall defect post-tumor excision.
- The defect was reconstructed using a sandwich omental flap, polypropylene mesh, and a split-thickness skin graft.
- Despite successful defect coverage, the patient experienced abdominal hernia and tumor recurrence.
Findings:
- The omental flap is a versatile reconstructive option, particularly in resource-limited settings, as it does not require advanced microsurgical skills.
- The case underscores the diagnostic and therapeutic complexities in managing pediatric sarcomas.
- Multidisciplinary care is essential for optimizing outcomes in patients with recurrent LGFMS.
Implications:
- This case emphasizes the need for vigilant long-term surveillance for recurrence and hernia development after complex abdominal wall reconstruction in pediatric sarcoma patients.
- The omental flap offers a valuable, accessible reconstructive technique for surgeons facing challenging abdominal wall defects.
- Further research into optimizing surgical and adjuvant therapies for recurrent pediatric LGFMS is warranted.
Introduction And Importance:
Low grade Fibromyxoid sarcoma (LGFMS) is a rare soft tissue sarcoma. LGFMS has an indolent clinical behavior but it is prone for late local recurrence and metastasis. In children it is commonly seen in the subcutaneous tissues relative to adults where it presents in deep soft tissues. These patients are best managed in a specialized unit with a multidisciplinary team. For patients with sarcoma, wide local excision remains the treatment of choice. Large complex abdominal wall defects present a unique reconstructive challenge to the surgeon following tumor removal.
Case Presentation:
Here, we present a case of a 9-year old pediatric male patient with complex abdominal wall defect post excision of a recurrent fibromyxoid sarcoma, reconstructed with a sandwich omental flap, monofilament polypropylene mesh (Bard® Mesh) and split-thickness skin graft (STSG).
Clinical Discussion:
Despite the success of covering the defect, the patient still had quite a bit of morbidity with the following:abdominal hernia defect and tumor recurrence. Our case demonstrates the diagnostic and therapeutic challenges in management of sarcomas hence the need for these patients to be managed through a multidisciplinary approach.
Conclusion:
The omental flap is quite versatile, and knowing how to raise it does not require sophisticated microsurgical skills. It adds to the reconstructive surgeon's armamentarium, especially in resource-limited settings.
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