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Tissue Expander-Assisted Component Separation for Pediatric Abdominal Wall Reconstruction.

Rachel Marie Segal1, Alvin Wong2, Michelle Zaldana-Flynn2

  • 1From the Department of Surgery, UC San Diego School of Medicine, San Diego, CA.

Annals of Plastic Surgery
|September 23, 2023
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Summary

Tissue expander-assisted component separation effectively repairs large congenital abdominal wall defects in children. This staged approach provides sufficient tissue for closure, offering a safe alternative when primary repair isn't possible.

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Area of Science:

  • Pediatric Surgery
  • Reconstructive Surgery
  • Abdominal Wall Reconstruction

Background:

  • Congenital abdominal wall defects like omphalocele and gastroschisis often require complex surgical repair.
  • Primary closure may not be feasible for large defects, necessitating alternative reconstructive strategies.
  • Tissue expander-assisted component separation offers a method to augment local tissue for repair.

Purpose of the Study:

  • To evaluate the efficacy and safety of tissue expander-assisted component separation for treating pediatric congenital abdominal wall defects.
  • To present the largest case series to date on this technique in a pediatric population.
  • To assess the outcomes and complication rates associated with this staged approach.

Main Methods:

  • Retrospective chart review of 9 pediatric patients with large congenital abdominal wall defects.
  • Placement and subsequent removal of tissue expanders to achieve tissue expansion.
  • Component separation, with or without mesh, followed by abdominal wall closure.

Main Results:

  • Successful repair was achieved in all 9 patients using staged reconstruction with tissue expander-assisted component separation.
  • Average defect size decreased from 87.6 cm² to 54 cm² after tissue expansion and before closure.
  • Overall complication rate was 36.4%, including surgical site infection, seroma, and skin necrosis.

Conclusions:

  • Tissue expander-assisted component separation is a safe and effective technique for staged reconstruction of congenital abdominal wall defects in pediatric patients.
  • This method successfully augments local soft tissue, enabling primary closure when primary repair is not initially possible.
  • The technique avoids the need for flap reconstruction, simplifying the surgical process.