Acellular flowable dermal matrix for ostomy reconstruction: a safe and effective minimally invasive technique

Acellular dermal matrices have long been used for complex abdominal wall closure and, more recently, for ostomy reconstruction.

To describe ostomy reconstruction with acellular flowable dermal matrix (AFDM) in a pediatric patient with a complex abdominal wall defect.

A 14-year-old female who was diagnosed with unspecific hemorrhagic colitis at age 6 months and who underwent several abdominal surgeries (including total colectomy and terminal ileostomy) reported frequent, severe periostomy skin ulcerations secondary to improper fitting and ostomy bag leakage due to multiple periostomy skin retraction as a result of multiple abdominal scars. Under sedation, 2 small (5 mm) peristomal skin incisions were made, through which dissection and release of dermal scar tissue was performed. Afterwards, AFDM 40 mL was injected subcutaneously until a uniform, flat surface around the ostomy was achieved. The patient was discharged a few hours postoperatively, after verification of proper fit of the ostomy bag with no leakage. At 18-month follow-up, the patient was very satisfied with the result, with fewer ostomy bag changes and improved quality of life.

This case report indicates that AFDM is a safe and effective minimally invasive technique for ostomy reconstruction, with minimal complications and satisfactory medium-term results.