Abdominal Mesh Use in Pedicled Rectus Abdominis Flaps for Pelvic Reconstruction

Area of Science:

• Reconstructive surgery
• Plastic surgery
• Surgical outcomes

Background:

• Rectus abdominis flap is used for perineal wound coverage after pelvic surgery.
• Flap harvest can lead to donor site morbidity like hernia or bulge.
• The role of mesh in this procedure is not well-defined.

Purpose of the Study:

• To evaluate the risk-benefit profile of mesh use in rectus abdominis flap donor site closure.
• To compare outcomes between patients who received mesh versus primary closure.

Main Methods:

• Retrospective chart review of 100 patients undergoing rectus abdominis flap for pelvic defects (July 2012-January 2021).
• Patients stratified by mesh use and primary fascial closure.
• Analysis of donor site outcomes, including hernia development and infection rates.

Main Results:

• Mesh use did not significantly decrease hernia rates when primary fascial closure was achieved.
• Mesh use was associated with significantly higher infection rates requiring intervention (12% vs 0%).
• Primary fascial closure showed a trend towards decreased hernia rates in mesh patients (P=0.058).

Conclusions:

• Mesh reinforcement of the rectus abdominis flap donor site offers no added benefit when primary fascial closure is possible.
• Mesh use is linked to increased infection rates and does not prevent hernias or bulges.
• Prioritize primary fascial closure for optimal donor site outcomes.