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Rectus Muscle Flap-augmented Closures in Wide-gap Exstrophy Bladder

Mir Fahiem-Ul-Hassan1, Vinay Jadhav2, Raashid Hamid1

  • 1Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Begaluru, Karnataka, India.

African Journal of Paediatric Surgery : AJPS
|September 16, 2024
PubMed

Insights

The rectus abdominis flap significantly reduces wound dehiscence after complete primary repair of exstrophy (CPRE). This technique aids in achieving bladder continence, especially in cases with wide pubic diastasis.

Area of Science:

  • Pediatric Urology
  • Surgical Reconstruction
  • Bladder Exstrophy Management

Background:

  • Wound dehiscence is a significant complication following complete primary repair of exstrophy (CPRE).
  • The study investigates the use of an inferior epigastric artery based rectus abdominis flap for abdominal wall closure in CPRE.
  • This approach is used alongside osteotomy and postoperative hip spica immobilization.

Purpose of the Study:

  • To evaluate the effectiveness of the rectus abdominis flap in preventing wound dehiscence after CPRE.
  • To assess the impact of the flap on achieving bladder continence.

Main Methods:

  • A comparative study involving 60 patients undergoing CPRE from June 2014 to June 2021.
  • Group I (30 patients): CPRE with rectus flap repair for abdominal wall closure (CPRE-RF).
  • Group II (30 patients): CPRE without rectus flap repair.

Main Results:

  • No wound dehiscence or bladder prolapse occurred in the CPRE-RF group (n=30).
  • In contrast, 6 patients in the CPRE-alone group experienced wound dehiscence, and 1 had bladder prolapse (statistically significant difference).
  • Primary bladder continence was achieved in 4 patients in the CPRE-RF group versus 3 in the CPRE group.

Conclusions:

  • The rectus abdominis flap is effective in preventing wound dehiscence in CPRE.
  • This surgical technique contributes to achieving the ultimate goal of bladder continence, particularly in patients with wide pubic diastasis.
Abstract

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