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ALT flap Reconstruction of abdominal defects in Bladder Exstrophy: Technique, complications and rescue procedure

T. G A¹, M. Balabolu¹, S. Kumar¹, S. Panaiyadiyan¹, A. Seth¹, S. Jain¹

¹AIIMS, New Delhi, Urology, New Delhi, India

Introduction:

Bladder exstrophy is a rare congenital anomaly. Incidence is 2 per 100,000 births. Being left untreated until adulthood is even rarer. The main reasons for delay include lack of awareness and poor socioeconomic conditions. The pedicled ALT flap in the context of reconstruction of complex abdominal wall defects was first reported by Kimata et al. in 1999. ALT flap is classically described as a cutaneous or fasciocutaneous flap based on the perforators from the descending branch of the LCFA (LCFA-db). The descending branch of the LCFA (LCFA-db) provides a long pedicle with a wide arc of rotation and also allows both proximal and distal flow. This allows the flap to be used for defects as superior as the supraumbilical region. Hence we use this flap in the abdominal reconstruction of patients with extrophy of bladder and describe possible complication and rescue procedure.

Material and methods:

We describe the procedure in 5 patients who had extrophy of bladder and underwent an abdominal wall repair along with surgery for extrophy. Four patients had good flap uptake, while 1 patient had ischemia of flap in immediate post operative period, which was rescued with reexploration.

Results:

There were 4 male patients and 1 female in the study. One male patient underwent cystectomy with urinary diversion. The abdominal defects were managed with an ALT flap cover, all had good flap take. One patient had ischemia of flap in immediate post operative period, which required reexploration and reperfusion of flap with vascular graft transfer to the flap pedicle. At Follow up all patients had good abdominal wall cover.