Radial Artery Pedicle Flap To Cover Exposed Mesh After Abdominal Wound Dehiscence-An Easy Solution To A Difficult Problem

摘要

Abdominal wall dehiscence poses a difficult problem to treat. It is ever difficult to treat an exposed mesh when it is utmost important to retain it to give strength to the abdominal wall. Many flaps have described in literature. Each flap has limited area of reach on the abdominal wall.A 55 year old thin built man had undergone operation for perforation peritonitis. Post operatively the wound gaped exposing bowel. Closure of burst abdomen was done by a mesh 30X30 cm. After 3 days of operation abdominal wound again developed superficial dehiscence, skin margins necrosed leaving a gap of 13X 7 cm of exposed mesh.A radial artery pedicled flap planned from the left forearm was used to cover the exposed mesh. Flap detachment and insetting was done after 3 weeks with good aesthetic result and acceptable donor site scar. Case report A 55 year old male of thin built reported to casualty of J.N.Medical college and Hospital , Aligarh Muslim University, Aligarh with pain and distension of abdomen. Clinical and radiological study confirmed perforation peritonitis.Patient was operated and duodenal perforation was closed by modified Graham repair.Post operatively, patient had serous discharge from the main wound and the wound gaped. Then complete burst abdomen developed with evisceration of small bowel.Subsequent surgery was undertaken when the infection was controlled. Burst wound was closed with in-lay (size 30X 30 cm) poly propylene mesh after cutting its cornersAfter 3 days of surgery, skin stitches start giving way and by 7 th day whole of the incision gaped exposing 13 X 7 cm of the mesh.