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CC BY-NC 4.0 · Arch Plast Surg 2018; 45(04): 375-378
DOI: 10.5999/aps.2017.00822
Case Report

Successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug

Yasunori Sashida
Department of Plastic Surgery, Okinawa Prefectural Hokubu Hospital, Nago, Japan
,
Munefumi Kayo
Department of Surgery, Okinawa Prefectural Hokubu Hospital, Nago, Japan
,
Hironobu Hachiman
Department of Surgery, Okinawa Prefectural Hokubu Hospital, Nago, Japan
,
Kazuki Hori
Department of Surgery, Okinawa Prefectural Hokubu Hospital, Nago, Japan
,
Yukihiro Kanda
Department of Surgery, Okinawa Prefectural Hokubu Hospital, Nago, Japan
,
Akihiro Nagoya
National Hospital Organization, Kinki-chuo Chest Medical Center, Sakai, Japan
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In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.

Keywords

Intestinal fistula - Perforator flap - Ultrasonography, Doppler - Abdominal wound closure techniques


Publication History

Received: 10 May 2017

Accepted: 19 September 2017

Article published online:
03 April 2022

© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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