Combined serratus anterior and latissimus dorsi myocutaneous flap for obliteration of an irradiated pelvic exenteration defect and simultaneous site for colostomy revision

Abstract

Background: Usually, several surgical methods are used, with re-suturing, free skin grafting and local flaps, for thereconstruction of wall defects after abdominoperineal resection. However, or larger defects, free flaps have beenpreferred because they can provide a large area of well-vascularized soft tissue, which is suitable for defect repair.We present the case of a large abdominal wall defect, which was treated with a free combined serratus anteriorand latissimus dorsi myocutaneous flap, resulting in a successful outcome.Case presentation: A 38-year-old female originally had squamous cell carcinoma of the cervix uteri, and hadundergone radical hysterectomy and oophorectomy followed by radiotherapy. She had a recurrence of thecervical cancer after 13 years, and underwent pelvic exenteration. However, the mid-abdominal wound developeddehiscence and an abdominal full-thickness defect communicating with the pelvic cavity. Furthermore, the adheredcolon developed necrosis, which drained stools into the pelvic cavity, resulting in chronic peritonitis. During surgery,the empty pelvic cavity was filled with a combined serratus anterior and latissimus dorsi myocutaneous flap toprevent chronic peritonitis, to create a new stoma in the skin paddle of the flap for the necrotic colon, and toseparate the pelvic cavity from the drained stools. The patient could walk in the absence of abdominal herniaformation and relapse of infection.Conclusions: A combined serratus anterior and latissimus dorsi myocutaneous free flap was applied to cover theraw surface and reinforce the abdominal wall and to fashion a new colostomy, as well as successfully filling thepelvic cavity with a large muscle body and long vascular pedicle. This is the optimal method for reconstructingsevere abdominal wall defects that have many complications.