An 18-year-old female patient who underwent surgery for cloaca exstrophy (healing with numerous previous intestinal tracts and urinary tracts) in another medical center, arrived at our Service with incontinent abdominal wall cutaneous sequelae.
1.
We programmed reconstruction of the wall, incisional hernia repair and repair of the urinary ostoma, working as a team with the Department of Surgery and Pediatric Urology.
1st Surgical time:
It consisted of the placement of 2 expanders of 1000cc. (with expansion capacity cc) and 15.2 cm. long-cellulose expansion capacity with greater rectangular annulus x apocostalis muscle position at the lower abdominal area.
The expansion was performed at a rate between 50 and 100 cc of saline solution at intervals of 1 week to 20 days, according to the patient's tolerance, up to 1300cc.
1.
2nd Surgical time:
After expansion surgery of the wall and urinary ostoma is programmed.
The Pediatric Plastic Surgery team removed the expanders and the urologist performed the plasty of the urinary ostoma.
Both surgical teams then proceeded to reconstruction of the upper and middle thirds of the wall using the remnant tissues of the abdominal rectus sheath, rectus abdominis muscle and remaining tricial tissue.
In the lower third and pubis, due to the absence of tissue, it is decided to use a prosthetic mesh of polypropylene (Prolene®) 15 x 10 bones above the ligament latissimus dorsi or both. a
The reconstruction of skin and cellulose-fat tissues is achieved with the advancement of expanded lateral tissues.
1.
The patient was admitted favorably without complications and reconstructive surgery of the vagina was performed one year later.
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Despite diastases, the patients gait is almost 17cm unaffected and, by decision, no treatment has been given.
