Abdominoplasty of cloacal exstrophy: application of reconstructive methods to recurrent and primary cases.
BACKGROUND
Surgical repair of cloacal exstrophy is still challenging. At birth, patients undergo bladder closure, colostomy, and osteotomy of the pubic bone (if necessary, when the interpubic range is wide and cannot be brought together with the hands). This abdominal defect is closed primarily by urologists or pediatric surgeons, if possible, but the patient may experience a relapse of bladder exstrophy and an abdominal defect. Abdominal reconstruction was performed for a series of recurrent and primary (preventive) cases.


METHODS
Abdominal wall reconstruction was performed using the rectus abdominis and external oblique muscle fascia flaps, and reinforcement of the bilateral rectus abdominis muscles in 2 cases of cloacal exstrophy patients. One was a recurrent case treated at 7 months old, and the other was done primarily at 2 days after birth.


RESULTS
The closure of the abdominal wall was successful and no relapse of bladder exstrophy or abdominal defect has occurred. These patients are now undergoing rehabilitation.


CONCLUSIONS
Cloacal exstrophy usually has many serious complications. The abdominal-wall defect is often large and accompanied by a wide detachment of the pubic bone. Even if the simple closure of abdominal wall is possible at birth, it is usually insufficient. Abdominal-wall repair must be done thoroughly, soon after birth, and plastic surgery techniques should be used.
Department of Plastic Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. ta.matsui@scchr.jp
Takahiro
T
Matsui
Susam
S
Park
Tomohiro
T
Shiraishi
Masaru
M
Horikiri
D034861:Abdominal Wall / Q000002:abnormalities* / Q000601:surgery*; D001746:Bladder Exstrophy / Q000601:surgery*; D002585:Cesarean Section; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010027:Osteotomy; D011247:Pregnancy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D013524:Surgical Flaps; D013520:Urologic Surgical Procedures / Q000379:methods*