title: The "sliding door" technique for closure of abdominal wall defects after rectus abdominis musculocutaneous flap transposition.
abstract: Radical surgery is often necessary in patients with local recurrence of rectal cancer or in those with carcinoma associated with an anal fistula. The surgery may include extended excision of the perineal area and can create a large dead space in the pelvis and a large skin defect, often necessitating reconstruction of the pelvic floor using rectus abdominis musculocutaneous (RAM) flap transposition. Wound dehiscence and incisional hernia are common complications of RAM flap transposition. We report herein our encounter with 3 patients in whom we used a "sliding door" technique for reconstruction of the abdominal wall after the creation of a RAM flap. One patient underwent abdominoperineal resection with sacrectomy and RAM flap transposition; he experienced a postoperative surgical site infection and wound dehiscence, which we urgently repaired by reconstructing the abdominal wall using the sliding door technique. Two other patients underwent posterior pelvic exenteration with sacrectomy and RAM flap transposition. These patients underwent simultaneous abdominal wall reconstruction using the sliding door technique. No patient experienced postoperative pelvic sepsis, wound dehiscence, or incisional hernia. The sliding door technique might be useful for preventing wound dehiscence and incisional hernia in patients undergoing RAM flap transposition.
authors.affiliation: Dept. of Surgery,Nara Medical University.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakamoto
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Koyama
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kobata
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Nagao
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueda
authors.forename: Naoto
authors.initials: N
authors.lastname: Nishigori
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Keijiro
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Obara
authors.forename: Hisao
authors.initials: H
authors.lastname: Fujii
authors.forename: Akira
authors.initials: A
authors.lastname: Kido
authors.forename: Munehisa
authors.initials: M
authors.lastname: Koizumi
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D017568:Rectus Abdominis / Q000601:surgery*; D013524:Surgical Flaps