title: Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap.
abstract: We present a surgical treatment for bladder reconstruction in a case of chronic vesicocutaneous radiation-induced fistula and reconstruction of the abdominal wall after resection of a liposarcoma in the rectus abdominis muscle. Fistulas are sequelae after radiotherapy. To regain bladder function and reconstitute abdominal wall stability, a microsurgical flap approach should be considered. A male patient underwent resection of a liposarcoma in the rectus abdominis muscle with adjuvant radiotherapy, suffering from a chronic vesicocutaneous fistula. A bipedicled combined latissimus dorsi and serratus anterior flap was carried out after resection of the fistula for reconstruction of the urine bladder and the abdominal wall. Ascending urethrography 4 weeks postoperatively showed no leakage. In the 4-month follow-up period, no signs of recurrence of the fistula or herniation occurred. A bipedicled flap allowed reconstruction of the urine bladder and the abdominal wall. Using non-irradiated, well-perfused intra-abdominal muscle tissue over the urine bladder prevented recurrence of the fistula.
authors.affiliation: Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Ludolph
authors.forename: Hendrik
authors.initials: H
authors.lastname: Apel
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.forename: Justus P
authors.initials: JP
authors.lastname: Beier
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery; D000368:Aged; D017577:Cutaneous Fistula / Q000601:surgery*; D006801:Humans; D008080:Liposarcoma / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D001747:Urinary Bladder Fistula / Q000601:surgery*
keywords: abdominal wall reconstruction; bladder reconstruction; free latissimus dorsi flap; free serratus anterior flap; vesicocutaneous fistula