Abdominal wall reconstruction for extensive necrosis following abdominoplasty in a patient with subcostal scars

Abdominal wall necrosis in a patient with previous abdominal scars

Abstract

Abdominal wall defects encompass a wide spectrum of musculo-fasciocutaneous anomalies. We present the case of a 42-year-old female with multimorbidity and bilateral subcostal scars who presented to our plastic surgery department with extensive soft tissue necrosis following simultaneous repair of an incisional ventral hernia and abdominoplasty performed by a senior general surgeon. Three tissue expanders were used to reconstruct the abdominal wall, allowing harvesting of sufficient adjacent autologous tissue for definitive correction of the defect. Five years after surgery, an acceptable aesthetic result and adequate abdominal stability were observed. Extensive soft tissue necrosis is a rare but significant complication that is predictable with experience and adequate surgical training in body contouring. Tissue expansion remains a viable and safe alternative for patients with complex abdominal wall defects who are not candidates for other reconstruction techniques. This report highlights the importance of adequate assessment of the abdominal wall with previous scars before an abdominoplasty.