The exstrophy–epispadias complex represents a spectrum of genitourinary malformations ranging from simple glanular epispadias to an overwhelming multisystem defect, cloacal exstrophy. Neonatal total reconstruction of bladder exstrophy–epispadias complex is the treatment of choice. An adult patient presenting with untreated exstrophy is very rare. Malignant transformation, commonly adenocarcinoma, in such cases is a known complication due to mucosal metaplasia of urothelium. Management in such cases necessitates a radical surgical procedure that often results in a massive defect in the anterior abdominal wall. Providing a cover for such defects is a challenging task for the reconstructive surgeon. Local skin flaps and wide mobilisation of the rectus muscle are the usually employed techniques for closure of such defects. However, these may be inadequate in extremely large defects such as those encountered in our patients. We, hereby, describe our technique of closure of the abdominal wall defect using a pedicled anterolateral thigh flap.
- urological surgery
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Contributors This particular case and gargantuan challenges posed during the management were dealt by joint endeavours of urology and plastic surgery department. First patient was managed primarily under RN and PK with inputs from plastic surgery department represented by DG. The authors had discussion with plastic surgeons regarding the best possible way to manage such a challenge after resection of the tumour. Similarly, second patient was managed primarily under AS in collaboration with plastic surgeons and management was very much similar to first case as illustrated. Plastic surgeon, DG, explained to us in detail the various options available to us for abdominal wall reconstruction and guided us to the best possible option available with careful regard to the outcome. Surgery could be seen as consisting of two major steps; radical cystectomy was first done by urologists and plastic surgeon then took over the reconstructive surgery aided by urologists. All the authors were involved in drafting the initial manuscript and thereafter taking it to final version which is being submitted here, after scrutinising every minor details.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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