A multidisciplinary team from the Sant Pau hospital in Barcelona has performed the first 'perfect' reconstruction of the abdominal wall, so that it recovers all its functionality. This intervention has become the best reconstructive option in cancer patients, affected by radiotherapy or abdominal trauma.
The hospital has already performed five interventions of this type, on four sarcoma patients and a woman with serious consequences to the abdominal wall as a result of a car accident. He estimates that he will be able to carry out between three and four a year on very selected patients, with the abdominal area destroyed by trauma, a tumor or a hernia.
The new model consists of the restitution of the affected abdominal muscle with another from another area of the same patient's body, which is usually the gracilis, the vastus lateralis muscle (both in the thigh) or the latissimus dorsi, located in the back, depending on the size of the area to be reconstructed.
“These muscles are dispensable, so we use the one that generates the minimum functional and aesthetic consequences,” explained Manuel Fernández-Garrido, assistant to the Sant Pau Plastic Surgery service. “We model and place the new muscle in the recipient area just as the resected muscle was. Then, we join the blood vessels and nerves of the new muscle to those of the recipient area, using the nerve of the original muscle,” he specified.
As soon as the nerves regenerate, the donor muscle performs exactly the same function as the original. In less than a year, it contracts naturally and maintains the characteristic tone and function of the abdominal wall,” the doctors say.
Until now, abdominal wall reconstructions were merely structural. Once the tumor (sarcoma) was removed, a mesh was placed to support the internal organs and the area was covered with skin. “This meant the loss of the muscle that keeps the internal abdominal organs in place and that is essential to perform any natural movement, such as getting up from a chair, for example,” says Fernández-Garrido.
Thanks to the new model, the patient completely recovers abdominal muscle function and can return to a normal life, free of postoperative complications and functional alterations such as the inability to lift weight or exercise. Even in some patients there is no difference between the replaced muscle and the original.
The idea of muscle transplantation arose in the weekly meetings of the functional unit for malignant bone and soft tissue tumors (sarcomas) of Sant Pau. The first intervention – on an injured woman – was performed a year ago using a reinnervated muscle from the back. After six months, symmetry of abdominal wall contraction was evident and it has now been confirmed that the nerve has regenerated and full muscle function has been restored.
