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29
th
CONGRESS OF THE ESPU
14:42–14:47
S17-4 (VP)
ABDOMINOPLASTY WITHOUT OSTEOTOMIES USING
GROIN FLAPS TO CLOSE THE ABDOMINAL WALL DEFECT
IN THE MANAGEMENT OF EXSTROPHY-EPISPADIAS
COMPLEX
Amilcar GIRON
1
, Marcos MELLO
2
, Ricardo BERJEAUT
2
, Marcos MACHADO
2
,
Gabriel SILVA
2
, Bruno CEZARINO
2
, Lorena OLIVEIRA
2
, Roberto IGLESIAS
2
and
Francisco DÉNES
2
1) Hospital das Clinicas, São Paulo, Brazil., Urology, São Paulo, BRAZIL - 2) University of São Paulo, Brazil, Urology,
São Paulo, BRAZIL
PURPOSE
We demonstrate the GROIN FLAP technique to close the abdominal wall of children with exstrophy-
epispadia complex without osteotomy and without radical soft tissue mobilization. The advantages
over current techniques for complete repair are the small risk of penile tissue loss and the avoidance
of osteotomies.
MATERIAL AND METHODS
Abdominal wall repair consists in using hypogastric skin and rectus and obliquus externus abdomi-
nalis muscle aponeurosis flaps. These groin flaps are rotated to the midline resulting in a very strong
abdominal wall support. Groin flaps are made of the rectus anterior aponeuroses rotated medially,
flipped over, and sutured with prolene sutures to close the defect. By rotating the facial flaps medi-
ally, complete reinforcement of the abdominal wall to the level of the pubic bone is achieved. This
permits the abdominal closure maintenance without tension.
RESULTS
During the last 30 years, GROIN FLAP was applied to 128 patients with bladder exstrophy that
came from all over the country. Most of these patients returned to their home areas making difficult
their follow up. However, we have 44 cases that have regular clinical visits. Mean follow-up was
10.3±4.5 years (2y8 mos–16y). Successful closure was achieved in 43 patients (97.7 %) as a sin-
gle procedure; one patient had complete wound dehiscence and needed another reconstruction
(2.2 %). Four patients (9.1 %) presented abdominal hernias that needed surgical management.
CONCLUSIONS
One-staged reconstruction using GROIN FLAPS has advantages over the traditional approaches
to bladder exstrophy. It reduces the surgical steps and facilitates the closure of the abdominal wall
without the need of osteotomies and consequent immobilization during the postoperative period. It
is feasible at any age and can be also very useful as a rescue technique even after previous failed
procedures. Finally, It minimize the number of surgeries.