PMC4996055_01
Preoperative view (a) and large abdominal wall defect after resection of the tumor (b).
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F0001
Caucasian woman with a known-covered exstrophy, uterus didelphys, and external genital malformations (Figure 1), that did not affect her ability to procreate (two caesarean sections), presented with recurrent macroscopic haematuria. CT scan showed a left third grade hydronephrosis associated to a dysmorphic bladder, with a endoluminal neoformation of 10 cm of maximum diameter with irregular margins which appeared strictly in contact with the near organs and extending up to the abdominal skin. Cranially to the bispinoiliac line, the rectus abdominis muscles were sutured along the midline, while caudally, a full-thickness defect extended from the abdomen to the vaginal orifice (10 x 16 cm; Figure 1).
Intraoperative view showing the musculo-cutaneous muscle-sparing vastus lateralis flap including a portion of fascia lata (b and c) and the pedicle of the flap (a).
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F0002
The flap was passed under the rectus femoris muscle and a subcutaneous tunnel to reach the defect (Figure 2).
The tunnel in the inguinal region (a) and the insetting of the flap (b).
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F0003
The VL filled the dead space in the pelvic floor and was sutured to the upper border of the vagina and its skin island provided an additional resurfacing layer (Figure 3).
Final intraoperative view.
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The early postoperative result is shown in Figure 4.