Complex Abdominal Wall Reconstruction (Cawr) in Port Site Metastases (Psm) With Permanent Polypropylene Reinforced Tissue Matrix (Pprtm)

Objective to report the use of a PPRTM for CAWR after PSMs resection. Our report highlights the possibility of bridging 2 larges defects with a single mesh with no need of myocutaneous flaps that are common reconstructive options for oncologic defects. Case Report 79F with endometrial cancer presented with several anterior abdominal wall masses. Biopsy confirmed PSMs. Given their isolated nature, the two PSMs on right (9 × 6 cm) and one on left (4 × 3 cm) iliac fossa were resected with a 5 mm margin, resulting in two large bilateral defects. The pre-peritoneal space below acuate to arcuate was dissected to create sufficient space to wrap the abdominal wall with a single piece. On the right side, the gap was significantly bigger, and the therefore a transverse abdominal release (TAR) was performed to create space for overlapping cranially. An 40 × 25 cm was trimmed to cover the space completely. The gaps were partially reapproximated and attached to the mesh. A seroma was drained in the clinic on day 22 post-operatively. Follow-up at six months demonstrated good integrity of abdominal wall with no bulge. Conclusion Abdominal wall reconstruction after full thickness PSMs resection is challenging. It can be performed safely and effectively with attention to surgical technique, patients' risk of infection, and type of mesh, avoiding myocutaneous flaps. PPRTM would seem to be an adequate implant to perform the bridging repair, minimize morbidity and recurrence in these high-risk patients.