Reconstruction of the abdominal wall after excision of a bulky desmoid tumor and postoperative electromyography investigation to demonstrate its integrity

Abstract

The reconstruction of the abdominal wall following the removal of a bulky desmoid tumor involving the left rectus abdominis muscle from the xiphoid to the umbilicus is presented. After the tumor was removed, only the lateral third of the left rectus abdominis remained intact and, consequently, the muscles of the abdominal wall were mobilized according to the Ramirez technique. A polypropylene mesh was placed between the two rectus abdominis muscles and their posterior sheaths, the muscles having been sutured in the midline without tension. The anterior abdominal wall was further reinforced by using an inferiorly pedicled dermal flap in the cutaneous area between the umbilicus and the pubis. This is an area commonly removed in an abdominoplasty. An electromyographical study demonstrated that the muscles involved were functioning perfectly – both at rest and under stress – about 40 days after the surgery.