Salvage of stoma stenosis using a fenestrated ultrathin ALT perforator flap following Kock pouch ileostomy

TL;DR

This case report describes a successful surgical technique using an ALT flap to fix a narrowed stoma after an ileostomy, showing its potential for complex abdominal wall reconstruction.

Contribution

The study introduces the use of a fenestrated ultrathin ALT flap to address stoma stenosis at the mucosa-skin interface, a novel application in reconstructive surgery.

Findings

A fenestrated ultrathin ALT flap successfully salvaged a stenotic stoma following a Kock pouch ileostomy.

The flap restored functional defecation and prevented stenosis recurrence over a two-year follow-up.

Postoperative complications were managed effectively, leading to long-term success without donor site morbidity.

Abstract

Abdominal wall defects can present a challenge for reconstructive surgeons, especially in the presence of major visceral issues. Anterolateral thigh flaps (ALT) are widely used in complex abdominal wall repair, whether pedicled or free, innervated, or denervated. Previous reports primarily focus on reconstruction of the outer layers of the abdominal wall (muscle, fascia, and skin); however, this case highlights the potential of ALT flaps to address complications at the mucosa-skin interface, particularly stomal issues. This case report aims to demonstrate the versatility of the ALT flap at the mucosa-skin contact area, specifically to salvage a stenotic stoma following a Kock pouch (K-pouch) ileostomy. The patient developed multiple complications, including stomal retraction, stenosis, and leakage, which required innovative reconstructive techniques. Here, transposition of a fenestrated ultrathin pedicled ALT flap was used to reconstruct the abdominal wall while accommodating a retracted stoma in the middle of the skin paddle, restoring functional defecation. Initial postoperative complications, such as stomal leak and partial flap dehiscence, were managed with secondary flap adjustments, resulting in long-term successful outcomes. At the two year of follow-up, the stoma remained functional, with no recurrence of stenosis or skin irritation, and the donor site healed without morbidity [1].

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