Reconstructive Procedures: Trunk and Perineal Reconstruction

Due to the natural process of pregnancy, the abdomen can be stretched significantly by the uterus and foetus. This leads to a form of tissue expansion of the muscle, fascia, and skin of the abdominal wall, which while maintaining some form of elasticity may unfortunately never return to its original quality, much like a balloon that has been filled with air for a long time.

In most instances, these defects are small and do not cause much problem. However, there is a subset of women who develop significant widening between the abdominal six-pack muscles (diastasis recti) and who even develop para-umbilical hernias. These can be the cause of much distress and potentially pain, despite exercising or binding. In addition, there is usually a significant amount of loose skin which is not amenable to conservative management.

In these instances, truncal reconstruction can be performed by way of a mini- or full abdominoplasty. The defect in the muscle and fascia can be repaired and excess skin removed, thus restoring the silhouette you desire along with allowing you to return to normal function.

Most abdominal surgeries and surgical scars heal without issues. However, there occasionally can be a breakdown in the fascial and muscle repair of the abdominal wall, leading to an incisional hernia. Risk factors for these include obesity, diabetes mellitus or previous infection at the surgical site. The bulges resulting from the incisional hernia can be quite significant, and lead to difficulty with daily activities. A plastic surgeon, commonly with general surgical support, is well trained to repair these defects in a sequential, safe manner with long term success.

A pressure sore usually arises from prolonged pressure on the soft tissue over a bony surface. In the trunk, this is usually the sacral and hip bone areas, and are common in patients who are immobile for a prolonged period. These sores can range from superficial to deep, and if chronic can even involve bony infection.

Methods to treat pressure sores include conservative measures with dressings and antibiotics, along with pressure off-loading by way of regular turning or pressure-relief devices. It is also important to keep the perineal area clean. In severe cases, or where the patient is motivated to maintain pressure off-loading, surgery is an option. The wound is first cleaned thoroughly, before reconstruction is performed, usually with surrounding tissue from the thighs or buttocks. Whilst not everyone with a pressure sore is a candidate for surgery, it can potentially lead to significantly improved quality of life without the need for constant dressings.