Case PresentationDr Junaid Ahmad

Jinnah Hospital Lahore

History

A 22yr

Married

Female

Resident of Pakpattan

Referred to OPD by Gynaedepartment on 11th November 2013

History

Recurrent abortions due to abdominal scarring for three years

History

Flame burn since age 5yrs Initially managed by dressings SSG was done 9 months later at THQ Sahiwal

After marriage she got problems during pregnancies.

Three pregnancies without a live issue No history of co-morbidities like DM, HTN or IHD

History

First pregnancy was aborted spontaneously at the 7th month of gestation

Second pregnancy ◦ Born alive 7th month gestation

◦ Died second day

Third pregnancy◦ Baby of 7 months gestation at JHL

◦ Died after 2 days

◦ Weight 1.5Kg

Less abdominal protuberance during gestation

Examination

GPE was normal

Systemic Examination revealed no abnormality

Gynecological examination was normal

Local Examination

29x30cm of scarring extending from anterior chest to abdomen

Lower halves of both breast involved

Multiple vertical tight linear scar bands.

Healed donor sites of SSG on both thighs.

Investigations

Routine investigations were normal

US abdomen was normal

Management Plan?

Management Plan

Multi disciplinary approach

Gynecological evaluation

Release of scar

Soft tissue Coverage

Gynecological Evaluation

Gynecologist evaluated the patient and find out no other cause of abortion of her pregnancy other than scarring

Release Approach?

Upper abdomen

Lower Abdomen

At the level of Umbilicus

Release Approach

Abdomino-plastyincision because

During pregnancy lower abdomen expands much more

Just release incision was given

20x30cm defect was created

Soft tissue coverage options?

Soft tissue coverage options?

Pedicled ALT flap

Pedicled TFL flap

Free flaps

SSG

Bilateral Pedicled ALT

Three team approach

Bilateral Pedicled ALT

Left ALT raised

Right ALT raised

Final Operative Results

Final Operative Results

Donor Site Grafted SSG

Follow up

Patient was called 15th Post operative day

Stitches removed

One Month Follow up

One Month Follow up

One Month Follow up

Follow up

More follow up will be presented once patient’s problem of pregnancies is solved……

Thank You