A 36-year-old man presented with a recurrent lump in his right upper abdomen for two years measuring 13x10 cm. An MRI and biopsy found spindle cells consistent with a benign myofibroblastic neoplasm. The surgical plan was a wide local excision with abdominal wall reconstruction. The reconstruction was performed using the omentum-mesh-skin technique, which involves placing mesh between the omentum and skin to close a large abdominal wall defect. This technique is recommended for complex abdominal wall reconstructions due to the challenging nature and high risk of recurrence for these types of tumors.

1. SKIN-OMENTUM-MESH-SANDWICH
TECHNIQUE
FOR
LARGE ABDOMINAL WALL DEFECT
CLOSURE
PRESENTER
DR. NEELAM AHIRWAR,LHMC
DR ARUN KAPUR , DR SANJAY, DR ANJU, DR
M P ARORA

2. CLINICAL DETAILS
MR X , 36 Yrs resident of
Delhi presented with c/o
• Recurrent lump in right
upper abdomen × 2 yrs
• Single parietal 13×10 cm
lump
• Umbilicus, epigastrium,
right hypochondrium

3. MRI ABDOMEN
& CORE NEEDLE
BIOPSY
Multiple cores of spindle
cells in sheets and
fascicles with cells with
mild pleomorphism set in
a collagenous stroma
S100, SMA - negative

4. SURGICAL PLAN
•Wide local excision
with abdominal wall
reconstruction.

5. WIDE LOCAL EXCISION

6. RECONSTRUCTION USING OMENTUM,
MESH AND SKIN

7. DISCUSSION
• Benign myofibroblastic neoplasms originating from the
muscle aponeurosis and classified as deep fibromatoses .
• 3% of all soft tissue tumors and 0.03% of all neoplasms.
• Aggressive local infiltration
• High recurrence rate

8. • Associated with familial adenomatous polyposis (FAP)
• Reconstruction of complex defects of the anterior abdomen is
both challenging and technically demanding for
reconstructive surgeons.
• We recommend omentum- mesh –skin technique for closure
of such large defects

9. Thankyou