This case presentation summarizes the history and management of a 22-year-old female patient with recurrent pregnancy loss due to extensive abdominal scarring from a childhood burn injury. She had three prior pregnancies that did not result in a living child. Evaluation found her scarring was restricting her abdominal expansion during pregnancy. The management plan involved a multidisciplinary approach with gynecology, plastic surgery, and general surgery. An abdominoplasty incision was made to release the scarring, creating a 20x30cm defect. This was reconstructed using bilateral pedicled anterolateral thigh flaps for soft tissue coverage. Follow up at one month found the flaps had healed well. Further follow up would be provided if

1. Case Presentation
Dr Junaid Ahmad
Jinnah Hospital Lahore

2. History
 A 22yr
 Married
 Female
 Resident of Pakpattan
 Referred to OPD by Gynae
department on 11th November
2013

3. History
Recurrent abortions due
to abdominal scarring
for three years

4. 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

5. 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

6. Examination
GPE was normal
Systemic Examination
revealed no abnormality
Gynecological examination
was normal

7. 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.

8. Investigations
Routine investigations
were normal
US abdomen was normal

9. Management Plan?

10. Management Plan
 Multi disciplinary
approach
 Gynecological
evaluation
 Release of scar
 Soft tissue Coverage

11. Gynecological Evaluation
 Gynecologist evaluated the patient and
find out no other cause of abortion of her
pregnancy other than scarring

12. Release Approach?
 Upper abdomen
 Lower
Abdomen
 At the level of
Umbilicus

13. Release Approach
 Abdomino-plasty
incision because
 During pregnancy
lower abdomen
expands much
more
 Just release
incision was given
 20x30cm defect
was created

14. Soft tissue coverage options?

15. Soft tissue coverage options?
 Pedicled ALT flap
 Pedicled TFL flap
 Free flaps
 SSG

16. Bilateral Pedicled ALT
 Three team approach

17. Bilateral Pedicled ALT

18. Left ALT raised

19. Right ALT raised

20. Final Operative Results

21. Final Operative Results

22. Donor Site Grafted SSG

23. Follow up
 Patient was called 15th Post operative day
 Stitches removed

24. One Month Follow up

25. One Month Follow up

26. One Month Follow up

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

28. Thank You