(CS-120) Immediate Abdominal Wall Reconstruction and Fleur-de-Lis Panniculectomy Following Resection of Massive Ovarian Cystadenoma

Jessica Reid, MS; Laural Adams, BA; Ireland Coates, BA; Cameron Belding, MD; Abigail Chaffin, MD

Introduction:

Giant epithelial ovarian tumors, including serous and mucinous cystadenomas, are rare benign neoplasms that can reach massive dimensions, often exceeding 10 cm.¹ Their expansion causes significant abdominal distension, thinning of the abdominal wall, and loss of domain, creating complex gynecology-oncology and reconstructive challenges.² Following tumor resection, the risk of fascial dehiscence or evisceration can be life-threatening.³ This highlights the critical need for multidisciplinary management to ensure oncologic safety and durable abdominal wall restoration.⁴

Methods:

A 41-year-old G4P3104 woman with morbid obesity (BMI of 62.5 kg/m²), abnormal uterine bleeding, and newly diagnosed type 2 diabetes mellitus presented with progressive abdominal distension. Imaging revealed a 28 cm right ovarian cystic mass with benign features and normal tumor markers. After medical stabilization for sepsis and anemia, she underwent a coordinated surgical procedure. The gynecology-oncology team performed an exploratory laparotomy, total abdominal hysterectomy, right oophorectomy, and left salpingectomy. Plastic surgery simultaneously addressed the abdominal wall laxity. We performed an immediate abdominal wall reconstruction utilizing a fleur-de-lis panniculectomy and midline fascial plication, reinforced by an onlay ovine-derived tissue matrix* to recruit fascia and eliminate dead space.

Results:

Intraoperative findings included a 40 cm torsed ovarian tumor containing 25.2 liters of serosanguinous fluid. Pathology confirmed a benign cystadenoma (585.8 g) with torsion necrosis and an endometrial polyp. The patient healed without major wound complications, demonstrating restored abdominal wall stability and an over 50-pound weight loss post-operatively.

Discussion: Fascial loss following massive tumor resection necessitates durable reconstruction using vascularized tissue flaps to ensure long-term abdominal wall integrity.⁴ We selected an ovine-derived reinforced tissue matrix specifically for the clean-contaminated nature of the surgical field (simultaneous hysterectomy). Unlike fully synthetic mesh, which poses a high risk of chronic infection and explantation in contaminated environments, this matrix resists bacterial colonization and supports rapid revascularization.⁵ It provides the necessary tensile strength to support the attenuated fascia without the long-term complications associated with permanent synthetic foreign bodies. This case demonstrates that early collaboration between gynecology-oncology and plastic surgery is essential in managing giant benign ovarian tumors.