Reconstruction of a large full‐thickness abdominal wall defect with flow‐through‐based alt flaps: A case report

Abstract

An extensive 35 × 20 cm sized full-thickness abdominal wall defect was created after resection of aggressive abdominal fibromatosis in a 19-year-old male patient. Immediate reconstruction was not possible due to prolonged operation time and resulting severe bowel edema. A silicone sheet with NPWT was applied over the exposed viscera. After 1 week, silicone sheet was substituted with a composite mesh. Then, abdominal wall reconstruction with bilateral free anterolateral thigh (ALT) flaps (30 × 12 cm and 25 × 12 cm sized) was performed. Since there was only a single reliable recipient vessel available, we linked 2 ALT free flaps sequentially in a flow-through fashion to the left inferior epigastric artery and vein. Two donor sites were closed primarily. The flap fully survived and the defect was covered successfully without any complication for 11 months of follow up. Multiple flaps may be needed for large full-thickness abdominal wall defect coverage. Linked fasciocutaneous free flaps could be a solution with a less donor site morbidity even in the case of limited available recipient vessels. The purpose of this study is to introduce our experience of extensive full-thickness abdominal wall reconstruction using only ipsilateral deep inferior epigastric vessels.

Anterolateral thigh flap for abdominal wall reconstruction. A case report

“…Some of the most commonly used loco-regional flaps include the external oblique muscle, tensor fascia lata, rectus abdominis muscle, rectus femoris muscle, ALT with or without a portion of vastus lateralis muscle, latissimus dorsi muscle and omental flaps [ 7 ]. Using a fasciocutaneous flap is desirable in order to replace the complex and unique musculo-fascial system of the abdominal wall [ 11 ]. Two of the most used flaps for reconstruction of the abdominal wall are the tensor fascia lata (TFL) and ALT flaps.…”

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

“…Moreover, the branches and the distal end of the descending branch of the LCFA can be used as chain‐linked vessels to connect other flaps, thereby expanding the repair area of these sequential flaps (He et al, 2016; He et al, 2018; Henn et al, 2017; Hsu et al, 2009; Miyamoto et al, 2015). The flap can also carry cutaneous nerves; Thus, it can be used to repair weight‐bearing areas (Kim et al, 2019). Koshima et al first described a fabricated chimeric flap, which consisted of a flow‐through ALT flap used as a bridge flap, to reconstruct massive cervical defects (Koshima, 2001); it consists of at least two flaps that are simultaneously harvested, and the vascular pedicles of these flaps are fabricated together into a single vascular source by micro‐anastomosis (Song et al, 2016).…”

Combined use of ipsilateral latissimus dorsi flap and anterolateral thigh flap to reconstruct extensive trunk defects

“…Shoham et al (Shoham et al, 2013) reconstructed a large chest wall defect (not full‐thickness) with a combination of an LD musculocutaneous flap and a vertical rectus abdominis musculocutaneous flap. Kim, Lee, Kim, Chang, and Moon (2019) reported the use of bilateral ALT flaps to reconstruct a full‐thickness abdominal wall defect. The defect in their patient was extensive; however, it did not extend to the chest wall, as in our Cases 2 and 3.…”