The Anatomic Feasibility of a Functional Chimeric Flap in Complex Abdominal Wall Reconstruction

Abstract

Background Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch. Methods Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin. Results Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps. Conclusions This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.

Subtotal Thigh Flap for Large Abdominal Wall Defect Reconstruction in Patient With Recurrent Dermatofibrosarcoma Protuberans

“…7 Various types of flaps for adequate coverage have been reported. 3,[8][9][10][11][12][13][14] The thigh-and back-based flaps are mostly recommended because these 2 approaches offer enough skin paddle and additional muscle and fascia components. Also, chimeric flaps from these sites are available, especially for large defects.…”

“…The objectives of massive abdominal reconstruction include adequate coverage with or without function restoration 7 . Various types of flaps for adequate coverage have been reported 3,8–14 . The thigh- and back-based flaps are mostly recommended because these 2 approaches offer enough skin paddle and additional muscle and fascia components.…”

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…Due to the complexity of many ventral hernias, a multidisciplinary team that includes plastic surgery is required to provide the most effective care [8]. The involvement of plastic surgery helps optimize tension-free closures which decreases the likelihood of recurrence [4].…”

“…The involvement of plastic surgery helps optimize tension-free closures which decreases the likelihood of recurrence [4]. In the instances in which primary closure cannot be achieved even with mesh, plastic surgery can offer component separation or free or pedicled flaps to the appropriate patients [8]. Hernias can present as challenging defects that lack an overall consensus on the best approach, and benefit from an individualized approach which plastic surgery can provide with its varied toolbox [8,9].…”

“…In the instances in which primary closure cannot be achieved even with mesh, plastic surgery can offer component separation or free or pedicled flaps to the appropriate patients [8]. Hernias can present as challenging defects that lack an overall consensus on the best approach, and benefit from an individualized approach which plastic surgery can provide with its varied toolbox [8,9]. Multiple examples exist in the literature describing collaboration between general surgery and plastic surgery for the operative management of hernias [4,7].…”