The Tensor Fascia Lata Free Flap in Abdominal‐Wall Reconstruction

Abstract

The pedicled tensor fascia lata flap (TFL flap) is a method of choice for abdominal-wall reconstruction. Frequently, the size and location of the defect produce this option. Microsurgical transfer may overcome these disadvantages. Therefore, the ability of the TFL free flap to reconstruct complex abdominal wounds was evaluated. Seven patients with full-thickness abdominal-wall defects reconstructed by TFL free flaps were reviewed. Their average age was 44.6 years (range: 27 years to 59 years); follow-up averaged 10.5 months (range: 2 months to 18 months). Fifty-seven percent of the wounds were either infected or contaminated; the defect averaged 15 cm x 26 cm Six 85.7 percent) of the wounds involved the epigastrum. No total flap loss was seen, but three flaps developed distal tip necrosis (42.9%). Microsurgical transfer of the TFL free flap overcomes the limitations of the arc of rotation seen with the pedicled flap. It increases the vascularity of the distal portion of the flap. The TFL free flap is therefore an option in abdominal wounds, particularly those with defects of large size or supraumbilical location.

Reconstruction of a full-thickness abdominal wall defect using an anterolateral thigh free flap

“…The fasciocutaneous LCVA-vl flap is fairly thin (2.6 cm on average) [24] and a large area up to 25 × 18 cm can be harvested with its underlying aponeurosis [22]. The length of the pedicle can vary from 10 to 18 cm [25,26] depending on the patient's anatomy and the dissection of the perforators; vessel caliber is usually greater than 2 mm which makes microsurgical anastomosis quite feasible. The donor site lies in a less ''social'' zone than other flaps and, since no muscle is harvested, there is minimal morbidity.…”

Reconstruction of Complex Abdominal Wall Defects

“…The disadvantage is that it requires multiple stages and uncontaminated operative field. Various muscle and myocutaneous flaps like tensor fascia lata [10], rectus femoris [11], rectus abdominis [12] and latissimus dorsi [13] have been reported in literature for repair of abdominal wall defects. In this series we have used pedicled latissimus dorsi myocutaneous flap in one case only to cover Gore-Tex mesh for the patient requiring postoperative radiotherapy.…”

Abdominal Wall Reconstruction in a Trauma Setting

“…Both sides can be harvested to cover large defects. In the series reported by Williams et al [42], the complication rate in these reconstructions was as high as 44%; distal vascularity of flaps was unreliable in both pedicled and free flaps and a donor morbidity of 18% was reported. Disa et al [43] have used devascularized fascial grafts in patients with contamination, infection, and fistulas and reported successfully closing all wounds.…”