Pedicled vertical myocutaneous gracilis (VMG) flap for reconstruction of a large composite lower abdominal defect

Management of the complex abdominal wall defect after tumour extipiration represents a challenge and requires careful planning. We report a case of a 76-year-old gentleman treated initially for a T4N0M0 Dukes B sigmoid cancer with anterior resection in 2008. He re-presented 6 months after chemotherapy with a histopathologically proven anterior abdominal wall adenocarcinoma of colonic origin with involvement of the underlying parietal wall and rectus muscle. En bloc resection was undertaken with the harvesting of a vertical myocutaneous gracilis, VMG, pedicled flap (11 × 22 cm) to fill the abdominal soft tissue defect. A concurrent supraumbilical incisional hernia, poor coverage from other local pedicle flap options and multiple co-morbidities made the pedicled VMG the only viable option. We report its success as a valuable option in the reconstructive armamentarium for complex abdominal defects.