Reconstruction of Type II abdominal wall defects: Anterolateral thigh or tensor fascia lata myocutaneous flaps?

 

 Permissions and Reprints

ABSTRACT

Introduction: Reconstruction of complex abdominal wall defects is both challenging and technically demanding for plastic surgeon. Objectives in abdominal wall reconstruction are consistent and include restoration of abdominal wall integrity, protection of intra abdominal viscera and prevention of herniation. Materials: We conducted a retrospective study on five patients in whom lateral thigh flaps such as anterolateral thigh (ALT) flaps and tensor fascia lata (TFL) myocutaneous flaps as pedicled or free flaps were used for complex abdominal wall Type II defects over a 5-years period between 2007 and 2012. Results: In two patients, free flaps were used for reconstruction of the upper abdomen and both were ALT. In three patients of lower abdominal defects, one patient had bilateral pedicled ALT flaps, one pedicled TFL myocutaneous and one free TFL myocutaneous in view of ipsilateral electric burn scars. There were no flap losses. Patients were followed up beyond 6 months and found to have a good abdominal contour and only one of five had clinical evidence of herniation. Conclusion: It can be concluded that flap from the Lateral thigh (ALT or TFL) is flap of choice for large Type II abdominal defects. Including vascularised fascia in the flap maintains abdominal wall integrity and use of synthetic mesh is not necessary. Upper abdominal defects need free flaps and in lower abdominal defects a pedicled flap suffices.

• REFERENCES

• 1 Read RR. Ventral, epigastric, umbilical, spigelian and incisional hernias. In: Cameron JL. editor. Current Surgical Therapy. 5th ed.. Philadelphia: Mosby; 1995: p. 491-6
  Google Scholar
• 2 Larson GM, Vandertoll DJ. Approaches to repair of ventral hernia and full-thickness losses of the abdominal wall. Surg Clin North Am 1984; 64: 335-49
  CrossrefPubMedGoogle Scholar
• 3 Hurwotz DJ, Hollins RR. Reconstruction of the abdominal wall and groin. In: Cohen M. editor. Mastery of Plastic and Reconstructive Surgery. Boston: Little, Brown; 1994: p. 1349-59
  Google Scholar
• 4 Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthony JP. Complex abdominal wall reconstruction: A comparison of flap and mesh closure. Ann Surg 2000; 232: 586-96
  CrossrefPubMedGoogle Scholar
• 5 Tukiainen E, Leppäniemi A. Reconstruction of extensive abdominal wall defects with microvascular tensor fasciae latae flap. Br J Surg 2011; 98: 880-4
  CrossrefPubMedGoogle Scholar
• 6 Sharma RK, Verma GR, Biswas G. Reconstruction of a major abdominal and chest wall defect using latissimus dorsi and extended deep inferior epigastric artery flap. Ann Plast Surg 1992; 28: 366-9
  CrossrefPubMedGoogle Scholar
• 7 Bauer JJ, Harris MT, Gorfine SR, Kreel I. Rives-stoppa procedure for repair of large incisional hernias: Experience with 57 patients. Hernia 2002; 6: 120-3
  CrossrefPubMedGoogle Scholar
• 8 Nettelblad H, Tarpila E. Abdominal wall reconstruction with vascularised autologous tissue. Scand J Surg 2003; 92: 297-300
  CrossrefPubMedGoogle Scholar
• 9 Rifaat MA, Abdel Gawad WS. The use of tensor fascia lata pedicled flap in reconstructing full thickness abdominal wall defects and groin defects following tumor ablation. J Egypt Natl Canc Inst 2005; 17: 139-48
  PubMedGoogle Scholar
• 10 Hurwitz DJ, Hollins RR. Reconstruction of the abdominal wall and groin. In: Cohen M. editor. Mastery of Plastic and Reconstructive Surgery. 1st ed.. Vol. 1. Boston: Little, Brown; 1994
  Google Scholar
• 11 Mathes SJ, Nahai F. Clinical Application of Muscle and Musculocutaneous Flaps. St. Louis: Mosby; 1982: p. 364-85
  Google Scholar
• 12 Mathes SJ, Nahai F. Reconstructive Surgery Principles Anatomy and Technique. New York: Churchill Livingstone; 1997
  Google Scholar
• 13 Ohtsuka H, Ochi K, Seike H. Reconstruction of a large lateral abdominal wall defect with an ilio-lumbar bi-pedicled flap. Br J Plast Surg 1984; 37: 327-9
  CrossrefPubMedGoogle Scholar
• 14 Terashi H, Hashimoto H, Shibuya H, Ishii Y, Sato H, Takayasu S. Use of groin flap and anterolateral thigh adipofascial flap of tensor fascia lata for reconstruction of a wide lower abdominal wall defect. Ann Plast Surg 1995; 35: 320-1
  CrossrefPubMedGoogle Scholar
• 15 Koshima I, Nahai F. The versatile superficial inferior epigastric artery free flap. Br J Plast 1992; 45: 270
  Google Scholar
• 16 Classen D. The extended deep inferior epigastruic artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645
  CrossrefPubMedGoogle Scholar
• 17 Gottlieb ME, Chandrasekhar B, Terz JJ, Sherman R. Clinical applications of the extended deep inferior epigastric flap. Plast Reconstr Surg 1986; 78: 782-92
  CrossrefPubMedGoogle Scholar
• 18 Mathes SJ, Bostwick 3^rd J. A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects. Br J Plast Surg 1977; 30: 282-3
  CrossrefPubMedGoogle Scholar
• 19 Parkash S, Palepu J. Rectus abdominis myocutaneous flap – Clinical experience with ipsilateral and contralateral flaps. Br J Surg 1983; 70: 68-70
  CrossrefPubMedGoogle Scholar
• 20 DeFranzo AJ, Kingman GJ, Sterchi JM, Marks MW, Thorne MT. Rectus turnover flaps for the reconstruction of large midline abdominal wall defects. Ann Plast Surg 1996; 37: 18-23
  CrossrefPubMedGoogle Scholar
• 21 Spear SL, Walker RK. The external oblique flap for reconstruction of the rectus sheath. Plast Reconstr Surg 1992; 90: 608-13
  CrossrefPubMedGoogle Scholar
• 22 Ramasastry SS, Futrell JW, Williams SL, Hurwitz DJ. Internal oblique muscle pedicle flap for coverage of a major soft tissue defect of the groin. Ann Plast Surg 1985; 15: 57-60
  CrossrefPubMedGoogle Scholar
• 23 Williams JK, Carlson GW, deChalain T, Howell R, Coleman JJ. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg 1998; 101: 713-8
  CrossrefPubMedGoogle Scholar
• 24 Caffee HH. Reconstruction of the abdominal wall by variations of the tensor fasciae latae flap. Plast Reconstr Surg 1983; 71: 348-53
  CrossrefPubMedGoogle Scholar
• 25 Hill HL, Nahai F, Vasconez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg 1978; 61: 517-22
  CrossrefPubMedGoogle Scholar
• 26 Ninkovic M, Kronberger P, Harpf C, Rumer A, Anderl H. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg 1998; 101: 971-8
  CrossrefPubMedGoogle Scholar
• 27 Kuo YR, An PC, Kuo MH, Kueh NS, Yao SF, Jeng SF. Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularized fascia lata. J Plast Reconstr Aesthet Surg 2008; 61: 195-9
  CrossrefPubMedGoogle Scholar
• 28 Houtmeyers P, Opsomer D, Van Landuyt K, Monstrey S. Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata. J Reconstr Microsurg 2012; 28: 205-9
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 Kuo YR, Kuo MH, Chou WC, Liu YT, Lutz BS, Jeng SF. One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: Clinical experience and functional assessment. Ann Plast Surg 2003; 50: 149-55
  CrossrefPubMedGoogle Scholar
• 30 Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: Review of 140 cases. Ann Plast Surg 2002; 48: 161-6
  CrossrefPubMedGoogle Scholar
• 31 Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC. et al. Free anterolateral thigh flap for extremity reconstruction: Clinical experience and functional assessment of donor site. Plast Reconstr Surg 2001; 107: 1766-71
  CrossrefPubMedGoogle Scholar
• 32 Kuo YR, Kuo MH, Lutz BS, Huang YC, Liu YT, Wu SC. et al. One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg 2004; 239: 352-8
  CrossrefPubMedGoogle Scholar
• 33 Kayano S, Sakuraba M, Miyamoto S, Nagamatsu S, Taji M, Umezawa H. et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: Review of 20 consecutive cases. J Plast Reconstr Aesthet Surg 2012; 65: 1525-9
  CrossrefPubMedGoogle Scholar