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

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.

Keywords: Complex anterior abdominal wall defects; pedicle and free anterolateral thigh flaps and Tensor Fascia Lata Flap; reconstruction; vascularised fascia.

Figure 1

Classification of abdominal defects by Mathes ( Zone 1A: Upper midline defect, Zone 2: Upper quadrant defect of the abdomen, Zone IB: Lower midline defect, Zone 3: Lower quadrant defect of the abdomen (Extending across midline))

Figure 2a

Pre-operative case of Type II electrical burns defects in the right lower abdomen and groin

Figure 2b

Intraoperative after complete harvesting of the tensor fascia lata free flap

Figure 2c

At 1-year post-operative follow-up

Figure 3a

Pre-operative large lower midline and lower lateral quadrants of Type II electrical burns defect with unstable scar

Figure 3b

After transferring bilateral pedicled anterolateral thigh flaps over the defect

Figure 3c

At 2-year post-operative follow-up

Figure 4a

Intraoperative photograph showing after excision of the tumour with abdominal wall defect in left lower quadrant

Figure 4b

After complete islanding the flap on anterolateral thigh pedicle

Figure 4c

After complete inset of the flap

Figure 4d

Post-operative follow-up