Pedicled Anterolateral Thigh Flaps for Salvage Reconstruction of Complex Abdominal Wall Defects

Gurjot S. Walia, BS, Justin M. Broyles, Joani M. Christensen, Andrea Y. Lo, Danielle H. Rochlin, Francis F. Daily, Sachin M. Shridharani and Justin M. Sacks

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, USA

^*Correspondance to: Justin M. Sacks 

 PDF  Full Text DOI: 10.25107/2474-1647.1298

Abstract

Background: Extensive abdominal wall defects can arise following injury or tumor resection. Reconstruction of these full-thickness defects can be augmented with pedicle flaps, providing necessary soft-tissue when local options are inadequate. Though the pedicled anterolateral thigh (ALT) flap has been used to cover a wide range of defects, its utility in abdominal wall reconstruction has not been well described. Further, many surgeons conventionally adhere to the use of a free flap for upper abdominal defects and a pedicle flap for lower abdominal defects, yet it is our experience that a pedicled ALT flap can be used to salvage patients and reconstruct defects anywhere in the anterior abdomen up to the xyphoid process.Methods: We conducted a retrospective study to assess and discuss our single institution experience with the use of pedicled ALT flaps for salvage abdominal wall reconstruction. Inclusion criteria were all patients of the senior author who underwent reconstruction of full-thickness composite abdominal wall defects with a pedicled anterolateral thigh flap from 2011-2015. Charts were reviewed for demographic data as well as outcomes measures, including fascial defect size, skin inset paddle size, acellular dermal matrices (ADM) used, underlying etiologies, and major and minor complications.Results: A total of seven patients, ages 28 to 74 years, were included in this case series. All patients had recurrent hernias, infection, sarcomas and/or enterocutaneous fistulae with multiple prior abdominal operations. Mean inset skin paddle was 189 cm2 and mean fascial defect size was 233 cm2. Pedicled ALT flaps were inset via a subcutaneous tunnel through the groin. There were no intraoperative complications, flap failures, or hernia recurrences. Two patients (28%) had postoperative complications of infection, with 1 reoperation within 30 days of surgery.Conclusion: The pedicled ALT flap is a favorable option that should be routinely considered for reconstruction of composite full-thickness abdominal wall defects given its durable blood supply and ability to cover large cutaneous defects with minimal donor site morbidity.

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Cite the article

Walia GS, BS, Broyles JM, Christensen JM, Lo AY, Rochlin DH, et al. Pedicled Anterolateral Thigh Flaps for Salvage Reconstruction of Complex Abdominal Wall Defects. Clin Surg. 2017; 2: 1298.