Huge abdominal wall reconstruction with island pedicle anterolateral thigh flap with tensor fascia lata plus vastus lateralis muscle

Abstract

Full-thickness abdominal wall defects may result from trauma, tumor resection, or infection. Management of these defects poses a significant challenge. Few studies have been conducted on using the pedicle anterolateral thigh (ALT) flap to reconstruct a defect of over half the anterior abdominal wall. We report a large abdominal wall reconstruction with island pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle. An 80-year-old man with a large recurrent abdominal wall tumor had undergone two tumor resections after 2010. The pathology report demonstrated fibromatosis in 2010. Recently, computed tomography revealed a large, lobulated mass measuring approximately 11.8 cm × 5.3 cm × 8.8 cm, with heterogeneous enhancement, located at the left abdominal wall with cutaneous and subcutaneous involvement and adjacent omentum thickening. Wide excision and subsequent reconstruction of the abdominal wall defect with a pedicle ALT flap was conducted. The permanent histology report confirmed fibrosarcoma. Partial skin necrosis was noted after reconstruction surgery, and a second operation was performed to debride the necrotic skin. Wound healing was optimal, without any recurrence. Large primary abdominal fibrosarcoma is rare; thus, reconstruction of the postoperative defect is particularly challenging for plastic surgeons. In this case, we successfully used the pedicle ALT flap with tensor fascia lata plus vastus lateralis muscle to reconstruct the abdominal wall defect in the patient. This is an effective yet simple single-stage reconstructive procedure for defect repair.