Reconstruction de l’aponévrose musculaire de la zone donneuse du lambeau antérolatéral de cuisse par plaque synthétique : technique et bénéfice

Abstract

The anterolateral thigh flap is sometimes harvested with a portion of the quadriceps muscle fascia, which can lead to muscle hernias or adhesions at the donor site. Studies report an 11 to 32% incidence of muscle hernias and an 8 to 26% incidence of persistent weakness at the donor site. There is no data in the scientific literature presenting a surgical technique for the prevention of muscle hernias at the donor site of the anterolateral thigh flap. The objective of our study is to describe our technique for placing a synthetic mesh when closure of the fascia is not possible during the harvesting of an anterolateral thigh flap, in order to reduce the risk of postoperative muscle hernias and to analyze its benefits. As part of a prospective study, we present here our technique for reconstructing the fascia by placing a non-resorbable synthetic mesh. Twenty-two patients underwent the placement of a mesh for the reconstruction of the fascial defect, which averaged 9.6cm. One year after the procedure, none of the patients presented with a muscle hernia or adhesions at the donor site. According to studies, muscle hernias and scar adhesions occur in 11 to 32% of cases and are both unsightly and disabling for patients. Although it is difficult to quantify the benefit in terms of muscle strength, fascia reconstruction effectively prevents this type of complication. When the defect is greater than 8cm, we believe it is essential to reconstruct the fascia during harvesting to prevent the occurrence of hernia or adhesion at the donor site. While not affecting limb function, muscle hernia is at least aesthetically bothersome and should be systematically prevented. Reconstruction of the muscle fascia at the donor site of the anterolateral thigh flap with a non-resorbable synthetic mesh, in cases of a defect greater than 8cm, prevents the occurrence of muscle hernias and adhesions, which can lead to aesthetic and functional complications.