Single-stage reconstruction of complex lateral thoracoabdominal defect using free tissue transfer and an arteriovenous loop

Abstract

Thoracoabdominal defects usually result from trauma, tumour resection, infection or they may be congenital. Reconstruction of these defects is absolutely necessary, for function preservation, especially in cases of full-thickness and complex defects. Use of flaps or combination of flaps and alloplastic materials is usually the key to a successful reconstruction. Several different methods for the reconstruction of thoracoabdominal defects have been described with very good to excellent results. We present the case of a 69-year-old patient who presented to our unit with a rapidly growing mass on the right lateral thoracoabdominal wall. After full-thickness tumour resection, the defect was reconstructed by using a free anterolateral thigh flap along with the central part of the vastus lateralis muscle and a larger surrounding part of the fascia lata. The ipsilateral greater saphenous vein was dissected to mid-calf, reversed and anastomosed to the femoral artery in an end to side fashion thus creating an arteriovenous loop which was later divided in the middle, for anastomoses with flap’s vessels. Flap survived in its entity without any complication from the donor or the recipient site. The patient had an uneventful recovery and left the hospital 7 days later. No abdominal wall herniation was noted on 3 months of follow-up. Single-stage reconstruction of complex lateral thoracoabdominal defect by using free anterolateral thigh together with a part of the fascia lata and an arteriovenous loop might be a reliable solution in cases where proper vessels are not available for anastomosis or other options are not feasible.