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Complex Abdominal Wall Reconstruction of Full Thickness Oncologic Defects using Pedicled and Free Flaps Combined with Mesh
Diwakar Phuyal, MD; Fuad Abbas, BS, Anshumi Desai, MD; Kashyap Tadisina, MD; Kyle Xu, MD; Juan R. Mella, MD; Raffi Gurunian, MD, PhD; Sarah N. Bishop, MD;
Cleveland Clinic Foundation
2025-01-10
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Complex abdominal wall reconstruction (AWR) is a challenging multidisciplinary task involving large-volume tissue rearrangement in patients with full-thickness defects following oncologic resection. The purpose of this study is to describe our experience with AWR of large composite defects that required soft tissue coverage with autologous reconstruction via pedicled and/or free flaps and fascial repair with mesh.
Methods:
A case series of nineteen patients who underwent AWR for composite full thickness abdominal wall defect at two health care system after IRB approval.
Results:
Average age of the patients was 48.48 +- 12.37 and average BMI was 29.71 +- 6.66 kg/m2. Eight cases were for tumor resection, four cases of open abdomen or multiple enterocutaneous fistulas and six cases of large or recurrent hernia with loss of domain. Median fascial defect was 800 [IQR 429-870 cm2]. All the patients got anterolateral thigh (ALT) flap; 11 patients also had vastus lateralis (VL) with ALT among which were neurotized. 3 patients got chimeric flap with tensor fasciae latae and rectus femoris included in the ALT/VL. 7% received bioprosthetic mesh, 69% got synthetic mesh and 23% got biologic mesh. There was 1 case of partial flap necrosis, 2 case of infection, 2 hematomas, 2 mesh exposure, and 1 total flap loss due to flap congestion. Overall mortality was 21%.
Conclusion:
The ALT/vastus lateralis flap combined with mesh is a reliable option for large abdominal wall defects of the abdominal wall requiring reconstruction of the musculofascial system and overlying soft tissue.
