Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , ZHANG Yixin ² , PENG Xiaowei ¹ , ZHOU Bo ¹ , Lü Chunliu ¹

1. Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China;

Corresponding?author：

LI Zan, Email: zzanli@163.com

Keywords：

Abdominal wall defect; anterolateral thigh myocutaneous flap; pedicled flap; abdominal wall tumor; wound repair

DOI：

10.7507/1002-1892.201901005

Video：

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Objective To explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection.Methods Between September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly.Results All wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites.Conclusion Pedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, Lü Chunliu. Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 712-716. doi: 10.7507/1002-1892.201901005 Copy

1.	Althubaiti G, Butler CE. Abdominal wall and chest wall reconstruction. Plast Reconstr Surg, 2014, 133(5): 688e-701e.
2.	Scaglioni MF, Giuseppe AD, Chang EI. Propeller flap reconstruction of abdominal defects: review of the literature and case report. Microsurgery, 2015, 35(1): 72-78.
3.	Wong CH, Lin CH, Fu B, et al. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg, 2009, 124(2): 500-509.
4.	Harpf C, Ninkovic M, Kronberger P, et al. Dynamic and functional abdominal wall stabilization, reconstruction of extensive abdominal wall defects. Chirurg, 1997, 68(5): 488-492.
5.	Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
6.	Koshima I, Yamamoto H, Moriguchi T, et al. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the " mosaic” flap principle. Ann Plast Surg, 1994, 32(3): 321-327.
7.	Ting J, Trotter D, Grinsell D. A pedicled anterolateral thigh (ALT) flap for reconstruction of the epigastrium. Case report. J Plast Reconstr Aesthet Surg, 2010, 63(1): e65-e67.
8.	Kimata Y, Uchiyama K, Sekido M, et al. Anterolateral thigh flap for abdominal wall reconstruction. Plast Reconstr Surg, 1999, 103(4): 1191-1197.
9.	Hallock GG. A paradigm shift for soft-tissue coverage of the zones of the abdominal wall using perforator flaps. Plast Reconstr Surg, 2012, 130(3): 590-599.
10.	Rohrich RJ, Lowe JB, Hackney FL, et al. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg, 2000, 105(1): 202-217.
11.	Lin SJ, Butler CE. Subtotal thigh flap and bioprosthetic mesh reconstruction for large, composite abdominal wall defects. Plast Reconstr Surg, 2010, 125(4): 1146-1156.
12.	Ishida LH, Munhoz AM, Montag E, et al. Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores. Plast Reconstr Surg, 2005, 116(5): 1346-1352.
13.	Iida T, Mihara M, Narushima M, et al. Dynamic reconstruction of full-thickness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap. Ann Plast Surg, 2013, 70(3): 331-334.
14.	Bodin F, Dissaux C, Romain B, et al. Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection. Microsurgery, 2017, 37(1): 38-43.
15.	Ninkovi? M, Kronberger P, Harpf C, et al. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg, 1998, 101(4): 971-978.
16.	呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌Kiss皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
17.	Porshinsky B, Ramasastry S. Abdominal wall reconstruction with free flaps. Clin Plast Surg, 2006, 33(2): 269-280.
18.	Lannon DA, Ross GL, Addison PD, et al. Versatility of the proximally pedicled anterolateral thigh flap and its use in complex abdominal and pelvic reconstruction. Plast Reconstr Surg, 2011, 127(2): 677-688.
19.	Hallock GG. The island anterior intercostal artery perforator flap as another option for the difficult epigastric abdominal wound. Ann Plast Surg, 2009, 63(4): 414-417.
20.	宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
21.	宋達疆, 李贊, 周曉, 等. 游離帶感覺超薄股前外側穿支皮瓣修復?甲瓣供區創面的療效觀察. 中國修復重建外科雜志, 2017, 31(8): 987-991.
22.	宋達疆, 李贊, 周曉, 等. 游離分葉股前外側穿支皮瓣修復口腔頜面部惡性腫瘤術后頰部洞穿缺損. 中國修復重建外科雜志, 2018, 32(5): 607-611.

1. Althubaiti G, Butler CE. Abdominal wall and chest wall reconstruction. Plast Reconstr Surg, 2014, 133(5): 688e-701e.
2. Scaglioni MF, Giuseppe AD, Chang EI. Propeller flap reconstruction of abdominal defects: review of the literature and case report. Microsurgery, 2015, 35(1): 72-78.
3. Wong CH, Lin CH, Fu B, et al. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg, 2009, 124(2): 500-509.
4. Harpf C, Ninkovic M, Kronberger P, et al. Dynamic and functional abdominal wall stabilization, reconstruction of extensive abdominal wall defects. Chirurg, 1997, 68(5): 488-492.
5. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
6. Koshima I, Yamamoto H, Moriguchi T, et al. Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the " mosaic” flap principle. Ann Plast Surg, 1994, 32(3): 321-327.
7. Ting J, Trotter D, Grinsell D. A pedicled anterolateral thigh (ALT) flap for reconstruction of the epigastrium. Case report. J Plast Reconstr Aesthet Surg, 2010, 63(1): e65-e67.
8. Kimata Y, Uchiyama K, Sekido M, et al. Anterolateral thigh flap for abdominal wall reconstruction. Plast Reconstr Surg, 1999, 103(4): 1191-1197.
9. Hallock GG. A paradigm shift for soft-tissue coverage of the zones of the abdominal wall using perforator flaps. Plast Reconstr Surg, 2012, 130(3): 590-599.
10. Rohrich RJ, Lowe JB, Hackney FL, et al. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg, 2000, 105(1): 202-217.
11. Lin SJ, Butler CE. Subtotal thigh flap and bioprosthetic mesh reconstruction for large, composite abdominal wall defects. Plast Reconstr Surg, 2010, 125(4): 1146-1156.
12. Ishida LH, Munhoz AM, Montag E, et al. Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores. Plast Reconstr Surg, 2005, 116(5): 1346-1352.
13. Iida T, Mihara M, Narushima M, et al. Dynamic reconstruction of full-thickness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap. Ann Plast Surg, 2013, 70(3): 331-334.
14. Bodin F, Dissaux C, Romain B, et al. Complex abdominal wall defect reconstruction using a latissimus dorsi free flap with mesh after malignant tumor resection. Microsurgery, 2017, 37(1): 38-43.
15. Ninkovi? M, Kronberger P, Harpf C, et al. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg, 1998, 101(4): 971-978.
16. 呂春柳, 李贊, 周曉, 等. 帶蒂背闊肌Kiss皮瓣修復腫瘤切除術后胸壁皮膚軟組織缺損的臨床研究. 中國修復重建外科雜志, 2016, 30(12): 1498-1501.
17. Porshinsky B, Ramasastry S. Abdominal wall reconstruction with free flaps. Clin Plast Surg, 2006, 33(2): 269-280.
18. Lannon DA, Ross GL, Addison PD, et al. Versatility of the proximally pedicled anterolateral thigh flap and its use in complex abdominal and pelvic reconstruction. Plast Reconstr Surg, 2011, 127(2): 677-688.
19. Hallock GG. The island anterior intercostal artery perforator flap as another option for the difficult epigastric abdominal wound. Ann Plast Surg, 2009, 63(4): 414-417.
20. 宋達疆, 李贊, 周曉, 等. 股前內側接力穿支皮瓣修復游離股前外側穿支皮瓣供區的臨床應用. 中國修復重建外科雜志, 2017, 31(1): 52-56.
21. 宋達疆, 李贊, 周曉, 等. 游離帶感覺超薄股前外側穿支皮瓣修復?甲瓣供區創面的療效觀察. 中國修復重建外科雜志, 2017, 31(8): 987-991.
22. 宋達疆, 李贊, 周曉, 等. 游離分葉股前外側穿支皮瓣修復口腔頜面部惡性腫瘤術后頰部洞穿缺損. 中國修復重建外科雜志, 2018, 32(5): 607-611.

Chinese Journal of Reparative and Reconstructive Surgery

Application of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection

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