Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction_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 Province 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; modified pedicled anterolateral thigh myocutaneous flap; abdominal wall tumor; wound repair

DOI：

10.7507/1002-1892.201903030

Video：

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Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, Lü Chunliu. Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1305-1309. doi: 10.7507/1002-1892.201903030 Copy

1.	Althubaiti G, Butler CE. Abdominal wall and chest wall reconstruction. Plast Reconstr Surg, 2014, 133(5): 688e-701e.
2.	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.
3.	Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps Plast Reconstr Surg, 2002, 109(7): 2219-2230.
4.	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.
5.	Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
6.	張宏宇, 張才全, 王子衛, 等. 腹壁巨大缺損的修復重建. 中國修復重建外科雜志, 2005, 19(8): 629-631.
7.	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.
8.	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.
9.	Millard DR, Pigott R, Zies P. Free skin grafting of full-thickness defects of abdominal wall. Plast Reconstr Surg, 1969, 43(6): 569-582.
10.	Yang F. Radical tumor excision and immediate abdominal wall reconstruction in patients with aggressive neoplasm compromised full-thickness lower abdominal wall. Am J Surg, 2013, 205(1): 15-21.
11.	Williams JK, Carlson GW, deChalain T, et al. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg, 1998, 101(3): 713-718.
12.	Gravvanis AI, Tsoutsos DA, Karakitsos D, et al. Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery, 2006, 26(6): 432-438.
13.	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): e65-67.
14.	Posch NA, Mureau MA, Flood SJ, et al. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects. Br J Plast Surg, 2005, 58(8): 1095-1103.
15.	Sasaki K, Nozaki M, Nakazawa H, et al. Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg, 1998, 102(6): 2244-2252.
16.	Kuo YR, Kuo MH, Lutz BS, et al. One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg, 2004, 239(3): 352-358.
17.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
18.	Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: review of 20 consecutive cases. J Plast Reconstr Aesthet Surg, 2012, 65(11): 1525-1529.
19.	宋達疆, 李贊, 周曉, 等. 帶蒂股前外側肌皮瓣修復腹壁腫瘤術后全層缺損. 中國修復重建外科雜志, 2019, 33(6): 712-716.

1. Althubaiti G, Butler CE. Abdominal wall and chest wall reconstruction. Plast Reconstr Surg, 2014, 133(5): 688e-701e.
2. 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.
3. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps Plast Reconstr Surg, 2002, 109(7): 2219-2230.
4. 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.
5. Koshima I. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2358-2360.
6. 張宏宇, 張才全, 王子衛, 等. 腹壁巨大缺損的修復重建. 中國修復重建外科雜志, 2005, 19(8): 629-631.
7. 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.
8. 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.
9. Millard DR, Pigott R, Zies P. Free skin grafting of full-thickness defects of abdominal wall. Plast Reconstr Surg, 1969, 43(6): 569-582.
10. Yang F. Radical tumor excision and immediate abdominal wall reconstruction in patients with aggressive neoplasm compromised full-thickness lower abdominal wall. Am J Surg, 2013, 205(1): 15-21.
11. Williams JK, Carlson GW, deChalain T, et al. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg, 1998, 101(3): 713-718.
12. Gravvanis AI, Tsoutsos DA, Karakitsos D, et al. Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee. Microsurgery, 2006, 26(6): 432-438.
13. 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): e65-67.
14. Posch NA, Mureau MA, Flood SJ, et al. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects. Br J Plast Surg, 2005, 58(8): 1095-1103.
15. Sasaki K, Nozaki M, Nakazawa H, et al. Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg, 1998, 102(6): 2244-2252.
16. Kuo YR, Kuo MH, Lutz BS, et al. One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg, 2004, 239(3): 352-358.
17. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
18. Kayano S, Sakuraba M, Miyamoto S, et al. Comparison of pedicled and free anterolateral thigh flaps for reconstruction of complex defects of the abdominal wall: review of 20 consecutive cases. J Plast Reconstr Aesthet Surg, 2012, 65(11): 1525-1529.
19. 宋達疆, 李贊, 周曉, 等. 帶蒂股前外側肌皮瓣修復腹壁腫瘤術后全層缺損. 中國修復重建外科雜志, 2019, 33(6): 712-716.

Chinese Journal of Reparative and Reconstructive Surgery

Modified pedicled anterolateral thigh myocutaneous flap for large full-thickness abdominal defect reconstruction

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