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Subtotal Thigh Flap and Bioprosthetic Mesh Reconstruction for Large, Composite Abdominal Wall Defects

Lin, Samuel J. M.D.; Butler, Charles E. M.D.

Plastic & Reconstructive Surgery: April 2010 - Volume 125 - Issue 4 - pp 1146-1156
doi: 10.1097/PRS.0b013e3181d18196
Reconstructive: Trunk: Original Articles
Expert

Background: Transposition of well-vascularized flap tissue with or without implantable mesh is often required to repair full-thickness, composite abdominal wall defects. The authors hypothesized that the combination of an inlay of bioprosthetic mesh and a subtotal thigh flap would enable a reliable reconstruction for large, composite abdominal wall defects.

Methods: The authors retrospectively reviewed data on patients who underwent repair of large, composite abdominal wall defects with bioprosthetic mesh and free or pedicled subtotal thigh flaps at a major cancer center from 2004 to 2007. Patient, defect, surgical technique, and outcome data were obtained from a prospectively maintained database and medical charts.

Results: Seven patients who received eight subtotal thigh flaps (five pedicled and three free flaps with vein grafts to the femoral vessels) met the study criteria. Indications for reconstruction were tumor resection, enterocutaneous fistula, and abdominal wall osteoradionecrosis. All but one patient received preoperative radiotherapy (mean dose, 54.8 Gy). The musculofascial defect was repaired with a mean of 536.4 cm2 of bioprosthetic mesh. The mean subtotal thigh flap skin paddle size was 514 cm2. Complications included partial flap necrosis in one patient, a cerebrospinal fluid leak in one patient, partial split-thickness skin graft loss in two patients, a focal asymptomatic musculofascial repair-site bulge in one patient, and a hernia (not requiring surgery) in one patient. No bioprosthetic mesh infections, wound dehiscences, bowel obstructions, or seromas occurred (mean follow-up, 27.7 months).

Conclusion: Massive, composite abdominal wall defects can be repaired successfully with relatively minor complications using a combination of bioprosthetic mesh and subtotal thigh flaps.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication September 23, 2009; accepted October 28, 2009.

Presented in part at the 23rd Annual Scientific Meeting of the American Society of Reconstructive Microsurgery, in Rio Grande, Puerto Rico, January 13 through 16, 2007, and the 53rd Annual Meeting of the Plastic Surgery Research Council, in Springfield, Illinois, May 28 through 31, 2008.

Disclosures: Charles E. Butler, M.D., serves on the Speakers' Bureau for LifeCell Corporation. Neither of the authors has a financial interest in any of the products, devices, drugs, or procedures mentioned in this article.

Charles E. Butler, M.D. Department of Plastic Surgery, Unit 443; University of Texas M. D. Anderson Cancer Center; 1515 Holcombe Boulevard; Houston, Texas 77030; cbutler@mdanderson.org

©2010American Society of Plastic Surgeons