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One-Stage Reconstruction of Large Midline Abdominal Wall Defects Using a Composite Free Anterolateral Thigh Flap With Vascularized Fascia Lata

Kuo, Yur-Ren MD, PhD*; Kuo, Mei-Hui MD; Lutz, Barbara S. MD; Huang, Yu-Chi MD; Liu, Yi-Tien MD*; Wu, Shih-Chi MD§; Hsieh, Kun-Chou MD§; Hsien, Ching-Hua MD*; Jeng, Seng-Feng MD, FACS*

doi: 10.1097/01.sla.0000114229.89940.e8
Surgical Technique

Objective: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata.

Methods: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer.

Results: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients.

Conclusion: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.

Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite anterolateral thigh flap combined with vascularized fascia lata. The patients reported no difficulties in daily ambulating. The donor thighs morbidity is minimal objectively after investigation by kinetic dynamometer machine.

From the *Department of Plastic and Reconstructive Surgery, †Department of Rehabilitation & Physical Medicine, and §Department of General Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan; and the ‡Department of Plastic Surgery, University Hospital Örebro, Örebro, Sweden.

Reprints: Seng-Feng Jeng, MD, FACS, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.