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Dynamic Reconstruction of Full-Thickness Abdominal Wall Defects Using Free Innervated Vastus Lateralis Muscle Flap Combined With Free Anterolateral Thigh Flap

Iida, Takuya MD*; Mihara, Makoto MD*; Narushima, Mitsunaga MD*; Todokoro, Takeshi MD*; Hara, Hisako MD*; Yoshimatu, Hidehiko MD*; Koshima, Isao MD*; Kadono, Takafumi MD

doi: 10.1097/SAP.0b013e3182321b64
Reconstructive Surgery

Reconstruction of full-thickness abdominal wall defects remains a difficult surgical challenge. Although various reconstructive methods, including artificial mesh, pedicled and free flaps, have been reported, most reported reconstruction of only the fascia layer, leaving the resected rectus abdominis muscle unreconstructed. However, recent studies suggested the importance of dynamic reconstruction with functional muscle in preventing abdominal hernia in the long-term. According to the principle of reconstructive surgery, “replace lost tissue with similar tissue,” a functionally and aesthetically ideal reconstruction is to reconstruct all components of the abdominal wall structure, including skin, subcutaneous fat, fascia, and muscle. We present 2 cases with full-thickness abdominal wall defects in the upper abdominal region, which we reconstructed with a free innervated vastus lateralis muscle flap combined with a free anterolateral thigh flap. The motor nerve of the vastus lateralis muscle was sutured with the intercostal nerve, and reinnervation was confirmed by electromyography. This method allows reconstruction of all components of the abdominal wall with a single flap, and dynamic reconstruction is achieved which will reduce the risk of postoperative hernia. We believe this method can be a good option for reconstruction of full-thickness abdominal wall defects with long-term stability.

From the *Departments of Plastic and Reconstructive Surgery and †Department of Dermatology, The University of Tokyo, Bunkyo-kuTokyo, Japan.

Received March 2, 2011, and accepted for publication, after revision, August 9, 2011.

Conflicts of interest: none.

Funding: Partly supported by Princess Takamatsu Cancer Research Fund

Reprints: Takuya Iida, MD, Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7–3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.