Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome.
BACKGROUND
Free flaps have a distinct role in a select group of patients with large abdominal wall defects. They offer a completely autologous reconstructive solution in a single stage for difficult abdominal wounds for which pedicled flaps would be inadequate.


METHODS
From 1996 to 2005, five patients with complex abdominal wall defects underwent reconstruction using free flaps. All patients had multiple comorbidities, making the use of alloplastic materials relatively contraindicated. Flaps used included a free radial forearm flap in one patient, a tensor fasciae latae myocutaneous flap in two patients, a free anterolateral thigh myocutaneous flap in one patient, and free conjoined tensor fasciae latae and anterolateral thigh myocutaneous flaps in the last patient.


RESULTS
The mean defect size was 470 cm (range, 136 to 875 cm). The femoral artery and long saphenous vein reliably provided recipient vessels in cases for which suitable vessels could not be located within the abdomen. A temporary arteriovenous shunt of the long saphenous vein to the femoral artery could be created. This was later divided to provide a recipient artery and vein. Flap complications were wound edge necrosis, hematoma, infection, and venous thrombosis. All were successfully managed and there were no flap failures. The average length of hospitalization was 64 days (range, 41 to 128 days). Lateral thigh flaps based on the lateral circumflex femoral system are our preferred donor site. A large amount of soft tissue, strong fascia, and innervated muscle are available, enabling single-stage autologous reconstruction of the entire anterior abdominal wall.


CONCLUSIONS
Free flaps offer a reliable single-stage solution to complex abdominal wall defects. With these techniques, even the most challenging defects can be reconstructed with completely autologous tissue.
Wong
Chin-Ho
CH
Taipei, Taiwan; and Singapore From the Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University; the Department of General Surgery, Chang Gung Memorial Hospital; and the Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital.
Lin
Chih-Hung
CH
Fu
Brian
B
Fang
Jen-Feng
JF
D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D003646:Debridement; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply; D013526:Surgical Mesh; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*