title: Free tensor fasciae latae flap for abdominal wall reconstruction: overview and new innovation.
abstract: Extensive abdominal wall defects may result from tumor extirpation, traumatic injury, or soft tissue infections. Extensive traumatic injuries can often disrupt the soft tissue content of the abdomen as well as the bony support provided by the pelvis. Reconstruction of the lower abdomen should aim to recreate dynamic stability. Five patients with extensive lower abdominal wall disruption following traumatic injuries or infection were treated using a novel flap for functional reconstruction. We devised a free neurotized osteomyocutaneous tensor fasciae latae (TFL) flap that would restore bony continuity by providing a vascularized bone graft and simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest, reestablishing musculofascial continuity. A branch of the superior gluteal nerve was harvested with this composite flap and coapted to an intercostal nerve for reinnervation, thereby creating a dynamic muscle in these patients. All patients underwent successful free tissue reconstruction with 100% flap survival. The lower abdominal wall and bony integrity of the pelvis were successfully reconstructed. Reinnervation has shown clinical signs of maintained dynamic stability. The innervated TFL osteomyocutaneous flap is an ideal option for lower abdominal reconstruction in patients with complex abdominoperineal defects with loss of bony integrity.
authors.affiliation: The Plastic Surgery Group, Montclair, New Jersey 07042, USA. cchalfoun@psg1.com
authors.forename: Charbel T
authors.initials: CT
authors.lastname: Chalfoun
authors.forename: Michael P
authors.initials: MP
authors.lastname: McConnell
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Brenner
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
authors.forename: Mark
authors.initials: M
authors.lastname: Kobayashi
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D005206:Fascia Lata / Q000601:surgery / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016038:Skin Transplantation / Q000379:methods; D020858:Tissue and Organ Harvesting; D060053:Transplant Donor Site; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology