Reconstruction of abdominal wall defects using extended trilobed rectus abdominis musculocutaneous flap

Abstract

Reconstruction of extensive abdominal wall defects is difficult in many cases. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. Firstly, the peritoneum is closed by free fascia lata transplantation. Then, the rectus abdominis musculocutaneous flap is prepared adjacent to the abdominal wall defect and centering on the rectus abdominis muscle body on the contralateral side. The rectus abdominis musculocutaneous flap is elevated with the first flap toward the xiphoid process on the cranial side, the second flap toward the middle axillary line on the lateral side, and the third flap toward the lower abdominal region on caudal side as an extended trilobed rectus abdominis musculocutaneous flap with a deep inferior epigastric arteriovenous pedicle and transposed to the abdominal wall defect. This method was applied to a full-thickness abdominal wall defect produced by colon cancer resection in two patients. Case 1 was a 10 × 15-cm full-thickness right abdominal wall defect, and case 2 was an 8 × 14-cm full-thickness left abdominal wall defect. The postoperative course was favorable, and no complication, such as abdominal incisional hernia, developed. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. By preparing a trilobed flap, the flap-donor region could also be easily closed. This method may be useful for reconstruction of extensive full-thickness abdominal wall defects.

Level of Evidence: Level V, therapeutic study.