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.