A pedicled anterolateral thigh flap for reconstruction of abdominal wall soft tissue defect in the absence of microsurgical services- case report

TL;DR

This case report shows how a thigh flap can be used to repair abdominal wall defects without advanced microsurgery tools.

Contribution

Demonstrates the use of a pedicled anterolateral thigh flap for abdominal wall reconstruction in settings lacking microsurgical services.

Findings

The pedicled anterolateral thigh flap successfully covered a large abdominal wall defect in a trauma patient.

The flap can be used effectively with basic microsurgical tools like loupes instead of a full operating microscope.

This technique provides durable coverage to protect abdominal organs and restore function.

Abstract

The anterolateral thigh (ALT) flap is a known work horse flap for coverage of range of soft tissue defects. It is utilized both as pedicled and free flap. It is a versatile flap that covers large area of cutaneous territory and which can be augmented with the vastus lateralis muscle for bulk or with the tensor fascia for fascia reconstruction. It has a long, wide caliber pedicle which gives it the freedom to be mobilized proximally to the level of the xiphoid process of the sternum and distally to the level of the knee.

We have presented here a case of a 19-year old man with blast injury to the abdomen where we have used pedicled antero-lateral thigh flap to cover a large abdominal wall defect.

The anterolateral thigh flap is a workhorse flap in reconstructive surgery that can be used as a durable coverage for abdominal wall defects -to protect the abdominal viscera and avoid loss of domain and other disruptions of normal physiology.

The pedicled anterolateral thigh (ALT) flap was performed under 3.5× loupe magnification, demonstrating the feasibility of using this technique for abdominal wall defects in settings without full microsurgical services. While the procedure can be performed without an operating microscope, it still requires basic microsurgical equipment—such as loupes—and fundamental microsurgical skills, underscoring the importance of proficiency in these essential techniques.

•Abdominal wall defects can be full thickness defects resulting in loss of domain.•Abdominal wall defects result from infectious processes, trauma or tumor resections.•Reconstruction restores domain, contributes to posture and physiologic functions of the body.•Pedicled anterolateral thigh flap can be used for abdominal wall reconstruction.•Pedicled ALT flap is an excellent alternative in the absence of microsurgical services.

Abdominal wall defects can be full thickness defects resulting in loss of domain.

Abdominal wall defects result from infectious processes, trauma or tumor resections.

Reconstruction restores domain, contributes to posture and physiologic functions of the body.

Pedicled anterolateral thigh flap can be used for abdominal wall reconstruction.

Pedicled ALT flap is an excellent alternative in the absence of microsurgical services.

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