Journal of Plastic, Reconstructive & Aesthetic Surgery
Case reportReconstruction of abdominal wall by whole thigh flap
Section snippets
Case history
A 62-year-old male patient was admitted in the department of Oncosurgery with a large recurrent abdominal wall tumour extending from pubic symphysis to xiphisternum in the vertical axis and from one flank to another in the horizontal dimension (Fig. 1). On histopathological examination, a diagnosis of dermatofibrosarcoma was made. CT-scan showed the tumour involving all the layers of the abdominal wall including the peritoneum. The tumour was so extensive that it was not practically possible to
Operative steps
The tumour was excised in toto (Fig. 2). It extended to peritoneum on the left side and hence a full thickness excision including the peritoneum was done. On the right side, a part of transversus abdominis was not involved and was left intact. The greater omentum was raised on the right gastroepiploic vessels (Fig. 3) and part of it was fixed to the margins of the abdominal defect. A sheet of marlex mesh was placed over this and the remaining portion of the greater omentum was folded over it,
Technique of raising the flap
An incision was made vertically, commencing two and a half inches lateral to the pubic tubercle, from inguinal ligament down to the medial border of patella. A transverse incision was made one inch above patella going circumferentially along the lower thigh and reaching on posteromedial aspect just lateral to adductor longus. Vertically, the posterior incision was extended right up to the gluteal fold. Thus, approximately three-inch strip of skin covering the femoral canal and adductor canal
Discussion
Abdominal wall defects have been closed by various flaps by different reconstructive surgeons. However, not much literature is available about reconstruction of whole abdominal wall by any known single flap either free or pedicled. Lesnick (1953)6 described the closure of one-sided abdominal wall defect by mobilising a pedicled musculofascial flap from the opposite side.
The tensor fascia lata flap with its excellent arc of rotation has often been used to cover defects of the abdomen. However,
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