Subtotal thigh flap and bioprosthetic mesh reconstruction for large, composite abdominal wall defects

Background: Transposition of well-vascularized flap tissue with or without implantable mesh is often required to repair full-thickness, composite abdominal wall defects. The authors hypothesized that the combination of an inlay of bioprosthetic mesh and a subtotal thigh flap would enable a reliable reconstruction for large, composite abdominal wall defects. Methods: The authors retrospectively reviewed data on patients who underwent repair of large, composite abdominal wall defects with bioprosthetic mesh and free or pedicled subtotal thigh flaps at a major cancer center from 2004 to 2007. Patient, defect, surgical technique, and outcome data were obtained from a prospectively maintained database and medical charts. Results: Seven patients who received eight subtotal thigh flaps (five pedicled and three free flaps with vein grafts to the femoral vessels) met the study criteria. Indications for reconstruction were tumor resection, enterocutaneous fistula, and abdominal wall osteoradionecrosis. All but one patient received preoperative radiotherapy (mean dose, 54.8 Gy). The musculofascial defect was repaired with a mean of 536.4 cm of bioprosthetic mesh. The mean subtotal thigh flap skin paddle size was 514 cm. Complications included partial flap necrosis in one patient, a cerebrospinal fluid leak in one patient, partial split-thickness skin graft loss in two patients, a focal asymptomatic musculofascial repair-site bulge in one patient, and a hernia (not requiring surgery) in one patient. No bioprosthetic mesh infections, wound dehiscences, bowel obstructions, or seromas occurred (mean follow-up, 27.7 months). Conclusion: Massive, composite abdominal wall defects can be repaired successfully with relatively minor complications using a combination of bioprosthetic mesh and subtotal thigh flaps.