The 2003 Annual Meeting of OASYS_NEW

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Abdominal Wall Reconstruction with the Free Tensor Fascia Lata Myofasciocutaneous Flap Using Intraperitoneal Gastroepiploic Recipient Vessels

Singh N, Division of Plastic Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., McElderry 8152-A, JHOC 8, Baltimore, MD, USA and Chevray P, Plastic Surgery, Univ of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 443, Houston, TX, USA.

We report our experience with a method for definitive abdominal wall reconstruction using the free tensor fascia lata myofasciocutaneous flap anastomosed to the intra-peritoneal gastroepiploic vessels. This is a single stage reconstruction capable of reliably reconstructing a full thickness defect involving any region of the abdominal wall. The fascial component of the flap reconstructs the abdominal wall with like tissue including epimysium to minimize post-op bowel adhesions, and the cutaneous portion of the free tensor fascia lata provides durable and aesthetically acceptable external cover. Very large flaps can be harvested for defects up to a third of the abdominal wall and have the potential to be neurotized for function. The intraperitoneal gastroepiploic recipient vessels allow an uninterrupted tight fascial closure restoring structural integrity to the abdominal wall which is not topologically possible with extra-peritoneal recipient vessels. These recipient vessels, up to 10 cm in mobile length once dissected and 2-3mm in diameter, are conceptually superior because they are located immediately adjacent to the deep surface of the defect and should be preferred even when extra-peritoneal vessels are adequate. We present a series of three cases of full thickness upper and lower abdominal wall reconstruction utilizing this method for oncologic reconstruction. Prior abdominal surgery was not found to be an impediment. The technique is extendable to previously unreconstructable hernias.