Bilateral Fascia Lata Flap: An Alternative for Massive Abdominal Wall Defect Repair

Abstract

Summary: The abdominal wall represents a unique structure of dermo-myotendinous conformation that is considered a surgical challenge. The musculocutaneous pedicled flap, using tensor fasciae latae muscle (TFL), is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure. It is a well-suited procedure because it provides both a semirigid fascia layer and adequate skin coverage. We present a case of a 61-year-old man with the diagnosis of squamous cell carcinoma of the bladder, clinical stage IV (T4bN1M1), complicated with an ileo-recal-urethrocutaneous fistula. We reconstructed a massive defect of the abdominal wall by rotating bilateral pedicled TFL flaps. The therapeutic plan comprised 2 surgical procedures. The first surgical intervention was intended to obtain and temporarily fix the flap, and to allow the delay phenomenon to occur. Three weeks later, we performed the abdominal wall reconstruction by repositioning the bilateral TFL flaps and placing a dual prolene with regenerated oxidized cellulose mesh. We performed a successful palliative procedure in a terminal oncologic patient. Combined with a massive oncologic procedure (done by the oncologic surgeon), we were able to solve the cutaneous fistula and provided a significant improvement in the quality of life. The patient was discharged with no procedure-related complications. He has remained healthy 18 months after surgery, and there has been no evidence of ventral hernia. Bilateral TFL flaps represent a viable alternative for primary or secondary abdominal wall reconstruction in selected cases. This reconstructive strategy should be considered when plastic and reconstructive surgeon faces large and complex abdominal wall defects, associated with significant lack of skin cover.

Fascia Lata Grafting Combined with Gluteal Flaps for Pelvic Floor Reconstruction after Oncologic Resection

“…We usually use the fascia of vastus lateralis located along the superolateral aspect of the thigh, 35 and avoid involving the tensor fasciae latae, which is a gluteal muscle serving to tense the fascia lata. 36 The fascial defect at the donor site was covered with absorbable polyglycolic acid sheets, which were reported to reduce seroma formation after latissimus dorsi flap harvest. 37 No patient reported persistent pain, seroma, hematoma, or dysmobility of the donor site caused by fascia harvesting.…”

A Review of Advanced Abdominal Wall Hernia Patch Materials

“…[ 61 ] Common derivatives include carboxymethylcellulose (CMC), [ 123–125 ] methylcellulose (MC), [ 97 ] and oxidized regenerated cellulose (ORC). [ 126–128 ] In recent years, the application of bacterial cellulose (BC) in the fabrication of advanced AWHPMs has been significantly attractive. [ 61,129,130 ] BC produced by bacteria (e.g., Komagataeibacter xylinus X‐2 [ 59 ] ) has a linear structure comprised of beta‐1,4‐glucan chains.…”