Dynamic reconstruction of complex abdominal wall defects with the pedicled innervated vastus lateralis and anterolateral thigh PIVA flap

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2015-06, Vol.68 (6), p.837-845
• Main Authors: Vranckx, J.J, Stoel, A.M, Segers, K, Nanhekhan, LL
• Format: Article
• Language: English
• Subjects: Abdominal Wall - physiopathology; Abdominal Wall - surgery; Abdominal wall reconstruction; Adult; Aged; Anterolateral thigh flap; Chronic Disease; Dynamic reconstruction; Electromyography; Eventration; Humans; Infected abdominal wall defect; Innervated flap; Male; Middle Aged; Muscle Contraction; Muscle Strength; Myocutaneous Flap - adverse effects; Myocutaneous Flap - physiology; Plastic Surgery; Quadriceps Muscle - innervation; Quadriceps Muscle - transplantation; Quality of Life; Reconstructive Surgical Procedures - methods; Skin Transplantation - adverse effects; Soft Tissue Infections - surgery; Thigh - physiopathology; Time Factors; Torque; Transplant Donor Site - physiopathology; Vastus lateralis flap
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2015.03.009

Summary Background and aim Reconstruction of large and chronically infected recurrent abdominal wall defects with exposed bowel in a scarred wound environment, when component release has been previously performed but failed, is a veritable challenge. We use a pedicled innervated vastus lateralis muscle with a fasciocutaneous anterolateral thigh flap (PIVA flap) to restore the continuity of the abdominal wall with vascularised tissues and create a dynamic component that improves the functional outcome. Materials and methods A one-stage PIVA flap was used in 15 patients with grade 4 transmural chronically infected defects. They had a mean of 4.53 previous laparotomies and important co-morbidities. We determined post-operative reconstructive abdominal wall strength using a validated quality-of-life (QoL) hernia-related questionnaire and modified it to quantify donor-site morbidity at the thigh. We measured the maximal force generated at 60°/s and the force velocity at 120°/s by isokinetic dynamometric analysis at 3 and 12 months. Electromyography (EMG) was performed 12 months after the reconstruction to analyse the contractile integrity of the vastus lateralis segment. A two-sided sign test was used to analyse data. Results All transmural chronic wounds healed without recurrence. Dynamometric strength increased significantly in the abdominal wall musculature ( p