Abdominal Wall Reconstruction Using Unique Composite Anterolateral and Fascia Lata Perforator Free Flap After Failed Attempts

A growing number of patients undergoing abdominal procedures have complex full thickness abdominal wall defects, the reconstruction of which remains challenging on many occasions. The objective of this article is to present a solution for a complex case of abdominal wall reconstruction on a fifty-year-old woman with anterior abdominal wall resection of a symptomatic recurrent desmoid tumor repaired in several occasions with prosthetic mesh and local recurrent complications with infected fistulized cavity. The reconstruction of the defect after resection was carried out using biological mesh and a fasciocutaneous composite perforator microsurgical free flap. Fascial component was taken from tensor fascia lata muscle and adipocutaneous component from the anterolateral thigh flap. This free flap was anastomosed to the gastroepiploic vessels. The postoperative evolution at discharge and in subsequent follow-ups was satisfactory, with complete integrity of the abdominal wall and good visceral continence when standing and during Valsalva maneuver.