The abdominal wall serves as vital protection for internal organs and it maintains functions requiring the generation of Valsalva such as urination, coughing, and defecation. When it comes to large defects on abdominal wall, harvesting an adequate size of flap would be challenging. A subtotal thigh flap would be one of the choices as it provides a well-vascularized large flap with muscle components. Here, we presented a case who underwent reconstruction of a large abdominal wall defect with a subtotal thigh flap.
A 59-year-old male suffered from a 20 x 15 cm2 tumor on the right lower abdominal wall with ulceration 4 years ago. The pathology report of the tumor showed Dermatofibrosarcoma Protuberans. Excision of the tumor resulted in a 15x13 cm2 abdominal wall defect. To cover the defect, a pivot flap rotated from the left abdominal wall and a pedicled ALT flap was harvested from his right thigh successfully. Four years after the operation, a recurrent huge mass sizing 23 x 22 cm2 arose at the previously reconstructed area with compression to the small intestine. Excision of the tumor, partial omentum and part of the intestine caused a 28 x 30 cm2 huge defect in the abdominal wall. We harvested a 28 x 30 cm2 subtotal thigh flap from his left thigh to reconstruct the defect. Eventually, microvascular anastomosis with left deep inferior epigastric vessels was made. The flap is in good condition and the donor site is covered with a split thickness skin graft. In summary, the utilization of subtotal thigh flap may be a good choice for large abdominal wall defect reconstruction as it is able to remain good perfusion of relatively large skin paddle compared to other free flaps.