Objective
Behçet’s disease is a chronic inflammatory disorder with systemic vasculitis characterized by recurrent oral and genital ulcers, uveitis, arthritis and specific skin lesions, etc. Particularly, gastrointestinal presentations of Behçet’s disease are correlated with significant morbidity and mortality. Any segment of the alimentary tract can be involved, leading to mucosal ulcer, ischemia bowel, bowel obstruction, fistula and abscess formation, and bowel perforation. Herein, we salvaged a Behçet’s patient with complex abdominal wall defect following initial colon perforation, and the patient is currently free of gastrointestinal problem after several interventions.

Patient and Methods
This is a 48-year-old patient diagnosed with Behçet’s disease for more than 10 years. In the beginning, there was only eye involvement with relapsing anterior and posterior uveitis; thus, he regularly followed up at our immunology and rheumatology out-patient department for immunosuppressive therapy, including cyclosporine, prednisolone, and azathioprine. However, clinical manifestations of multiple painful oral ulcers, skin lesions, and left knee arthritis gradually occurred, and he started to experience recurrent infectious diarrhea 5 years ago. Unfortunately, he suffered from subsequent descending colon perforation at that time, so he received laparoscopic partial colectomy. In addition, Hartmann's operation was done 5 days later because of anastomotic leakage, and the intra-abdominal abscess was treated with repeated percutaneous drainage. The end colostomy was taken down 3 years later with excision of the abdominal scar adherent to the intestine, which lead to consecutive complex abdominal wall reconstruction.

Results
The pathology result of the perforated colon revealed necrotizing inflammation and granulation tissue formation. After the excision of the anterior abdominal wall, the abdominal wall defect was 18 x 10 cm with 18 x 8 cm fascia defect. As a result, a bioprosthetic mesh was used to repair the fascia. Because the skin defect was too large and wide to be closed with local skin, a large combined flap of anterolateral thigh (ALT), tensor fascia lata (TFL), and vastus lateralis (VL) muscle flaps were designed for reconstruction of the abdominal wall defect. Congestion of the flap due to much muscle volume related tension occurred the next day, and was solved with rotation flap from the epigastric area and skin graft.

Conclusions
Combined pedicled thigh-based flaps work well to recreate the abdominal wall and provide satisfactory life quality for the Behçet’s patient.