Reconstruction of a full-thickness abdominal wall defect using an anterolateral thigh free flap

We present an original case of reconstruction of the abdominal wall after full-thickness parietal resection using an anterolateral thigh flap harvested with its aponeurosis; we describe the advantages of this technique which has seldom been used for this indication. A 49-year-old male presented with a recurrent dermatofibrosarcoma protuberans involving the full thickness of the upper anterior abdominal wall; after excision, a 20 x 17 cm full-thickness defect was reconstructed with an omentoplasty, a bi-layered parietal prosthesis, and a fasciocutaneous free flap with its muscular aponeurosis from the anterolateral thigh. The postoperative course was uncomplicated. Functional and aesthetic results were satisfactory. There was no tumor recurrence or postoperative incisional hernia. Many reconstructive options have been proposed, but the anterolateral thigh free flap offers the advantage of an integral reconstruction of the abdominal wall without resultant donor site morbidity and with a satisfactory cosmetic result. In our hands, this flap is the ideal choice for reconstruction of the abdominal wall after loss of substance.