The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap

Historically, the mainstay of soft-tissue reconstruction in the groin and lower abdomen has been the anatomically consistent, easily elevated rectus abdominis flap, with variations. Insetting the rectus abdominis flap here requires creating an abdominal wall defect through which to pass the pedicle, which raises the risk of donor-site morbidity. Although popular as a free flap, the anterolateral thigh flap as a pedicled flap in the groin and lower abdomen has not been directly compared with the rectus abdominis flap.

Retrospective record review was conducted on 39 patients who underwent groin or lower abdominal wall reconstruction (30 anterolateral thigh flap and 10 rectus abdominis flap procedures) to address oncologic defects, lymphadenectomy, and complications of vascular bypass. Patient demographics and comorbidities, flap characteristics, postoperative complications, and time to heal were compared.

All patients in both the anterolateral thigh and rectus abdominis flap groups healed at the flap recipient sites. Despite similar patient characteristics, wound cause was different between the groups, with more infected wounds being treated in the anterolateral thigh flap group. Early postoperative complication rates were similar in both groups. Anterolateral thigh flap patients had shorter time to healing, with lower rates of delayed (>30 days) postoperative complications compared with rectus abdominis flap patients. Six rectus abdominis flap patients developed delayed abdominal incisional hernias. No donor- or recipient-site complications were encountered in anterolateral thigh flap patients after 90 days.

The pedicled anterolateral thigh flap is the preferred choice for reconstruction of wounds in the groin and lower abdomen.