Recipient vessels for microsurgical flaps to the abdomen: A systematic review

Large soft tissue defects of the abdominal wall resulting from various reasons may require free tissue transfer.

A literature search of PubMed and Cochrane electronic databases was conducted to identify articles involving abdominal wall reconstruction (AWR) with microsurgical flap. Number of cases, etiology, and reconstruction site, type of microsurgical flap and recipient vessels were analyzed.

Thirty-eight articles published between 1983 and 2016 reported on 149 patients undergoing free flap AWR. TFL was used in 43 patients (28.8%), LAD in 43 (28.8%), and ALT in 28 (18.7%). Conjoined ALT and TFL flap was reported in 24 patients (16.1%). The inferior epigastric artery/vein were the most commonly utilized recipient vessels (n = 43 patients). Intraperitoneal vessels were used in 18 cases, the gastroepiploic vessels being the most common (n = 9). Femoral vessels were used directly or along with a vein graft in 14 patients. AV loop or vein graft was reported in 46 patients. Great saphenous vein rerouting was used in 8 cases. DLCF vessels were used in 2 patients to support an AV loop or directly the pedicle of a microsurgical flap. The internal thoracic vessels were used in only 3 patients.

The current review analyzed articles on AWR using microsurgical flaps with a special emphasis on the recipient vessels. The literature review demonstrated that there is no standard approach to repair a complex abdominal defect given the diversity of patient population. The choice of microsurgical flap and selection of recipient vessels should be tailored to the individual patient's circumstances.