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Updated: Jan 14, 2026

Engineered Vascularized Muscle Flap
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Neo-inguinal reconstruction: algorithm for layered vascularized tissue coverage using plug flap following oncologic

Tony C T Huang1, Justin W Maroun2, Basel A Sharaf3

  • 1Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA. tonyct.huang@gmail.com.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|October 22, 2025
PubMed
Summary

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Reconstructing the inguinal ligament after tumor resection is complex. Using a soft tissue plug can prevent bowel herniation and protect vital structures during oncologic surgery.

Area of Science:

  • Oncology
  • Surgical Reconstruction
  • Hernia Repair

Background:

  • Inguinal ligament resection in pelvic tumor surgery poses reconstruction challenges.
  • Loss of the inguinal ligament increases risks of bowel incarceration and neurovascular damage.
  • Extensive tissue defects and exposed major vessels complicate inguinal region reconstruction.

Purpose of the Study:

  • To evaluate the efficacy of neo-inguinal reconstruction using soft tissue plugs after radical resection of pelvic tumors involving the inguinal ligament.
  • To assess the prevention of postoperative bowel herniation and protection of femoral neurovascular structures.

Main Methods:

  • Retrospective case series of six patients undergoing radical pelvic tumor resection with inguinal ligament involvement.
  • Mesh placement combined with layered local flaps to create soft tissue plugs.
Keywords:
Abdominoinguinal reconstructionCancer reconstructionInguinal ligamentLocal flapsTissue plug

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  • Utilized rectus abdominis, rectus femoris, omentum, and sartorius flaps for reconstruction.

    • Main Results:

    • Five liposarcomas and one metastatic lung cancer were treated.
    • Inguinal ligament was resected in 4 patients and divided in 2.
    • One patient without a soft tissue plug developed incarcerated inguinal hernia; one with a plug developed hernia after strenuous activity but did not require surgery.

    Conclusions:

    • Neo-inguinal reconstruction with a soft tissue plug is beneficial for patients undergoing extensive oncologic resection.
    • Soft tissue plugs effectively create a barrier between femoral vessels and mesh, preventing bowel herniation.
    • This technique aids in managing complex inguinal defects following tumor removal.