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Updated: Mar 19, 2026
Engineered Vascularized Muscle Flap
Published on: January 11, 2016
Functional Reconstruction of Abdominal Wall in Prune Belly Syndrome Using Vastus Lateralis Muscle Flaps: A
Jakub Opyrchał1, Dominika Krakowczyk2, Daniel Bula3
1Maria Sklodowska- Curie Memorial National Cancer Center, 2nd Department of Oncologic Surgery, Gliwice, Poland.
Insights
This study introduces a novel surgical technique using thigh muscle flaps to reconstruct the abdominal wall in Prune Belly Syndrome (PBS). This dynamic approach restores muscle function, improving core strength and quality of life for affected children.
Area of Science:
- Pediatric Reconstructive Surgery
- Congenital Disorders
- Microsurgery
Background:
- Prune Belly Syndrome (PBS) presents with severe abdominal muscle deficiency, impairing vital functions.
- Existing reconstructive methods for PBS primarily address cosmetic issues, failing to restore full abdominal wall functionality.
- Restoring dynamic muscle function is crucial for physiological processes like coughing and defecation.
Purpose of the Study:
- To introduce and evaluate a novel dynamic reconstructive approach for the anterior abdominal wall in Prune Belly Syndrome.
- To focus on restoring true muscle dynamics and physiological function, not just cosmetic appearance.
- To present the first reproducible surgical solution for functional abdominal wall reanimation in PBS.
Main Methods:
- Utilized bilateral pedicled musculo-fascial Vastus Lateralis (VL) flaps harvested from the thighs.
- Transposed innervated and vascularized VL flaps to the anterior abdominal wall, preserving neurovascular pedicles.
- Anchored flaps to the costal arch and pubic symphysis to recreate rectus abdominis function, enabling dynamic contraction and intra-abdominal pressure generation.
Main Results:
- Confirmed active muscle contraction and significant improvement in core function via EMG and motor testing.
- Demonstrated restored abdominal wall activity and enhanced motor abilities in patients.
- Observed reduced symptoms related to ineffective intra-abdominal pressure, including constipation and respiratory infections.
Conclusions:
- The described technique represents a transformative step in pediatric reconstructive surgery for Prune Belly Syndrome.
- This dynamic flap approach achieves both anatomical reconstruction and functional reanimation of the abdominal wall.
- The method offers improved long-term quality of life by restoring physiological function through microsurgical precision.
Abstract:
Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by severe abdominal wall muscle deficiency, leading to significant impairment of respiratory, urinary, and gastrointestinal function. Despite numerous reconstructive attempts, no technique has achieved full functional restoration of the anterior abdominal wall. This paper introduces a novel dynamic reconstructive approach using bilateral pedicled musculo-fascial Vastus Lateralis (VL) flaps for functional abdominal wall reconstruction in PBS. Unlike traditional abdominoplasty-based procedures that mainly address cosmetic deformity, this method focuses on restoring true muscle dynamics and physiological function. The technique involves harvesting innervated, vascularized VL flaps from both thighs and transposing them to the anterior abdominal wall through a subcutaneous tunnel while preserving their neurovascular pedicles. The muscles are anchored to the costal arch superiorly and the pubic symphysis inferiorly, effectively recreating the functional vector of the rectus abdominis. This configuration enables dynamic contraction of the abdominal wall and reinstates the ability to generate intra-abdominal pressure required for coughing, defecation, and postural control. Follow-up assessment, including electromyography (EMG) and motor testing, confirmed active muscle contraction and marked improvement in core function. Patients demonstrated restored abdominal wall activity, enhanced motor abilities, and reduced symptoms related to ineffective intra-abdominal pressure, such as constipation and respiratory infections. This study presents the first reproducible surgical solution achieving both anatomical reconstruction and functional reanimation of the abdominal wall in PBS. The described technique offers a transformative step in pediatric reconstructive surgery, combining microsurgical precision with physiological restoration to improve long-term quality of life.
