Use of pedicled thigh flaps for complex abdominal wall reconstruction: A case series

Complex abdominal wall defects that result from oncologic resection, infection, or trauma often require advanced reconstructive techniques beyond primary fascial closure or mesh reinforcement alone. In cases where primary closure is not feasible due to extensive tissue loss, pedicled thigh-based flaps offer a robust, vascularized solution to restore abdominal wall integrity. In this case series, we present three consecutive patients who underwent abdominal wall reconstruction using variations of the pedicled thigh flap based on the lateral femoral circumflex vascular pedicle, performed in conjunction with mesh reinforcement. Each patient presented with a large, complex defect following cancer resection or hernia repair complicated by prior infection or radiation. The reconstructions utilized different variations of the anterolateral thigh (ALT) flap, including fasciocutaneous, fascial, and myocutaneous components, tailored to defect size and tissue requirements. In all cases, biologic or bioresorbable mesh was incorporated to support myofascial continuity. All patients had uncomplicated recoveries, with one experiencing minor superficial wound dehiscence managed conservatively. No flap failures, donor site morbidity, or hernia recurrences were observed during follow-up periods. Our findings support the use of pedicled thigh flaps as a versatile and reliable option for complex abdominal wall reconstruction, especially when combined with mesh to optimize structural support and minimize donor site complications.