Abdominal defect reconstruction due to advanced lobomycosis with anterolateral thigh (alt) flap: a case report

Lobomycosis, also known as lacaziosis, is a chronic subcutaneous mycosis caused by Lacazia loboi and endemic to tropical regions of South America. Medical therapy alone has demonstrated limited efficacy, and wide surgical excision remains the mainstay of treatment, particularly in extensive or long-standing disease. However, radical resection may result in complex soft tissue defects requiring advanced reconstructive strategies. We report the case of a 42-year-old male with advanced lobomycosis involving the left lower hemiabdomen. Wide local excision with 2 cm macroscopic margins was performed, resulting in exposure of the anterior rectus sheath and external oblique aponeurosis. Immediate reconstruction was achieved using a pedicled anterolateral thigh (ALT) flap based on musculocutaneous perforators of the descending branch of the lateral circumflex femoral artery. The flap was rotated 180 degrees to increase its arc of reach and allow tension-free inset without microvascular anastomosis. The donor site was managed with split-thickness skin grafting. Postoperatively, adjuvant systemic itraconazole therapy was administered. The flap demonstrated complete viability with no vascular compromise, and satisfactory functional and aesthetic outcomes were achieved. This case highlights the pedicled ALT flap as a safe, versatile, and reliable reconstructive option for extensive abdominal defects secondary to deep mycoses, offering robust vascularity and low donor-site morbidity while preserving abdominal wall function.