Anterolateral thigh-vastus lateralis flap for abdominal wall reconstruction: A systematic review

Complex abdominal wall reconstruction (AWR) requires restoration of durable soft-tissue coverage and musculofascial continuity. Anterolateral-vastus lateralis (ALT/VL) flaps can be harvested as composite myocutaneous constructs or as chimeric/extended configurations, enabling transfer of multiple tissue components on a single source pedicle and supporting both structural and functional reconstruction.

A systematic review was performed to evaluate the use of ALT/VL-based flaps for abdominal wall reconstruction. Indications, reconstructive patterns, flap configurations, motor innervation, mesh use, and reported outcomes were analyzed descriptively. Additionally, an illustrative institutional case is presented to contextualize the operative strategy.

Twenty-eight studies, encompassing 157 patients and 162 ALT/VL-based flaps were included. The most frequent indications were post-oncologic defects, trauma, and enterocutaneous fistula-associated reconstructions. Reconstructions were predominantly pedicled flaps (n = 149, 91.9%), with free flaps (n = 13, 8.1%) reserved for selected defects. ALT/VL reconstruction proved modular: pure ALT/VL constructs were commonly applied, whereas extended configurations were preferentially reported in larger or more complex defects. Motor innervation was preserved or restored in 50.6% of cases. Mesh was used variably (46.9%) and appeared driven by defect biology rather than flap design. Abdominal complications occurred in 24.2% of patients (n = 38), whereas total flap loss was not reported. Complications were not associated with flap configuration or mesh use, but were increased without motor innervation.

ALT/VL-based reconstruction represents a reliable option for complex abdominal wall defects across a broad spectrum of indications. However, given the predominance of Level IV-V evidence and non-standardized outcome reporting, no causal inferences can be drawn from the pooled data.