Postoperative complications after abdominal wall reconstruction using anterolateral thigh and tensor fasciae latae...

The anterolateral thigh (ALT) and tensor fasciae latae (TFL) flaps are useful options for autologous abdominal wall reconstruction. However, direct comparisons of postoperative outcomes continue to be limited. We aimed to compare postoperative complications associated with these two flap types.

We conducted a single-center retrospective comparative study involving patients who underwent abdominal wall reconstruction using ALT or TFL flaps after tumor resection between 2002 and 2025. The primary and secondary outcomes were short- and long-term recipient-site postoperative complications, respectively.

Twelve and 9 patients were included in the ALT and TFL groups, respectively. All TFL flaps were pedicled and used for infraumbilical lateral defects, whereas ALT flaps included free flaps, were used for a wider range of defects, and more often included skin paddles. Short-term recipient-site complications occurred in 2 out of 12 ALT patients and 6 out of 9 TFL patients, including partial flap necrosis in 3 TFL patients. The incidence was higher in the TFL group (odds ratio, 10.0; 95% confidence interval, 1.3-76.9; P =.032), and the Clavien-Dindo severity grades were also higher (P =.034). Long-term recipient-site complications occurred in 0 out of 9 ALT patients and 2 out of 8 TFL patients, comprising 1 patient with abdominal hernia and 1 with abdominal bulge (P =.21).

ALT flaps were associated with fewer and less severe short-term recipient-site complications than TFL flaps. TFL flaps may continue to be an option for infraumbilical lateral defects, whereas ALT flaps may be preferable for larger or midline-crossing defects, or when skin replacement or free flap transfer is required.