Closure of complex abdominal wall defects with bilateral rectus femoris flaps with fascial extensions

Large full-thickness abdominal wall defects present a difficult reconstructive problem. Synthetic mesh has significant drawbacks and should be used only as a temporizing measure. Ideally abdominal wall defects should be resurfaced with well-vascularized autologous fascia and skin. A variety of myofascial, myocutaneous, and myofasciocutaneous flaps have been described. This report describes two cases of near-total abdominal wall reconstruction using bilateral rectus femoris myocutaneous flaps with fasciocutaneous extensions of superficial thigh fascia and skin. In both cases the rectus femoris flaps and fascial extensions healed, and the patients went on to full recovery. In one patient the skin over the fascial extension did not survive and had to be debrided and the underlying vascularized fascia resurfaced with a skin graft. The extended rectus femoris flap is a reliable and versatile flap that leaves negligible functional deficits. The fascial extensions are reliable and well perfused and should be included in the reconstruction of larger abdominal wall defects. The skin overlying the fascial extensions is less reliable, and selective use is recommended.