FREE INNERVATED LATISSIMUS-DORSI MUSCLE FLAP FOR RECONSTRUCTION OF FULL-THICKNESS ABDOMINAL-WALL DEFECTS

Full-thickness abdominal wall defects continue to be a challenge for t he reconstructive surgeon. The most frequently used reconstructive tec hniques are transfer of a pedicled, local abdominal flap or a distant flap from the thigh region. The purpose of this paper is to present a new approach to full-thickness abdominal wall reconstruction using an innervated free latissimus dorsi musculocutaneous flap. Four patients with large full-thickness abdominal wall defects underwent reconstruct ion with a free innervated latissimus dorsi muscle flap. In two patien ts, staged abdominal wall reconstruction was performed. Primary closur e was first obtained with a skin graft. During the subsequent definiti ve reconstruction (with an innervated free latissimus dorsi muscle fla p), this skin graft was not excised. Instead, deep dermabrasion of the skin graft was performed, leaving a residual dermal layer. This layer was then covered with a free innervated latissimus dorsi muscle flap. In these two cases, there was no need for the use of a prosthetic mes h. A single stage reconstruction was performed in the other two cases. After abdominal wall sarcoma resection, Prolene mesh was placed and s ubsequently covered with a free innervated latissimus dorsi muscle fla p. There were no free flap failures. The average time of surgery was 4 hours, 50 minutes. The average hospital stay was 14 days. No signific ant complications occurred except for one donor site seroma. No hernia s have occurred postoperatively. The mean follow-up was 21 months. Pos toperatively, electromyographic testing was performed regularly in all patients to document reinnervation of the latissimus dorsi muscle fla p. With reinnervation and intensive muscle training, the transplanted latissimus dorsi muscle offers enough contractile capacity and strengt h to adequately replace the function of the missing abdominal wall mus cles. In complicated staged reconstructions, dermabrasion of the tempo rary skin graft allows for the use of a residual dermal layer as a fas cia-like substitute to aid in the restoration of structural integrity. The combination of the dermal layer with an innervated free latissimu s dorsi muscle provides a strong, vascularized fascial repair as well as an overlying vascularized soft-tissue coverage. In conclusion, adeq uate functional dynamic reconstruction of full-thickness abdominal wal l defects is possible using an innervated free latissimus dorsi muscle flap. The reinnervated latissimus dorsi muscle is suitable for recons titution of the missing functional and anatomic components of complex abdominal wall defects.