90th Annual Meeting Abstracts
Tunneled Tensor Fascia Lata Myofascial Flap for Complex Abdominal Wall Reconstruction: Clinical and Anatomical Considerations
*Frederick Wang, B.S., *Samuel Buonocore, M.D., *Deepak Narayan, M.D.
Yale University School of Medicine, New Haven, CT
Objective: This study describes the treatment of two patients with recurrent infected abdominal wall defects using a tunneled, delayed pedicled tensor fascia lata (TFL) myofascial flap. One flap was reinforced with Parietex Composite mesh prior to flap inset. We also identified the course and anatomy of the lateral femoral cutaneous nerve (LFCN) through dissection in 5 cadavers.
Design: Case report.
Setting: Tertiary care university hospital.
Patients: Two patients presented with recurrent abdominal wall defects. The first was a 62 year-old female with 3 prior hernia repair attempts and a 1 year history of multiple draining sinuses from the abdominal wall. The second was a 68 year-old male with 15 prior repair attempts.
Interventions: The TFL was elevated and delayed for 4 weeks in both cases. In the second case, Parietex Composite mesh was positioned underneath the TFL flap and allowed to incorporate for 4 weeks. The flaps were then harvested and tunneled subcutaneously to the site of the abdominal defect. Patients were followed up for a minimum of 11 months.
Main Outcome Measures: Follow-up for 1 year.
Results: Both patients have stable repairs but had seromas requiring drainage. We identified a variant of LFCN that traversed the TFL flap, necessitating meticulous dissection during surgery.
Conclusions: We describe a new technique of incorporating Parietex Composite mesh into the tensor fascia lata prior to flap harvest for reconstruction of complex abdominal wall defects as well as a method for tunneling the flap after delay. The incorporated mesh becomes vascularized prior to flap transfer, decreasing its potential for infection and allowing it to strengthen a flap repair in the setting of a contaminated wound.