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British Journal of Plastic Surgery (1983) 36,334-336 0 1983 The Trustees of British Association of Plastic Surgeons Reconstruction of the anterior abdominal wall above the umbilicus using a tensor fasciae latae myocutaneous island flap J. S. WATSON Welsh Regional Plastic Surgery, Burns and Oral Surgery Centre, St Lawrence Hospital, Chepstow Summary-The pedicled tensor fasciae latae myocutaneous flap is a well-recognised and reliable method of reconstruction of full-thickness defects of the lower abdominal wall and groin. Its superior reach can be extended above the level of the umbilicus by the simple manoeuvre of flexing the hip. The tensor-fasciae latae myocutaneous flap has to the level of the umbilicus (Mayou et al., 1981; become a reliable and widely used flap in O’Hare and Leonard, 1982). This short presen- reconstructive surgery (Hill et al., 1978; Bostwick tation shows how the same flap can be made to et al., 1979). It has been used to reconstruct reach well above the level of that anatomical full-thickness defects of the lower abdominal wall landmark. Fig. 1 Fig. 2 Figure l-Recurrent adeno-carcinoma invading the abdominal wall in the region of the umbilicus and the right iliac fossa. Figure 2-Circular excision of the abdominal wall from 7 cm above the umbilicus to the right iliac fossa, including the old right paramedian scar. 334

Reconstruction of the anterior abdominal wall above the umbilicus using a tensor fasciae latae myocutaneous island flap

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British Journal of Plastic Surgery (1983) 36,334-336 0 1983 The Trustees of British Association of Plastic Surgeons

Reconstruction of the anterior abdominal wall above the umbilicus using a tensor fasciae latae myocutaneous island flap

J. S. WATSON

Welsh Regional Plastic Surgery, Burns and Oral Surgery Centre, St Lawrence Hospital, Chepstow

Summary-The pedicled tensor fasciae latae myocutaneous flap is a well-recognised and reliable method of reconstruction of full-thickness defects of the lower abdominal wall and groin. Its superior reach can be extended above the level of the umbilicus by the simple manoeuvre of flexing the hip.

The tensor-fasciae latae myocutaneous flap has to the level of the umbilicus (Mayou et al., 1981; become a reliable and widely used flap in O’Hare and Leonard, 1982). This short presen- reconstructive surgery (Hill et al., 1978; Bostwick tation shows how the same flap can be made to et al., 1979). It has been used to reconstruct reach well above the level of that anatomical full-thickness defects of the lower abdominal wall landmark.

Fig. 1 Fig. 2

Figure l-Recurrent adeno-carcinoma invading the abdominal wall in the region of the umbilicus and the right iliac fossa. Figure 2-Circular excision of the abdominal wall from 7 cm above the umbilicus to the right iliac fossa, including the old right paramedian scar.

334

RECONSTRUCTION OF THE ANTERIOR ABDOMINAL WALL ABOVE THE UMBILICUS 335

Case report

A 62-year-old man presented with intestinal obstruction due to a recurrent adenocarcinoma of the colon with spread to the skin around the umbilicus and to the site of an old drainage wound in the right iliac fossa (Fig. 1). The primary tumour had been resected 2 years pre- viously. He underwent a laparotomy through a circular excision of the abdominal wall from 7 cm above the

umbilicus but by flexing the hip it could be made to close the defect completely; the viable fascial layer closing the defect in the abdominal wall musculature and the skin of the flap the skin defect (Fig. 3). Flexion of the hip was maintained for one week then gradually relaxed until he was walking 20 days post-operatively. The tip of the flap developed some cutaneous necrosis but the fascia re- mained viable, its suturing held and the abdominal wall subsequently healed without herniation (Fig. 4A, B).

Fig. 3

Figure 3-Tensor fasciae latae flap in place with the hip flexed.

umbilicus to the right iliac fossa including the right Comment paramedian scar (Fig. 2). A further colonic resection was performed. There were tumour deposits in the pelvis so a defunctioning colostomy was fashioned to prevent large

The blood supply to the tensor fasciae latae flap

bowel obstruction in the near future. comes off the lateral aspect of the profunda

The abdominal wall defect was closed by a tensor femoris and courses horizontally to enter the

fasciae latae island flap taking the fascia down to the muscle 10 cm below the anterior superior iliac

level of the lower thigh and the skin two-thirds of the spine. By flexing the hip the position of the

way from the anterior superior iliac spine to the femoral vascular hilum can be made to move nearly 10 cm condyle. With the patient lying supine on the operating proximally so increasing the reach of the flap table, the flap would only reach to the level of the above the level of the umbilicus.

336 BRITISH JOURNAL OF PLASTIC SURGERY

Fig. 4

Figure 4-Face view (A) and lateral view (B) to show the reconstruction 10 weeks later. There is no herniation at the site of operation and the wound is well healed.

References

Bostwick, J., Hill, H. L. and Nahai, F. (1979). Repairs in the lower abdomen, groin or perineum with myocutaneous or omental flaps. Plastic and Reconstructive Surgery, 63, 186.

Hill, H. L., Nahai, F. and Vasconez, L. 0. (1978). The tensor fascia lata myocutaneous free flap. Plastic and Reconstruc- tive Surgery, 61, 517.

Mayou, B. J., Beard, R. C. and Abdulrour, E. E. (1981). A one-stage reconstruction of the anterior abdominal wall with a musculocutaneous flap. British Journalof Surgery, 68,840.

O’Hare, P. M. and Leonard, A. G. (1982). Reconstruction of major abdominal wall defects using the tensor fasciae latae

myocutaneous flap. British Journal of Plastic Surgery, 35, 361.

The Author

J. Stewart Watson, FRCS, MRCP, Consultant Plastic Surgeon, Plastic Surgery and Burns Unit, Withington Hospital, Manchester. Formerly Consultant Plastic Surgeon, Welsh Regional Plastic Unit, St Lawrence Hospital, Chepstow.

Requests for reprints to: J. S. Watson, FRCS, MRCP, Plastic Unit, Withington Hospital, Didsbury, Manchester M20 8LR.