Innervated Free Flap Abdominal Wall Reconstruction: A Systematic Review
28 March 2017
22 June 2017
28 August 2017 (online)
Background Reconstruction of large abdominal wall defects provides unique challenges to the plastic surgeon. Reconstruction with innervated free flaps has been described and allows for true functional replacement of “like with like.” The authors sought to determine the frequency and outcomes of such reconstructions.
Methods A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for research articles related to innervated free flaps in abdominal wall reconstruction.
Results Nine case series (16 patients) were included who underwent free flap reconstruction of the abdominal wall with motor and/or sensory innervation. Reconstruction was performed with latissimus dorsi (n = 5), tensor fascia lata (n = 4), rectus femoris (n = 2), combined tensor fascia lata-anterolateral thigh (n = 2), combined vastus lateralis-tensor fascia lata-anterolateral thigh flaps (n = 2), and vastus lateralis-anterolateral thigh (n = 1). All but one reconstruction had motor neurotization performed (n = 15), while only 12.5% (n = 2) had sensory neurotization performed. At least 66.6% of patients (n = 10) who had motor neurotization regained motor function as evidenced by documented clinical examination findings while 93.3% (n = 14) had “satisfactory” motor function on author's subjective description of the function. Both flaps that had sensory innervation were successful with Semmes–Weinstein testing of 3.61.
Conclusion A majority of neurotized free flap reconstructions for abdominal wall defects have been performed for motor innervation, which is almost invariably successful. Sensory neurotization has been carried out for a small number of these reconstructions, and also has been successful. Improvements in techniques and outcomes in innervated free flap abdominal wall reconstruction are important to advancing efforts in abdominal wall transplantation.
Keywordsabdominal wall reconstruction - anterolateral thigh flap - fasciocutaneous flap - free flap - innervated - innervation - neurotized - neurotization - plastic surgery - systematic review
- 1 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (03) 519-526
- 2 Koshima I, Soeda S, Yamasaki M, Kyou J. The free or pedicled anteromedial thigh flap. Ann Plast Surg 1988; 21 (05) 480-485
- 3 Williams JK, Carlson GW, Howell RL, Wagner JD, Nahai F, Coleman JJ. The tensor fascia lata free flap in abdominal-wall reconstruction. J Reconstr Microsurg 1997; 13 (02) 83-90
- 4 O'Hare PM, Leonard AG, Brennen MD. Experience with the tensor fasciae latae free flap. Br J Plast Surg 1983; 36 (01) 98-104
- 5 Chalfoun CT, McConnell MP, Wirth GA, Brenner KA, Evans GR, Kobayashi M. Free tensor fasciae latae flap for abdominal wall reconstruction: overview and new innovation. J Reconstr Microsurg 2012; 28 (03) 211-219
- 6 Penington AJ, Theile DR, MacLeod AM, Morrison WA. Free tensor fasciae latae flap reconstruction of defects of the chest and abdominal wall: selection of recipient vessels. Scand J Plast Reconstr Surg Hand Surg 1996; 30 (04) 299-305
- 7 Ninković M, Kronberger P, Harpf C, Rumer A, Anderl H. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg 1998; 101 (04) 971-978
- 8 Chevray PM, Singh NK. Abdominal wall reconstruction with the free tensor fascia lata musculofasciocutaneous flap using intraperitoneal gastroepiploic recipient vessels. Ann Plast Surg 2003; 51 (01) 97-102
- 9 Harii K, Omori S. Use of the gastroepiploic vessels as recipient or donor vessels in the free transfer of composite flaps by microvascular anastomoses. Plast Reconstr Surg 1973; 52 (05) 541-548
- 10 Hahn Jr E, Lee ES, Keith JD. A neurotized anterolateral thigh flap with a unique anastomosis to the gastroepiploic artery: a case report of a reconstruction of composite abdominal wall defect. Eplasty 2016; 16: ic29
- 11 Wong CH, Lin CH, Fu B, Fang JF. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg 2009; 124 (02) 500-509
- 12 Blondeel N, Boeckx WD, Vanderstraeten GG. , et al. The fate of the oblique abdominal muscles after free TRAM flap surgery. Br J Plast Surg 1997; 50 (05) 315-321
- 13 Koshima I, Nanba Y, Tutsui T, Takahashi Y, Itoh S, Kobayashi R. Dynamic reconstruction of large abdominal defects using a free rectus femoris musculocutaneous flap with normal motor function. Ann Plast Surg 2003; 50 (04) 420-424
- 14 Iida T, Mihara M, Narushima M. , et al. Dynamic reconstruction of full-thickness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap. Ann Plast Surg 2013; 70 (03) 331-334
- 15 Selvaggi G, Levi DM, Kato T. , et al. Expanded use of transplantation techniques: abdominal wall transplantation and intestinal autotransplantation. Transplant Proc 2004; 36 (05) 1561-1563
- 16 Broyles JM, Berli J, Tuffaha SH. , et al. Functional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft: a cadaveric study and review of the literature. J Reconstr Microsurg 2015; 31 (01) 39-44
- 17 Singh DP, Mavrophilipos VD, Zapora JA. , et al. Novel technique for innervated abdominal wall vascularized composite allotransplantation: a separation of components approach. Eplasty 2014; 14: e34
- 18 Giele H, Bendon C, Reddy S. , et al. Remote revascularization of abdominal wall transplants using the forearm. Am J Transplant 2014; 14 (06) 1410-1416
- 19 Giele H, Vaidya A, Reddy S, Vrakas G, Friend P. Current state of abdominal wall transplantation. Curr Opin Organ Transplant 2016; 21 (02) 159-164
- 20 Sasaki K, Nozaki M, Nakazawa H, Kikuchi Y, Huang T. Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg 1998; 102 (06) 2244-2252
- 21 Koshima I, Moriguchi T, Inagawa K, Urushibara K. Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer. Ann Plast Surg 1999; 43 (02) 199-203
- 22 Malheiro H, Ferreira A, Reis J, Choupina M, Ferreira A, Amarante J. Repair of a full-thickness abdominal wall defect with an innervated latissimus dorsi free flap. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (03) 146-148