Dual-purpose Laparoscopy and Bipedicled Anterolateral Thigh Flap for Abdominal Wall Reconstruction After High-voltage Electrical Burn.

Abstract

High-voltage electrical burns involving the abdominal wall pose complex management challenges, including delayed bowel perforation, progressive tissue necrosis, and durable reconstruction in compromised tissue. To our knowledge, no standardized approach has been described that combines visceral surveillance with abdominal wall reconstruction in this setting. We report a case of a 43-year-old man who sustained a 22,000-volt electrical injury with 30% total body surface area burns and a full-thickness lower abdominal wall defect (16 × 13 cm) exposing the intact peritoneum. Triple-contrast computed tomography on day 3 excluded bowel perforation. On day 22, diagnostic laparoscopy was performed for delayed visceral surveillance; in the absence of bowel pathology, intraperitoneal onlay mesh reinforcement was performed during the same procedure. On day 27, a bipedicled anterolateral thigh fasciocutaneous flap was elevated; sequential 10-minute bulldog clamp testing of each perforator produced equivalent reductions in perfusion, prompting a 4-day delay for choke-vessel maturation. On day 31, the flap was re-elevated and transposed, with the fascia lata sutured to the anterior rectus sheath as a second reinforcement layer superficial to the intraperitoneal onlay mesh. At the 6-month follow-up, the patient demonstrated complete wound healing, stable abdominal wall integrity without clinical hernia on physical examination or with Valsalva maneuver, independent ambulation with a below-knee prosthesis, and return to modified work duties. This integrated single-stage laparoscopic approach combining delayed visceral surveillance with definitive abdominal wall reinforcement may inform management of similar injuries.