Cesarean Delivery after Abdominal Wall Reconstruction Using an Anterolateral Thigh Flap with Vascularized Fascia Lata.

Abstract

Techniques for abdominal wall reconstruction include the use of prosthetic materials (synthetic or biological meshes), component separation, autologous tissue reconstruction, or a combination thereof. Reconstruction using prosthetic materials avoids additional trauma to healthy tissues but carries risks such as infection, adhesion to surrounding structures, and bowel obstruction caused by intestinal adhesions. Therefore, abdominal wall reconstruction using autologous tissue may be considered as an option suitable for women of childbearing potential. Only a few cases of successful childbirth following abdominal wall reconstruction have been reported, and opportunities to reincise and directly observe the reconstructed wall are rare. No previous reports have described intraoperative findings during reincision of a previously reconstructed abdominal wall. We report the case of a 23-year-old woman who underwent abdominal wall resection for a rectus abdominis tumor secondary to an immature ovarian teratoma. We reconstructed the abdominal wall using an anterolateral thigh flap with vascularized fascia lata, including the perifascial areolar tissue. The defect was reinforced with a well-vascularized flap sutured in an inlay manner, partially in 2 layers. The patient conceived naturally after reconstruction. The reconstructed abdominal wall remained strong and flexible, accommodating expansion of the abdominal circumference during pregnancy without herniation. We reincised the reconstructed abdominal wall during cesarean section and found no adhesions to the surrounding tissues. Therefore, an anterolateral thigh flap with vascularized fascia lata and perifascial areolar tissue may represent a promising option for abdominal wall reconstruction in young women with childbearing potential.