Abdominal wall soft tissue sarcomas patients have a high rate of postoperative complications
such as fistulas, chronical mesh infection, or functional alterations. In terms of
abdominal wall reconstruction, there are many surgical approaches: from the simplest
with partial thickness skin grafts to more demanding techniques like free flaps.
The main goal until now has been to achieve a stable coverage, but functional alterations
(coughing, urinating, defecating, exercising, etc.) can affect the patient´s quality
of life and it is not possible to prevent it without a dynamic coverage.
For this reason, it is proposed a cross-innervated gracilis free flap with the iliohypogastric
nerve to reconstruct functionally the rectus abdominis muscle in association with
two meshes to replace the peritoneum (biological) and the transversalis fascia (polipropilene).
Furthermore, apart from providing a stable coverage, it is pretended to restore a
symmetrical abdominal wall contraction.
Three patients with abdominal wall soft tissue sarcomas required unilateral rectus
abdominis resection, with an immediate reconstruction with double mesh and a functional
musculocutaneous gracilis free flap. At 6 months postoperatively, all patients presented
clinically symmetrical abdominal wall contraction. One year postoperatively, a control
electromyography (EMG) was performed over the reconstructed area, wherein two patients
present active motor gracilis muscle reinnervation, and one could not be confirmed.
Functional reconstruction is performed to replace anatomically and functionally all
the abdominal wall layers. The main reconstructive objectives are to avoid local postoperative
complications and to achieve a higher patient satisfaction.