Combined Versatility of a Pedicled Rectus Femoris and Anterior Lateral Thigh Chimeric Flap in Staged Complex Abdominal Wall Reconstruction: A Case Report in a Transplant Recipient.

Complex abdominal wall reconstruction (CAWR) can pose significant challenges for surgeons and their patients. An extra layer of complexity is added when considering reconstruction in patients with impaired immune function, such as after a solid organ transplant, due to increased risk for poor wound healing, infection, and subsequent incisional hernia formation. Options for CAWR include primary closure by local tissue advancement, component separation, skin grafts, alloplastic material/mesh, pedicled or free flaps, or abdominal wall allotransplantation. When considering flap use in CAWR, the choice of coverage depends on the location and size of the abdominal wall defect. At a certain point, end-stage abdominal wall deficits, where reconstruction with local tissue is not possible, need to be considered. In these instances, we propose using pedicled regional flaps or even free tissue transfer. Here, we describe a case of a 35-year-old immunosuppressed male with a large spigelian hernia with loss of domain that developed after a repeat cadaveric renal transplant for which he underwent a staged CAWR with temporary abdominal closure, subsequent ventral hernia repair with biological mesh in an underlay fashion, and utilization of tunneled anterior lateral thigh and rectus femoris pedicled flaps.