Innervated Pedicled Gracilis Flap for Dynamic Abdominal Wall Reconstruction

Abdominal wall reconstruction for full-thickness defects is a challenging procedure that usually requires the use of flaps. The gracilis flap is known to be used in hernia repair in which the abdominal muscles are still intact, but there are no reports in literature describing the use of an innervated gracilis for dynamic abdominal wall reconstruction after tissue loss due to severe trauma. We present a surgical technique in which the gracilis is harvested preserving the neurovascular pedicle, then tunneled underneath the adductor longus to cover the lower abdominal defect and provide it with basal muscle tone without tension on the pedicle. This results in restored integrity of the musculofascial abdominal wall and dynamic muscle function and support. The gracilis flap has been proven to be useful and versatile in reconstructive surgery with great potential in abdominal wall reconstruction having minimal donor-site morbidity and hernia recurrence risk.