Abdominal wall reconstruction.

Patients with abdominal wall reconstruction present a difficult management problem to the oncological surgeon. There were 36 patients treated for abdominal wall primary and secondary tumors between the years 1973 and 1982 at the Memorial Hospital. There were 25 abdominal wall sarcomas, 6 recurrent colon cancers, 2 recurrent bladder cancers, 1 cervical cancer, 1 recurrent endometrial cancer and 3 complications of radiotherapy treated by excision and reconstruction of the defect. The desmoid tumors were closed primarily. The recurrent sarcomas after radical excision, were reconstructed with Marlex mesh and local mobilization of skin and subcutaneous tissue. The recurrent colon bladder and endometrial cancers had been treated with over 5,000 cGy each. Three patients had significant full thickness skin loss secondary to radiotherapy. These patients comprised the group that required a myocutaneous flap to provide full thickness skin and fascia. The tensor fascia lata flap was used in eight patients. This group of patients did extremely well in contrast to the group of radiated patients with Marlex mesh reconstruction. There were less complications in the TFL group. We recommended the TFL flap for a large abdominal wall defect and for a previously radiated abdominal wall.