Abdominal Wall Reconstruction After Iliac Crest Free Graft

Abstract Background The iliac crest free graft with internal oblique muscle (IOM) is used for the reconstruction of composite head and neck defects. This graft can cause a muscular defect in the abdominal wall that requires complex reconstruction. We present the case of a 43-year-old male patient who underwent left mandibulectomy with left iliac crest flap (LICF). Methods Pacient diagnosed with squamous cell carcinoma of bucal mucosa. He received adjuvant chemotherapy, and had a mandibular recurrence, so a left mandibulectomy was decided, and in collaboration with abdominal wall surgeon, a LICF was extracted. The iliac crest free flap was harvested simultaneously with the resection and recipient site preparation with 2 teams of maxilofacial and abdominal wall surgeons. Internal oblique muscle and an island of subcutaneous tissue and skin were included. A reconstruction by plans is necessary for the donor site. The TAM is sutured to the iliac muscle. The 10 × 5 cm defect created in the oblique muscles was reconstructed by approximating its margins and placing an onlay 15 × 15 cm PVDF prosthesis. In the following days, bleeding at the level of the ileolumbar artery was observed and selective embolization was performed. The patient was discharged 50 days after without any other abdominal complication. Conclusion The closure of the abdominal wall defect is a challenging step and could be meticulously performed jointly maxillofacial and abdominal wall surgeons. The use of a synthetic mesh might help to the correct closure of abdominal wall.