Challenges in Reconstruction of Extensive Full-Thickness Abdominal Wall Defects Post-Radiotherapy for Recurrent Abdominal Wall Tumors: A Series Of Two Cases

Reconstructing extensive full-thickness abdominal wall defects after oncologic resections in irradiated fields presents significant challenges due to limited local tissue availability, poor wound healing, and a high risk of complications such as herniation and bowel adhesions. This study presents a series of 10 patients who underwent microsurgical reconstruction following radical tumor resection for recurrent abdominal wall malignancies. All patients had a history of prior surgeries and radiotherapy, requiring a combination of biological mesh and free myo-cutaneous flaps, primarily latissimus dorsi (LD) and anterolateral thigh (ALT) flaps, for reconstruction. Postoperative outcomes were favorable, with all flaps surviving and only minor complications such as localized wound dehiscence and partial skin graft loss, which were managed conservatively. The use of biological mesh provided structural reinforcement while minimizing infection risks, especially in irradiated fields. Flap selection was guided by defect location, size, and vascular supply, with vascular anastomoses performed using the deep inferior or superior epigastric vessels to ensure reliable perfusion. Intraoperative monitoring of peak inspiratory pressure helped prevent abdominal compartment syndrome, while postoperative management focused on early mobilization and abdominal binder support. Long-term follow-up showed no evidence of herniation, bowel dysfunction, or mesh-related complications, demonstrating the durability of this reconstructive approach. This study highlights the efficacy of combining microsurgical techniques with biological mesh in complex abdominal wall reconstruction, offering a reliable solution for patients with recurrent tumors in irradiated fields. A multidisciplinary approach is essential to optimizing outcomes in these challenging cases.