Pedicled Anterolateral Thigh Flap Reconstruction of Exposed Renal Allograft.

Complete abdominal wall dehiscence is an exceedingly rare complication following kidney transplantation. Reconstruction typically consists of abdominally based flaps; however, extensive prior surgeries, ostomies, and limited recipient vessels may necessitate alternative donor sites. This case describes the use of a pedicled anterolateral thigh flap reinforced with vascularized fascia lata to reconstruct a complex abdominal wall defect exposing a renal allograft in a patient with vertebral (V), anogenital (A), cardiac (C), tracheoesophageal (TE), renal (R), and limb (L) system (V.A.C.T.E.R.L.) association and a history of over 70 abdominal operations. The reconstruction was complicated by recurrent perinephric abscess and venous congestion. Successful flap salvage was ultimately achieved through medicinal leech therapy. This case highlights a systematic reconstructive approach in the setting of rare congenital anomalies, complex anatomy, and threatened flap viability.