Free Innervated Gracilis Muscular Flap for Functional Abdominal Wall Reconstruction Following Desmoid Tumor Resection: A Case Report and Literature Review.

Desmoid tumors (DTs) are rare, benign, locally aggressive myofibroblastic neoplasms. Complete resection with negative margins remains the standard treatment despite their lack of metastatic potential. As DT commonly involve the anterior abdominal wall, their excision may result in complex defects requiring advanced reconstruction. We herein present the first functional single-stage reconstruction of an abdominal wall defect with the use of a free innervated gracilis muscle flap transfer. A 29-year-old woman, presented with a palpable tumor on the left-side of her abdominal wall. She underwent surgery and on biopsy, the tumor was diagnosed as a DT. The patient underwent wide resection through an abdominoplasty approach, which resulted in a rectus abdominis defect involving the anterior rectus abdominis sheath. The 8 × 7cm-sized defect was reconstructed with free transfer of a neurotized gracilis muscle flap, anastomosed to the deep inferior epigastric vessels, whereas, the anterior branch of the obturator nerve was coapted to the ninth intercostal nerve. Finally, a monofilament polypropylene mesh was used for reconstruction of the missing anterior rectus sheath. Ever since and during a follow-up of 5 years, electromyographic examinations have demonstrated excellent re-innervation of the gracilis muscle flap. The patient underwent regular follow-up examinations, including CT imaging at 1, 2, and 5 years postoperatively, with no evidence of abdominal wall protrusion or tumor recurrence. This case demonstrates that the free innervated gracilis flap can provide a safe and reliable reconstructive option for complex abdominal wall defects following oncologic resection.