Reconstruction of Massive Ventral Hernias With Free Latissimus Dorsi Flap: Patient-Reported Outcomes Analysis.

Abstract

<h4>Background</h4>This study evaluates the postoperative functional and quality-of-life outcomes associated with using the free noninnervated latissimus dorsi muscle flap in combination with transversus abdominis release (TAR) and retrorectus mesh for massive ventral hernia repair (VHR).<h4>Methods</h4>Eighteen patients who underwent VHR were reviewed. Patients were contacted at least 2 years postoperatively and assessed using standardized patient-reported outcome measures (PROMs), including visual analog scale (VAS) for pain, Short-Form Health Survey (SF-12), Hernia-Related Quality-of-Life Survey (HerQLes), and Carolinas Comfort Scale (CCS). Data were analyzed using t tests and linear regression models.<h4>Results</h4>Comorbidities included diabetes (27.8%), chronic obstructive pulmonary disease (5.6%), smoking (5.6%), and immunosuppression (16.7%). The mean clinic follow-up was 8.9 months, with no flap failures or hernia recurrences. Medical complications occurred in 3 patients, and 5 patients (27.8%) experienced 8 surgical complications. Two patients died of unrelated causes. Of 16 survivors, 8 (50%) completed phone surveys at a mean follow-up of 36.8 months. Increasing age was positively correlated with Physical Component Summary-12 (PCS-12; 0.70, P < 0.05) and HerQLes scores (1.94, P < 0.05) but negatively with CCS scores (-2.40, P < 0.05). Larger abdominal wall defects were associated with lower PCS-12 (-2.31, P < 0.05) and HerQLes scores (-6.40, P < 0.05), whereas CCS scores increased with defect size (8.20, P < 0.05). Higher body mass index (BMI) was linked to lower Mental Component Summary-12 (MCS-12; -1.60, P < 0.05).<h4>Conclusions</h4>Free LD flap is effective for repair of massive ventral hernias. Age positively impacted quality-of-life scores, whereas higher BMI and larger defects negatively influenced outcomes.