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.

Robotic-assisted deep inferior epigastric perforator (DIEP) flap harvest minimizes donor-site morbidity by reducing fascial disruption and preserving rectus muscle integrity. Traditional criteria for robotic DIEP have limited use to short intramuscular perforators, but this case demonstrates the feasibility of a totally extraperitoneal (TEP) approach in a patient with a long (91.6 mm) intramuscular perforator. Using a multi-port robotic system and a 3 cm anterior fascial incision, we successfully dissected a 17 cm pedicle without muscle sacrifice or mesh reinforcement. A literature review highlights the rarity of TEP techniques, especially for long perforators. This case supports expanding robotic DIEP criteria based on perforator anatomy rather than strict length cutoffs and illustrates the potential of TEP dissection to avoid intra-abdominal entry while preserving abdominal wall integrity.

Nasal septum defects cause significant functional and aesthetic morbidity. In large septal defects requiring reconstruction, the goal is to achieve appropriate tissue matching, obtain well-vascularized tissue, and minimize donor site morbidity. Repair alternatives are quite limited in large defects. The medial femoral condyle (MFC) free flap is a preferred option in craniofacial reconstructions due to its vascularized, cortical bone with periostal architecture. In this article, we present a patient who underwent successful reconstruction of a severely advanced nasal septum defect using a medial femoral condyle free flap. A 63-year-old male patient underwent repair with a free MFC flap for an anterior septal defect approximately 2 × 2 cm in size. The cause of the septal defect was previous tumor surgery. A free flap from the medial femoral condyle was designed for repair; the flap bone size was approximately 2 × 2 cm, and the periosteum size was approximately 2 × 4 cm. The patient was followed up for 18 months, and no problems were detected during follow-up. The MFC free flap may be a suitable option for the reconstruction of large septal defects, providing structural support without the need for additional tissue transfer for mucosal covering. It may be kept in mind for the repair of large septal defects.