DOI: 10.14260/jemds/2014/3864 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 63/Nov 20, 2014 Page 13942 GROIN FLAP FOR LOWER ABDOMEN RECONSTRUCTION: A CASE REPORT Rishi Dhawan 1 , Avinash Gupta 2 , R. K. Mittal 3 , Sanjeev Uppal 4 , Ramneesh Garg 5 HOW TO CITE THIS ARTICLE: Rishi Dhawan, Avinash Gupta, R. K. Mittal, Sanjeev Uppal, Ramneesh Garg. “Groin Flap for Lower Abdomen Reconstruction: A Case Report”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 63, November 20; Page: 13942-13944, DOI: 10.14260/jemds/2014/3864 ABSTRACT: Abdominal wall reconstruction is a difficult problem to treat especially in presence of scarred tissue and associated other complications. The abdomen is divided into different zones for the purpose of reconstruction. Lower abdomen consists of zones 1B and 3. There a various options for lower abdomen reconstruction and groin flap is one of them. Although tensor fascia lata flap has been frequently used option we found groin flap to be quiet handy for lower abdomen reconstruction. We used groin flap for closure of this defect and found it very useful, easy and dependable. KEYWORDS: Groin flap; reconstruction; lower abdomen. INTRODUCTION: Reconstruction of abdominal defects can be challenging as frequently these defects are found in patients suffering from associated malnutrition, infective process or malignancy. Chronic wounds and enterocutaneous fistulae may also lead to severe abdominal scarring. Reconstruction of the abdominal wall consists of two components- a stable skin cover and providing an effective support system to maintain the intra-abdominal pressure. For the purpose of reconstruction abdomen has been divided into various zones. Zone 1 is the midline defect over the recti on both sides of the midline. This is further divided into zone 1A and zone 1B above and below umbilicus respectively. Zone 2 consists of lateral upper quadrant defects bilaterally. Zone 3 consists of abdominal wall defects in the lower lateral quadrants (Fig: 1). [1] The various options of lower abdominal reconstruction are primary closure, component separation or flap coverage- local, regional or free tissue transfer. It may also require a support system like prosthetic mesh, alloderm sheets or autogenous fascia. The various local and regional flaps used are rectus abdominis, tensor fascia lata and rectus femoris. The zone three defects may additionally be covered by external oblique advancement. [2] . Groin flap is also an option for zone 1B and zone 3 reconstruction but its use has been found to be limited in literature. We however found it to be quiet versatile in the two cases of lower abdomen reconstruction that we did. CASE REPORT: A 40 year old multi para lady, diagnosed and treated for trophoblastic disease developed an incisional hernia at the suture line of the previous cesarean section. Following mesh repair of the hernia the patient developed wound dehiscence with infected mesh and a copious purulent discharge. The mesh was removed and wound debrided. As the purulent discharge did not decrease she was investigated further and found to have an enterocutaneous fistula. After managing the fistula conservatively for five months the patient had a badly scarred abdomen and a fistula in the midline with a connected sinus tract opening in the right iliac fossa (Fig 2). The patient was planned for closure of the enterocutaneous fistula by the surgical team followed by debridement and reconstruction of the abdominal wall defect in the second stage. Following closure of enterocutaneous fistula, a single abdominal wound was created after debridement of sinus as shown in Fig: 3. A groin flap was planned for coverage, as it had an advantage