Functional Reconstruction of Abdominal Wall in Prune Belly Syndrome Using Vastus Lateralis Muscle Flaps: A Prospective Observational Study

Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by severe abdominal wall muscle deficiency, leading to significant impairment of respiratory, urinary, and gastrointestinal function. Despite numerous reconstructive attempts, no technique has achieved full functional restoration of the anterior abdominal wall. This paper introduces a novel dynamic reconstructive approach using bilateral pedicled musculo-fascial Vastus Lateralis (VL) flaps for functional abdominal wall reconstruction in PBS. Unlike traditional abdominoplasty-based procedures that mainly address cosmetic deformity, this method focuses on restoring true muscle dynamics and physiological function. The technique involves harvesting innervated, vascularized VL flaps from both thighs and transposing them to the anterior abdominal wall through a subcutaneous tunnel while preserving their neurovascular pedicles. The muscles are anchored to the costal arch superiorly and the pubic symphysis inferiorly, effectively recreating the functional vector of the rectus abdominis. This configuration enables dynamic contraction of the abdominal wall and reinstates the ability to generate intra-abdominal pressure required for coughing, defecation, and postural control. Follow-up assessment, including electromyography (EMG) and motor testing, confirmed active muscle contraction and marked improvement in core function. Patients demonstrated restored abdominal wall activity, enhanced motor abilities, and reduced symptoms related to ineffective intra-abdominal pressure, such as constipation and respiratory infections. This study presents the first reproducible surgical solution achieving both anatomical reconstruction and functional reanimation of the abdominal wall in PBS. The described technique offers a transformative step in pediatric reconstructive surgery, combining microsurgical precision with physiological restoration to improve long-term quality of life.