Background: The use of pedicled flaps from the thigh for abdominal wall reconstruction has been documented, although supraumbilical defects were previously thought unreachable.

Objective: This systematic review aimed to assess the feasibility of upper abdominal wall reconstructions using pedicled fascia lata (FL) flaps and to conduct clinical cases based on these findings.

Methods: A systematic review was conducted using PubMed and Embase databases, following the PRISMA statement. Studies examining the anatomy of the descending branch (DB) of the lateral circumflex femoral artery and the vascularization of the FL were reviewed. Five studies met the inclusion criteria, and three were further included for relevance. Additionally, five cases of large abdominal wall defect reconstructions, primarily in the central or upper quadrants, were selected following Mathes SJ's classification.

Results: Anatomical studies revealed perforators nourishing a wide area of the FL. The FL flap pedicle can extend up to 14-16 cm, which can be further increased by 3 cm by passing the flap beneath the rectus femoris and sartorius muscles and severing all relevant connections. All selected cases were successfully treated using a pedicled FL flap on the DB. Defect dimensions ranged from 10-15 cm in diameter, with pedicle lengths from 12-17 cm and flap sizes from 8 x 10 cm to 15 x 15 cm, surpassing the literature's average of 8.3 cm. Early complications were minimal, with one patient developing a small hernia at 10 months and another experiencing cutaneous dehiscence, both managed conservatively. All patients reported relief from pain or discomfort during exertion and regained satisfactory abdominal function. Follow-up periods ranged from 8 to 72 months.

Conclusions: The wide FL flap raised on DB perforators allows for a significant pedicle length to reach the supraumbilical area without tension, making it a viable option for upper abdominal wall reconstruction.