Secondary abdominal wall defect (AWD) could be caused by removal of cancer tissues, serious infection, and electric injury [
1]. The defected abdominal wall was supposed to be repaired and reconstructed in order to cover local skin and maintain the integrity of abdominal wall. For patients who underwent AWD reconstruction, attention should be paid to prevent the ventral hernia. In clinical practice, it was difficult to deal with the full-thickness defect in the abdominal wall induced by trauma [
2]. AWD usually coexists with multiple abdominal injuries, and the vital signs were unstable in such an acute situation. Furthermore, local AWD after trauma was more complicated as it usually presented with extensive necrosis in local wound surface after severe infection. This may lead to treatment delay in patients with AWD after trauma [
3]. According to previous reports, meshes or flaps were used for repairing and reconstruction of large AWD. However, the mesh repair was not suitable for full-thickness AWD with a size of > 40 cm
2 as it induced a high incidence of tissue necrosis or abdominal compartment syndrome (ACS) [
4]. For large-sized full-thickness AWD, autologous tissue transplantation was considered to be an effective method which could promote local vascularization [
5‐
7]. Autogenous anterolateral thigh (ALT) flap, a workhorse flap for various wounds [
8], has been used for treating abdominal wall with large skin paddle defects. There exist two types of ALT flaps: pedicled [
9] and free [
10]. Pedicled ALT flaps are featured by better blood flow, easy to perform, low incidence of complications, large area of reconstruction, and strong anti-infective ability. So far, the applying range of pedicled ALT flap reached to the groin area and even the lower abdomen area. However, for AWD located in the upper abdomen, the selection of pedicled anterolateral thigh flap is still controversial. It had been reported by Kimata et al. that one disadvantage of pedicled ALT flap in abdominal wall defect reconstructing is its limited range of orientation [
11]. In other words, it is difficult applying pedicled ALT flap for upper AWD or large AWD beyond the midline. In this study, we aim to investigate the efficacy of pedicled ALT flaps for the reconstruction of upper or large AWD and introduce experiences of our team.