a Preoperative abdominal tissue defect of patient #2 with an “open abdomen” situation after multiple revisional laparotomies following CCUD (the black arrow points to the umbilical stoma with an indwelling foley catheter) due to a devastated bladder outlet as a complication of radical prostatectomy. After placement of a mesh graft and extensive abdominal wound vacuum therapy, sufficient consolidation of the wound margins was achieved for reconstruction. b Intraoperative identification of the perforator artery. Two anatomic landmarks (black dots: anterior iliac spine and lateral patella) are connected with a thought line. Using a Doppler probe, the perforator artery is identified at a point halfway between the anatomic landmarks on this line (red dot: perforator artery). c The ALT flap is rotated into the defect, and the donor site is closed. Note the remnant skin defect at the donor site (black arrow), which is to be covered with a meshed skin graft. d Result 4-week postoperatively. The umbilical stoma of the CCUD was not compromised by the flap. CCUD, continent cutaneous urinary diversion; AIS, anterior iliac spine; PAT, patella; PERF, perforator artery.