Introduction
Managing complex defects of the abdominal wall has posed significant challenges for general and reconstructive surgeons since the early 2000s. Few studies have examined anterior abdominal wall reconstruction following excision of peripheral primitive neuroectodermal tumors, and there remains a scarcity of systematic data on the subject.

Case Report
A 26-year-old African female presented to one of the largest faith-based hospitals in Kenya with a four-year history of anterior abdominal wall swelling. She underwent wide local excision of the tumor, followed by reconstruction of the defect using a mesh and an anterolateral thigh (ALT) fasciocutaneous free flap.

Outcome
The patient tolerated the surgical procedures well and responded positively. The flap demonstrated 100% survival, and postoperative histology confirmed that all excision margins were free of tumor.

Conclusion
Abdominal wall reconstruction is a complex surgical procedure aimed at restoring both the structural integrity and functional capacity of the abdominal wall following trauma, surgery, or disease. The combination of a free ALT fasciocutaneous flap with mesh provides durable reinforcement and reduces the risk of hernia recurrence.