Flap Coverage of Anterior Abdominal Wall Defects

Abstract

Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen.

Complex Incisional Hernias

“…Several other free flap methods have been reported, in particular the latissimus dorsi muscle flap, the tensor fasciae latae flap and the anterolateral thigh flap [48,53,90,94,[96][97][98][99][100][101][102][103]. Here, possible disadvantages are flap loss from vascular problems and morbidity and loss of function from the flap harvesting.…”

New Surgical Strategy for Abdominal Wall Defects. A Successful Swine Model Experiment

“…Flap reconstruction offers immediate and definitive wound closure, mitigating the local milieu inflammatory response and local tissue injury [5]. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intra-abdominal viscera, and the prevention of herniation [6]. A new experimental surgical repair, an original method for the reconstruction of the abdominal wall, using deep inferior epigastria artery perforator propeller flap reinforced by an on lay prosthetic mesh, is presented for the first time in this article.…”

Reconstruction of massive full‐thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and split‐skin grafting

“…The use of abdominal negative pressure wound therapy (NWPT) with plastic draping over the abdominal content has become standard of care in most centers 2, 3 as a temporary mean to get the abdominal walls retracted toward the midline, handling swollen soft tissue as well as edematic inner organs due to heavy infection, trauma, etc. 4, 5, 6. Reconstruction of the abdominal wall will normally entail use of mesh, and in the infected setting, acellular dermal matrix (ADM) has gained increasing usage, as ingrowth and adherence occur also in contaminated and even infected wounds 6.…”

“…4, 5, 6. Reconstruction of the abdominal wall will normally entail use of mesh, and in the infected setting, acellular dermal matrix (ADM) has gained increasing usage, as ingrowth and adherence occur also in contaminated and even infected wounds 6. Nonabsorbable meshes in the infected patient will result in unsuccessful healing due to biofilm and insufficient ingrowth of tissue, and this is a common cause of loss of the implant 7.…”