Considerations in abdominal wall reconstruction

Reconstruction of complex defects of the central abdomen is both challenging and technically demanding for plastic 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, it is our goal to review pertinent anatomy, pre- and postoperative care regimens, and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the central abdomen.