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Patel et al. Plast Aesthet Res 2020;7:18 Plastic and
DOI: 10.20517/2347-9264.2019.15 Aesthetic Research

Review Open Access

Flap reconstruction of the abdominal wall

Sneha Patel, Alexander F. Mericli, Sahil K. Kapur, Margaret S. Roubaud, Charles E. Butler
Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Correspondence to: Dr. Alexander F. Mericli, Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer
Center, Houston, TX 77030, USA. E-mail: afmericli@mdanderson.org
How to cite this article: Patel S, Mericli AF, Kapur SK, Roubaud MS, Butler CE. Flap reconstruction of the abdominal wall. Plast
Aesthet Res 2020;7:18. http://dx.doi.org/10.20517/2347-9264.2019.15
Received: 26 Aug 2019 First Decision: 24 Mar 2020 Revised: 31 Mar 2020 Accepted: 10 Apr 2020 Published: 17 Apr 2020

Science Editor: Raúl González-García Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor
resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is
performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of
reconstructive techniques are available, the choice of which is based on a number of factors, including the size
and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and
adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free
tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal
soft tissue reconstruction, indications, technical nuances, and management of complications.

Keywords: Abdominal wall reconstruction, surgical flaps, pedicled flap, free flap, bioprosthetic mesh, hernia,
reconstructive surgical procedures

INTRODUCTION
Abdominal wall defects can occur in association with ventral hernias, trauma, tumors, infections or septic
evisceration. The abdominal wall is best conceptualized as a trilaminar structure, with each layer serving
a specific purpose: the muscular layer provides dynamic support and function, the fascial layer confers
strength and durability, and the skin and subcutaneous tissue serves as a barrier to infection and provides
a uniform, aesthetic contour. In abdominal wall reconstruction, each layer must be addressed and repaired
to obtain an optimal result. Contemporary methods of abdominal wall reconstruction emphasize synthetic
or bioprosthetic mesh for fascial repair and reinforcement, primary myofascial coaptation for a functional,
durable and dynamic repair, and a variety of soft tissue flaps and rearrangement techniques to address skin
deficits.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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