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Page 6 of 7 Patel et al. Plast Aesthet Res 2020;7:18 I http://dx.doi.org/10.20517/2347-9264.2019.15

or inadequate, due to injury from prior surgery, trauma, or radiation. In this situation, vein grafts can
be used to increase pedicle length. Common distant recipient vessels necessitating vein grafting include
the superficial femoral, descending branch of the lateral femoral circumflex, internal mammary, and
thoracodorsal.

As is true for any free tissue transfer, regardless of the area reconstructed, the flap should be examined
and evaluated with pencil Doppler ultrasonography every hour for the first 48-72 h. Any changes in flap
perfusion warrant a return to the operating room for exploration of the microvascular anastomosis.

POSTOPERATIVE CARE AND COMPLICATION MANAGEMENT
A patient with abdominal wall reconstruction is managed similarly to a patient with any major abdominal
surgery in the postoperative period. Diet is advanced in accordance with the return of bowel function, as
is standard fashion. Although an abdominal binder is commonly used in cases of ventral hernia repair and
abdominal wall reconstruction, a binder may be detrimental in flap cases due to the additional extrinsic
pressure it transmits to the flap and vascular pedicle. Therefore, binder utilization may be delayed until
the flap has developed adequate collateral circulation. Antiemetics, and if necessary, nasogastric tube
decompression, are employed to minimize postoperative nausea and retching which may stress the repair.
Similarly, aggressive postoperative pulmonary toilet is important to minimize coughing.

Closed-suction drains should be employed liberally for any surgery in which there is a significant amount
of soft tissue undermining or dead space creation [2,17] . Postoperative prophylactic antibiotics should be
considered in clean contaminated cases and/or in cases involving mesh [1-3] . Closed-incision negative
pressure dressings should be considered, as they have been demonstrated to contribute to a reduced
[18]
surgical site infection and surgical site occurrences rate in complex abdominal surgery . We counsel
all abdominal wall reconstruction patients to avoid lifting greater than 10 lbs. for 2-3 months following
surgery in order to minimize hernia occurrence.

CONCLUSION
A reliable skin closure is imperative for a durable, functional, and cosmetically-acceptable abdominal
wall. Depending on the defect characteristics a variety of local, regional, or free flaps are available for
reconstruction of the abdominal skin and subcutaneous tissue. Each flap has inherent advantages and
disadvantages, necessitating a tailored approach to each individual patient.

DECLARATIONS
Authors’ contributions
Participated in the accumulation of data, literature review, writing, and editing this manuscript: Patel S,
Mericli AF, Kapur SK, Roubaud MS, Butler CE

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.