Flap reconstruction of the abdominal wall

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.