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.

Keywords: bioprosthetic mesh; complex defects anterior abdominal wall; distant flaps; locoregional flaps; restoration abdominal wall integrity; synthetic mesh.

Figure 1

(A) An intraoperative photograph showing a full-thickness defect of the anterior abdominal wall with exposed viscera due to resection of gastric tumor involving the abdominal wall. (B) Intraoperative photograph showing elevation of the pedicled anterolateral thigh (ALT) myocutaneous flap. (C) Intraoperative photograph showing inset of pedicled ALT myocutaneous flap.