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

complex defects anterior abdominal wall - restoration abdominal wall integrity - locoregional flaps - distant flaps - bioprosthetic mesh - synthetic mesh

• References

• 1 Rohrich RJ, Lowe JB, Hackney FL, Bowman JL, Hobar PC. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg 2000; 105 (1) 202-216, quiz 217
• 2 Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 1992; 33 (2) 279-282, discussion 282–283
• 3 Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38 (6) 553-562
• 4 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (3) 519-526
• 5 Spear SL, Walker RK. The external oblique flap for reconstruction of the rectus sheath. Plast Reconstr Surg 1992; 90 (4) 608-613
• 6 Huwitz DJ, Hollins RR. . Reconstruction of the abdominal wall and groin. In: Cohen M, Goldwyn RM, , eds. Mastery of Plastic and Reconstruction Surgery. Boston: Little Brown; 1994. 1357
• 7 Wan DC, Tseng CY, Anderson-Dam J, Dalio AL, Crisera CA, Festekjian JH. Inclusion of mesh in donor-site repair of free TRAM and muscle-sparing free TRAM flaps yields rates of abdominal complications comparable to those of DIEP flap reconstruction. Plast Reconstr Surg 2010; 126 (2) 367-374
• 8 Caulfield WH, Curtsinger L, Powell G, Pederson WC. Donor leg morbidity after pedicled rectus femoris muscle flap transfer for abdominal wall and pelvic reconstruction. Ann Plast Surg 1994; 32 (4) 377-382
• 9 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg 2010; 125 (1) 209-214
• 10 Koh CE, Morrison WA. Functional impairment after latissimus dorsi flap. ANZ J Surg 2009; 79 (1-2) 42-47
• 11 Giovanoli P, Meyer VE. Use of vein loops in reconstructive procedures. Microsurgery 1998; 18 (4) 242-245
• 12 Wong CH, Lin CH, Fu B, Fang JF. Reconstruction of complex abdominal wall defects with free flaps: indications and clinical outcome. Plast Reconstr Surg 2009; 124 (2) 500-509