الفهرس 
Surgical anatomy of the anterior abdominal wallOnly 14 pages are availabe for public view
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Abstract
Multiple methods for abdominal wall reconstruction have been used with different rates of success. These reconstructions can be performed in either one stage or more.
In complex or large abdominal wall defects there are general agreement that midline fascial approximation with a mesh underlay, plus or minus component separation, provides better outcomes.
The component separation technique allows to mobilize the patient’s own abdominal wall to the midline with less tension. This restores more form and function to the patient. The added mesh to this repair to lower the recurrence rate.
In the case of adequate skin but a large deficit of fascia, the abdominal fascia can be repaired with polypropylene mesh and the skin closed by direct approximation.
If a large deficiency of skin and fascia is present, the reconstruction can be performed by regional flap reconstruction, by free tissue flap reconstruction, or by a staged reconstruction with placement of a tissue expander insertion as the first stage and fascial repair with polypropylene mesh and skin repair by direct approximation as the second stage.
Recurrent hernias may also be a significant challenge due to the placement of prior mesh and adhesions between the abdominal wall and intestines. Many recurrent hernias patients will have weakened abdominal wall tissues that do not hold sutures well. Techniques for repair of these hernias may involve placement of a single large sheet of synthetic mesh to repair the entire abdominal wall, utilization of the patient’s native tissues by means of separation of components technique, or the use of biomaterials which may serve as a matrix for tissue regeneration.
Myocutaneous flaps are also the preferred reconstructive option in contaminated wounds for which nonabsorbable prosthetic mesh cannot be safely used . Also, the wound VAC has been used to accelerate healing by secondary intention and wound preparation prior to reconstruction with flaps and/or grafts.
Finally, the laparoscopic mesh repair was also offered for patients with medium to large hernias. It allows intra-abdominal mesh placement using small incisions. The recovery is shorter and the recurrence rate is generally low .