الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Acquired abdominal wall defects can occur as the result of postoperative wound complications, trauma, or surgical resection.
Deformity of the abdominal wall can impair physical movements such as walking, bending and maintenance of body posture. Abdominal wall defects may also impair physiologic activities such as coughing, sneezing, defecation and micturation.
The restoration of the integrity of the abdominal wall, provide dynamic support and protect the abdominal contents are the primary goals of the reconstruction of the abdominal wall defects.
Knowledge of abdominal wall anatomy as it relates to the defect is paramount in planning the appropriate management.
Reconstruction of the myofascial layer restores visceral support and structural stability, also, the reconstruction of the cutaneous layer provides wound closure and aesthetic outcome.
The preoperative evaluation including complete history and physical, general medical evaluation, basic laboratory work, and diagnostic and radiological studies together with evaluating wound bed with careful examination of the tissues surrounding the defect either presence of acute inflammation and oedema or not, plays an important role in determining the appropriate reconstructive modality for an abdominal wall defect.
There are numerous reconstructive options available to surgeons when addressing complex abdominal wall defects.
Small skin and subcutaneous defects of the abdominal wall usually can be closed with local advancement or split thickness skin grafts (STSG).
Vacuum-assisted closure technique (VAC) is ideal in contaminated wounds and in poor vascular bed. Regardless of the defect size, VAC device helps in avoiding the unnecessary delays in achieving the abdominal wall closure by reducing the size of the wound, enhancing the formation of healthy granulation tissues with concomitant increase of the blood flow to the wound bed enabling the reconstruction of the defect either by local skin flaps or split thickness skin graft (STSG).
The component separation technique involving the longitudinal release of the medial edge of the external oblique aponeurosis and occasionally the release of the posterior rectus fascia. This procedure is especially useful for closing large midline musclofascial defects up to 30 cm transversely.
Prosthetics are often used for the repair of ventral hernias in which a pure fascial deficit exists. Meshes require adequate skin and subcutaneous tissue coverage and a stable wound bed.A variety of synthetic materials (Prolene, e PTFE, and Marelex) have been used to reconstruct the fascial defects successfully. Other materials such as human cellular dermal matrix (AlloDerm) and permacol have been reported to achieve long lasting and durable results in reconstruction of anterior abdominal wall defects. It is believed that AlloDerm is some what resistant to local infection and provide a static support to the abdominal wall.
Non-vascularized fascial grafts have excellent incorporation as autologous tissue. They are better suited to contaminated wounds than permanent mesh. However, fascial grafts have less tensile strength than PTFE or Polypropylene and require creation of a donor defect.
Large abdominal wall defects may be reconstructed using autologous tissue from local or distant source. Innervated flaps can provide dynamic support that simulates the normal action of the abdominal wall.
The tensor fascia latamyocutaneous flap (TFL) is useful in reconstructing abdominal defects inferior to the umbilicus. The rectus femoris can be used to cover defects involving the lower quadrants and the umbilical and the epigastric areas.
Free flaps for abdominal wall reconstruction are considered only as last resort. They are indicated when no other options are available, particularly when local tissues have been significantly destroyed or when pedicled flaps can not reach or are insufficient in size.
Various free flaps have been reported but the tensor fascia lata is the most common. The free innervated latissimusdorsi flap also has been described as a mean to re-establish the contractile force and strength of the abdominal wall.
Although the objective of reconstructing an abdominal wall is centered on restoration of abdominal wall continuity, the formulated procedure must include a comprehensive plan of preoperative and postoperative care of the patient aiming towards the restoration of the abdominal structure integrity.