Abdominal Wall Reconstruction

Anterior abdominal wall defects can be difficult and daunting problems to solve anywhere in the world. These musculofascial defects may range from simple incisional hernias following previous laparotomy to complex open abdominal wounds with exposed viscera and enteric fistulas following traumatic injury or necrotizing fasciitis. These latter wounds are commonly associated with significant functional disability that may limit the patient’s ability to care for themselves as well as place a burden on their family both physically and economically. Repair of such defects may be complicated by the formation of adhesions between the viscera and abdominal wall/hernia sac, lateralization of the rectus muscles and/or loss of skin and fascia, ileus, presence of enteric fistulae, and frequent malnutrition. Successful management and repair of such defects can be time-consuming, resource intensive, and economically challenging for both surgeon and hospital. This chapter will discuss a variety of techniques for managing and repairing abdominal wall defects. Frequently the reconstructive surgeon will be called to assist in such surgery.