An Algorithm for Abdominal Wall Reconstruction

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Learning Objectives: After studying this article, the participant should be able to: 1. Describe the anatomy of the anterior abdominal wall, including the neurovasculature and musculofascial layers. 2. List the goals of abdominal wall reconstruction. 3. Discuss the components of the preoperative evaluation of abdominal wall reconstruction. 4. Discuss the considerations in determining immediate versus delayed repair. 5. Be familiar with the following techniques: tissue expansion, vacuum-assisted closure device, abdominal components separation, prosthetic materials, local and distant muscle flaps, free tissue transfer.Acquired abdominal wall defects result from trauma, previous surgery, infection, and tumor resection. The correction of complex defects is a challenge to both plastic and reconstructive and general surgeons. The anatomy of the abdominal wall, as well as considerations in patient assessment and surgical planning, are discussed. A simple classification of abdominal wall defects based on size, depth, and location is provided. Publications regarding the various abdominal reconstruction techniques are reviewed and summarized to familiarize the reader with the treatment options for each particular defect. Finally, an algorithm is presented to guide the surgeon in selecting the optimal reconstructive technique. (Plast. Reconstr. Surg. 105: 202, 2000.)

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