A difficult abdomen: Clinical course-based management

For the practicing general surgeon, the management of complicated abdominal wall defects remains a challenging problem. Complex or recurrent abdominal wall defects might be the result of a failed prior attempt or of multiple attempts at surgical closure, severe trauma, necrotizing or other significant infections, radiation necrosis, or tumor resection. Decisions regarding technique for abdominal wall reconstruction are based on an assessment of the defect by location, the layers involved, and the etiology. Reconstructive options include direct tissue closure, prosthetic mesh, local advancement, regional flaps, distant flaps, or combined flaps and mesh. Previous studies have examined the results of specific techniques for using mesh or flaps, but not in a population of patients with complex abdominal hernias. Repairing such defects requires knowledge of the anatomy, surgical expertise, and awareness of the different techniques and supportive materials that will help close a complex abdominal wall defect and reconstitute an effective abdominal wall.