Flap reconstruction of the abdominal wall is required when there is a tissue defect that exceeds the availability of local tissue to be recruited to resurface the defect. As the majority of abdominal wall defects can be reconstructed with the surrounding redundant tissue from the torso, these defects requiring flap coverage represent a more complex subset of abdominal wall reconstructions. Indications for flap coverage vary by etiology of defect, defect characteristics, and timeline for closure. Flap reconstruction can be performed with local flaps rotation, advancement keystone flaps from the remaining tissue of the trunk. Regional flaps can be harvested from the back or thigh and maintain a pedicled blood supply from the axilla or groin. Free-flap reconstructions represent the most technically challenging flap transfers as they require arteriovenous microanastomosis to revascularize the flap in the recipient site.
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