Free Flap Reconstruction of Abdominal Wall Defects: A Systematic Review and Pooled Analysis

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Abdominal Wall Reconstruction

Background:

• Extensive abdominal wall defects present reconstruction challenges.
• Free tissue transfer is often necessary when conventional methods fail.
• This review synthesizes recent literature on free flaps for abdominal wall repair.

Purpose of the Study:

• To review the literature on free flap use for abdominal wall reconstruction over the past decade.
• To guide clinical decision-making in complex abdominal wall defect repair.
• To analyze outcomes and complications associated with free flap abdominal wall reconstruction.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Searched major databases (PubMed, Embase, Scopus, etc.) for studies from 2013-2023.
• Included studies with at least 3 months follow-up, analyzing surgical complications and outcomes.

Main Results:

• 104 free flaps were analyzed across 32 studies; no flap loss reported.
• Latissimus dorsi flaps were most common (36%) for oncologic resections (57%).
• Complications included partial flap necrosis (5.8%) and surgical site infection (5.8%); infection etiology predicted SSI.

Conclusions:

• Free flap reconstruction is a safe and effective method for large abdominal wall defects.
• Outcomes are consistent across different flap types and reconstruction timings.
• Initial infection at the defect site is a key predictor of postoperative surgical site infection.