Innovative Reconstruction of Depressed Abdominal Scars Using Adipofascial Flaps and W-Plasty

BACKGROUND Depressed abdominal scars resulting from childhood surgical interventions, such as appendectomies, often result in aesthetic and functional impairments due to dermal tissue deficiencies and adhesions to the anterior rectus sheath. Traditional methods, including subcision and fat grafting, have limitations in addressing extensive, adherent scars. This report describes a 22-year-old woman with a post-appendectomy depressed scar and outlines an innovative reconstructive approach involving scar tissue release, abdominal wall reinforcement, bilayered adipofascial flaps, and a W-plasty suturing. CASE REPORT A 22-year-old woman presented to our institution with an 8×2 cm depressed abdominal scar resulting from a childhood appendectomy complicated by postoperative infection. Preoperative imaging confirmed adipose deficiency, muscular disruption, and fibrotic adhesions. Under general anesthesia, the scarred epidermis was completely excised, and adhesions were released. The de-epithelialized scar tissue was anchored to the medial and lateral borders of the released anterior rectus sheath using interrupted sutures for reinforcement. Bilayered adipofascial flaps, comprising Scarpa and Camper fascia, were transposed to restore volumetric deficit, followed by W-plasty closure to minimize tension. Postoperative evaluations at 2 weeks and 1 year revealed no evidence of scar contracture, hypertrophy, or depression recurrence. CONCLUSIONS This report demonstrates that bilayered adipofascial flap reconstruction, combined with tension-distributing sutures, provides an effective solution for complex abdominal scars with deep adhesions and tissue deficiency. The technique overcomes key limitations of conventional approaches - including fat resorption and incomplete adhesion release - to achieve durable functional and aesthetic restoration.