A Classification and Management Framework for Reconstruction of Acquired Massive Abdominal Wall Soft-Tissue Defects:...

Massive abdominal wall soft tissue defects (MAWSTDs) present a reconstructive challenge that usually necessitates complex repair techniques. The aim of this study was to review and summarize all the repair techniques for acquired MAWSTD ever presented in the literature and utilize these findings to develop a standardized definition, classification system, and reconstructive algorithm for MAWSTDs.

A systematic review of PubMed, Scopus, Web of Science and Google Scholar was conducted according to PRISMA-ScR guidelines. Relevant articles reporting flap-based reconstruction, tissue expansion, abdominal wall transplantation (AWT) or combination(s) of these approaches for repair of acquired MAWSTD were included.

Of 2,926 articles screened, 226 met inclusion. Flap-based reconstruction was the most common method (86.7%), followed by tissue expansion (8.9%) and AWT (4.4%). Mean defect sizes reconstructed with flaps was (mean 342.1 cm², S.D ± 223.0 cm², range 100-992 cm²) and with tissue expansion 288.5 ± 196.8cm² (range: 64-851 cm²). Defects typically spanned zones M1-M5 and L1-L3. Oncologic resection was the most common indication (43% of studies, 612 patients). External tissue expanders are becoming increasingly common and preferred over traditional internal method of expansion. AWT (vascularized composite allotransplantation in 40%), was used for full-thickness loss following visceral transplantation or multiple prior failures. Finally, a novel definition and reconstructive classification were developed to guide the flow of management.

Flap-based approaches are most frequently utilized (order: regional, free, local, and combination(s)). Tissue expansion and AWT are other options, though less frequently utilized. One must consider both patient-specific and defect-specific factors when determining appropriate treatment strategies.