Abdominal Wall Reconstruction: A Literature Review

Abdominal wall reconstruction is a complex surgical challenge aimed at restoring the structural integrity and functional capacity of the abdominal wall. Despite advances in surgical techniques and biomaterials, recurrence and complication rates remain significant, highlighting the need for a comprehensive understanding of anatomy, biomechanics, and reconstructive strategies.

A narrative literature review was performed to evaluate the current principles of abdominal wall reconstruction, including anatomic considerations, risk factors, preoperative optimization, reconstructive techniques, mesh materials, and outcomes associated with different surgical approaches.

The abdominal wall demonstrates complex structural and biomechanical properties that influence reconstructive outcomes. Ventral and incisional hernias represent the most common indications for abdominal wall reconstruction, with patient-related factors such as obesity, smoking, and comorbidities significantly impacting outcomes. Preoperative optimization, including assessment of frailty, sarcopenia, and metabolic status, is critical in reducing postoperative complications. Reconstructive strategies range from primary closure and mesh reinforcement to component separation and flap-based reconstruction. Mesh remains the standard of care for defects >1 cm; however, outcomes vary by material and placement plane. Retrorectus mesh placement demonstrates the lowest recurrence rates, whereas onlay and intraperitoneal techniques are associated with higher complication profiles. Synthetic meshes generally outperform biological meshes in durability and cost-effectiveness, although biological materials may have a role in select high-risk or contaminated cases. Emerging adjuncts, including botulinum toxin A and negative-pressure wound therapy, further enhance reconstructive success in complex scenarios.

Abdominal wall reconstruction encompasses a range of techniques, including bridging mesh with skin grafting, flap reconstruction, permanent mesh reinforcement, and component separation. Outcomes are driven by individualized surgical planning, with appropriate selection of mesh, flaps, and adjunctive reconstructive strategies.