Autologous tissue repair of large abdominal wall defects

Background and method: Techniques for autologous repair of abdominal wall defects that could not be closed primarily are reviewed. Medline and PubMed were searched for English or German publications using the following keywords: components separation technique (CST), Ramirez, da Silva, fascia lata, tensor fasciae latae, latissimus dorsi, rectus femoris, myocutaneous flap, ((auto)dermal) graft, dermoplasty, cutisplasty, hernia, abdominal wall defect, or combinations thereof. Publications were analysed for methodological quality, and data on surgical technique, mortality, morbidity and reherniation were abstracted. Results and conclusions: The CST is the best documented procedure; it is associated with a high morbidity rate of 24.0 per cent and a recurrence rate of 18.2 per cent. Although the results of the da Silva technique are good (morbidity 5-20 per cent and reherniation 0-3 per cent), the poor methodological quality of the studies precludes firm conclusions. Repair with free fascia lata or dermal grafts is an alternative if the above techniques cannot be used, but wound complications affect 42 per cent of patients and recurrent hernia up to 29 per cent. Pedicled or free vascularized flaps are reserved for complex situations.