Advanced surgical and reconstructive techniques for abdominal wall necrosis secondary to severe infections: a systematic review of functional and aesthetic outcomes
DOI:
https://doi.org/10.56183/iberojhr.v5i1.724Palavras-chave:
Necrosis, Abdominal Wall, Systematic Review.Resumo
Abdominal wall necrosis secondary to severe infections presents reconstructive challenges and need advanced surgical techniques for accomplishing functional restoration and aesthetic outcomes. We conducted this systematic review to evaulate various reconstructive approaches including vacuum-assisted closure (VAC) therapy, regional and free flap transfers, biological and synthetic mesh implantation and posterior component separation techniques. Our findings indicate that mesh reinforcement like polypropylene and composite mesh provides structural stability but carries risks of infection and recurrence. Perforator-based fasciocutaneous and regional myocutaneous flaps have also shown superior vascularisation and reduced hernia recurrence though technical complexity and donor site morbidity remain concerns. Biological meshes such as acellular dermal matrix and porcine collagen also offer promising infection-resistant alternatives. Free flap transfers such as anterolateral thigh or latissimus dorsi flaps are emerged as effective techniques for large defects but demands microsurgical expertise. Posterior component separation with transversus abdominis release (TAR) enables tension-free fascial closure with improved durability. So, we came to a conclusion that abdominal wall necrosis following severe infections necessitates a range of reconstructive approaches. It is clear that direct closure is feasible in minor defects but limited by tension risks. Component separation techniques, including anterior and posterior approaches, enhance fascial mobilization with reported success rates exceeding 80%. Mesh-based reconstructions using synthetic or biological materials provide durability but carry infection risks. Negative pressure wound therapy (NPWT) optimizes wound bed conditions and reduce complications and improving graft integration. Pedicled flaps, such as rectus abdominis or anterolateral thigh flaps are effective to restore coverage with viable tissue and achie superior aesthetic outcomes. Free flaps are complex but offer critical reconstruction with a 90% success rate. Hybrid techniques integrating NPWT, mesh and flap reconstruction enhance functional integrity with outcomes varying based on defect size and infection control.
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Copyright (c) 2025 Jorge Luis Rivera Gastelum, Brayan Uriel Huerta Catalán, Roberto Kevin Galan Orozco, Ariadny Patricia Requena Salomón, Andrea Virginia Rivera Aguirre, Isabella Ballesteros Santos, Carol Alexandra Sánchez Martínez, Arahi Gabriela Cueller Ocampo
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