Clinical outcomes in abdominal wall autologous flap reconstruction: a systematic review.

IF 2.7 2区医学 Q1 SURGERY

Hernia Pub Date : 2026-07-09 DOI:10.1007/s10029-026-03787-4

Michalis Hadjiandreou, Sola Kim, Cheuk Ying Kyleen Kiew, Bijendra Patel, Parviz Lionel Sadigh, Gurjinderpal Singh Pahal, David Ross, Georgios Pafitanis

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引用次数: 0

Abstract

Purpose: Complex abdominal wall defects present major reconstructive challenges when restoration of fascial continuity must be combined with durable soft-tissuecoverage, visceral protection, and, in selected cases, functional repair. Although autologous flap reconstruction is well established for selected indications, its overall role across defect types has yet to be established.

Methods: A systematic review was performed in accordance with PRISMA guidelines (PROSPERO: CRD42023491916). PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from inception to April 2026 for studies reporting adult autologous flap-based abdominal wall reconstruction. Given substantial clinical and methodological heterogeneity, data were analysed descriptively.

Results: 172 studies comprising 4,421 patients were included. Pedicled flaps predominated (n=4,095, 92.6%), with free flaps used in 146 patients (3.3%) and mixed approaches in 180 (4.1%). Hernia-related pathology was the commonest indication (n=3751, 84.8%), followed by malignancy (n=470, 10.6%). Frequently used flap categories included anterolateral thigh, tensor fascia lata, rectus-based, and latissimus dorsi-based flaps. Flap selection was primarily defect-driven: fascia-bearing regional and turnover techniques were used mainly for structurally focused hernia repair, whereas composite flaps were used more often for oncologic, fistulating, traumatic, contaminated, or full-thickness defects. Common short-term complications include seroma, surgical site infection, and wound dehiscence. Flap failure and reported long term hernia recurrence were low. Free flaps were used more often for larger defects weighted mean 401 cm² vs 250 cm² for pedicled flaps), although size ranges overlapped.

Conclusions: Autologous flap reconstruction is a durable and versatile option for selected complex abdominal wall defects. Reconstructive strategy should be guided primarily by defect composition.

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腹壁自体皮瓣重建的临床效果：系统回顾。

目的：复杂腹壁缺损是腹膜连续性恢复的主要挑战，必须结合持久的软组织覆盖、内脏保护，并在特定情况下进行功能修复。虽然自体皮瓣重建在某些适应症中已经很好地建立起来，但其在缺陷类型中的整体作用尚未建立。方法：根据PRISMA指南（PROSPERO: CRD42023491916）进行系统评价。PubMed/MEDLINE、Embase、Scopus、Web of Science、Cochrane Library和谷歌Scholar检索了自成立至2026年4月报道成人自体皮瓣腹壁重建的研究。考虑到临床和方法学的异质性，对数据进行描述性分析。结果：纳入172项研究，包括4,421例患者。带蒂皮瓣占主导地位（n=4,095, 92.6%），自由皮瓣146例（3.3%），混合入路180例（4.1%）。疝相关病理是最常见的适应症（n=3751, 84.8%），其次是恶性肿瘤（n=470, 10.6%）。常用的皮瓣类型包括股前外侧皮瓣、阔筋膜张肌皮瓣、以直肌为基础的皮瓣和以背阔肌为基础的皮瓣。皮瓣的选择主要是缺陷驱动的：筋膜承载区域和翻转技术主要用于结构聚焦疝修复，而复合皮瓣更常用于肿瘤、瘘、创伤、污染或全层缺陷。常见的短期并发症包括血肿、手术部位感染和伤口裂开。皮瓣失败和报告的长期疝复发率很低。自由皮瓣更常用于较大的缺陷（加权平均值为401 cm²，带蒂皮瓣为250 cm²），尽管大小范围重叠。结论：自体皮瓣重建是治疗复杂腹壁缺损的一种持久、通用的方法。重建策略应主要以缺陷组成为指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.