Full-thickness abdominal wall defects are a reconstructive challenge, especially after oncologic resections with radiotherapy and the placement of a stoma. Limited defects can be closed using a component release of abdominal muscular layers which allows fascia closure and restoration of skin continuity. For medium to large defects this frequently leads to complications because of vascular impairment at the midline after very wide undermining laterally and tension medially. In such clinical settings, tissues should be introduced to bridge the full thickness gap. Uni-or bilateral pedicled fascia lata flaps have since long counted as the standard approach to restore the fascia defect. For meso-and epigastric defects however, the dissection should be performed very distally on the thigh where this tensor fascia lata is hardly vascularised. Moreover, fascia flaps will only restore the fascia layer just as dermal substitutes do. These strategies do not lead to musculocutaneous restoration with vascularised tissues in a like-with-like fashion, the goal of reconstructive surgery after all.
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