Answer:
Small defects may be amenable to direct approximation. One technique
called components separation involves separation of the rectus muscle from
the posterior rectus sheath and the external oblique from the the internal
oblique. The compound flap of rectus muscle with anterior rectus
sheath can be advanced 5 cm in the epigastrium, 10cm at the waistline,
and 3cm in the suprapubic region. The rectuc abdominis can also be used
based on superior or inferior epigastric artery. The muscle has a
wide arc of rotation. It can also be used as a turnover flap incorporating
the anterior rectus sheath.
Defects in the lower abdomen can be repair with a groin flap. This is based on the superficial circumflex artery and can be rotated to cover the lower abdomen.
For large defects the tensor fascia lata flap offers the advantages of large size, reliable blood supply, strength, and ease of dissection. It is based on the ascending branch of the lateral circumflex femoral artery. A very wide and long strip of fascia lata can be used to cover defects in the upper quadrant.
The rectus femoris flap is another option for large defects. It is based on the descending branch of lateral circumflex femoral artery.
The latissimus dorsi can be dissected to the thoracolumbar and gluteal fascia to cover defects in the upper and mid abdominal wall across the midline and ipsilateral abdominal wall.