“Thou Shalt Not Throw Away a Living Thing”: Innovative Use of Perforator Flaps in Abdominal Wall Reconstruction

Abdominal wall reconstruction represents a complex challenge for plastic surgeons, given the variable range of clinical situations requiring restoration of abdominal wall integrity. When significant myo-fascial defects are encountered, repair with either a synthetic or biological mesh is indicated, both with their respective advantages and drawbacks. Taking inspiration from the Gillies’ fourth plastic surgery “commandment” ( Thou shalt not throw away a living thing ), an innovative technique to obtain a vascularized autologous mesh from the tissues usually discarded during abdominal contouring procedures was conceived. In this paper the authors describe how to maximize the use of perforator flaps derived from abdominoplasty excision patterns in abdominal wall reconstruction, in order to simultaneously obtain restoration of abdominal wall integrity and improvement of the abdominal contour.