The reconstructive ladder is a useful way to systematically plan the closure of any wound on the extremities [36]. The reconstructive ladder begins with healing by secondary intention as the base level, and advance with primary closure, skin grafting, local flaps, regional flaps and free tissue transfer. The final methods for extremity reconstruction are the use of TNP and perforator flaps (Table 1) [50–53]. NF after abdominal surgery or spreading infections from the perineum or the lower extremities is extremely serious with great defects and carries a high morbidity and mortality rate (Figure 2). The goals of the reconstructive surgery in the management of complex AW defects (AWD) is

to restore

the structural and functional continuity of the muscle-fascial system, provide stable coverage and achieve local wound closure [60]. The PCI-32765 purchase size of the wound defect after NF of the abdominal wall typically depends on the type of infection and the way it spreads. For reconstructive purposes, AWD can be divided into midline or lateral, and to the upper, middle, or lower third of the abdomen. The most useful method for AS1842856 nmr ventral hernia repair with AWD is the use of “”Component separation technique”" by Ramirez and coworkers [61]. They used muscle-fascial components of the AW in continuity with their vascular and nerve supply to restore ventral defects. Midline partial defects of the skin and deep structures can be repaired in several ways. Firstly, we can use primary closure and skin grafts. The next option is a synthetic mesh [51], which cannot be used on the infected field. It comes in various Foretinib supplier sizes and shapes at low cost. Biological meshes [52] are resistant to infection, allow natural remodeling, potential stretching, are expensive and are of limited size. Further see more options include the component separation technique, free, local or distant flaps, TNP therapy, and tissue expansion [60]. A combination of all these techniques is also possible. The reconstruction of the structural components

of the AW is an important issue, but even more important is the restoration of the AW function. Midline complete defects can be repaired in similar fashion, because the defects include both skin and fascia, which often require component separation technique, biologic mesh, the local flaps with or without tissue expansion. Lateral defects are more often repaired using direct closures, skin grafts, local advancement flaps, distant flaps, or TNP therapy [60]. Figure 2 .A view of the abdominal wall from case III before second stage reconstruction of the soft tissue defects. Conclusion Necrotizing infections refer to rapidly spreading infections, usually located in the fascial planes of soft tissue areas, that result in extensive tissue necrosis, severe sepsis, wide spread organ failure and death.