Complex Abdominal Wall & Pelvic Reconstruction St. Louis

Complex abdominal wall and pelvic reconstruction surgery involve a variety of procedures to reconstruct defects from cancer removal, large hernias, and complicated wounds.  This may involve reshaping or rearranging the tissues or muscles in these areas to restore function and provide stability. Often these complex procedures require multi-specialty care, including the efforts of our reconstructive surgeons with those from surgical oncology, general surgery, colorectal surgery, Ob-Gyn, urology, etc.  

At your initial consultation Dr. Hulsen or Dr. Geiger will thoroughly review your medical history, prior surgical history, radiation treatments, recent laboratory testing, and any imaging (CT/MRI scans) as necessary.  A comprehensive exam will be performed to assess tissue laxity and availability for reconstruction. Our plastic surgeons will then formulate a plan utilizing the latest reconstructive techniques to help our patients attain safe, aesthetic, and long-lasting results.  


  • Length: 2-8 hours
  • Anesthesia: General
  • Inpatient recovery 1-7 days
  • Recovery: 1-6 weeks


  • Add strength to a massive hernia repair
  • Restore pelvic support
  • Reconstruct a defect after cancer removal
  • Improve quality of life

Before & After

Patient #7690

Before Complex Abdominal Wall
After Complex Abdominal Wall

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Massive Hernia Repair:

These repairs are often performed in conjunction with your general surgeon.  Exposure of the hernia will be performed in a “perforator sparing” technique, preserving as many blood vessels as possible to the abdominal skin.  This helps to optimize wound healing. Tunnels may be created to release some of the abdominal wall muscles and allow our surgeons to advance the remaining muscles centrally to repair the hernia defect.  Mesh is often incorporated to provide additional stability to the repairs. Several drains will be placed to remove fluid and allow quicker healing. Closure of the skin may involve several layers of dissolvable sutures, staples, negative pressure devices, or a combination of all depending on what provides optimal healing.   Patients are placed into an abdominal binder to provide additional external support to the repair, as well as comfort. An inpatient stays overnight or up to a few days will allow times for the bowels to “wake up” and resume normal function.  

Pelvic Reconstruction:

Some patients undergoing treatment of vaginal, anal, or rectal cancers require surgery to remove these tumors.  This can lead to substantial tissue loss and the need for complex reconstruction. Drs. Hulsen and Geiger are able to transfer healthy, non-radiated tissue from the abdomen, buttocks, or thighs into the region to fill the void and bring in a good blood supply for healing. Great care is taken to restore a normal appearance and functionality.  Drains will need to be placed to remove fluid and allow the tissues to mend. Sitting and/or motion restrictions may be required for a few weeks until the transferred tissue has adjusted well. An inpatient monitoring period of a few days is often required.  


Smoking and all forms of nicotine should be stopped at least 4 weeks prior to any major reconstruction.  This includes e-cigarettes, patches, and gum.

Any medications and supplements which cause an increased risk of bleeding should also be stopped 2 weeks prior to any major surgery. Please see our list of medications and supplements to avoid. As always, make sure to check with your doctor before stopping any medications.


Recovery and downtime vary from patient to patient depending on the severity and complexity of the reconstruction. Most patients have an inpatient hospital stay of a few days to a week while the body recovers.  Our reconstructive surgeons will provide education on positioning and any motion or pressure restrictions to optimize healing.  Pain medications will be prescribed to help make recovery more comfortable. Drainage tubes are usually removed within 1-3 weeks when the daily fluid output has decreased to acceptable levels. Plan to take 4-6 weeks off of work. 

Find Out More About Complex Abdominal Wall & Pelvic Reconstruction

To learn more about Complex Abdominal Wall & Pelvic Reconstruction, contact Chesterfield Plastic Surgery and arrange your consultation today.

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