The abdominal wall is multilayered. It is composed of muscle and fascia arranged in specific fashion to provide structure and function. The very anatomic structures can be utilized by means of tissue rearrangement to restore the abdominal wall defects. Defects can originate from complications resulting from intra-abdominal surgery, abdominal wall tumour resection etc. Very large defects may require the importing of the tissue from the thighs and/or with the use of meshes or acellular dermal matrix. The most important goal of reconstruction is to provide containment of the intra-abdominal viscera avoiding any risk of herniation.