Box top closure for huge incisional hernia

An x-flap plastic procedure is presented which affords a satisfactory closure of huge midline incisional hernia with the patient's own tissue, locally available. Advantages in reconstruction are gained by: (1) preserving and utilizing the peritoneal sac; (2) preserving the line of fusion of sac to fascia; (3) Reducing the opening by position of the patient (jack knifing); (4) reducing the opening by utilizing natural cleavage planes, i.e., diagonal advancement of flaps; (5) four flaps instead of traditional two thicken wall where strength is needed; (6) suture of each of four flaps progressively reduces opening, and multiplicity of sutures progressively relieves suture tension; (7) broad surfaces of tissue contact give strength and stability to closure.