Abdominal wall defect is a common and clinically challenging problem, whose repair and reconstruction require not only wound closure but also restoration of the abdominal wall’s anatomical structure and mechanical function. Abdominal wall defects were classified into three types: type Ⅰ, involving loss of skin and subcutaneous tissue; type Ⅱ, characterized by muscular and fascial defects with intact skin coverage; and type Ⅲ, representing full-thickness abdominal wall defects. In cases with large defect size or those complicated by infection, prior radiotherapy, or multiple previous surgeries, satisfactory long-term outcomes are often difficult to achieve with mesh repair or component separation techniques alone. In such situations, reconstructive procedures incorporating plastic surgical flap techniques are frequently required. Reconstruction of abdominal wall defects should be centered on restoration of load-bearing structures, with individualized decision-making based on soft tissue coverage conditions and infection risk. Plastic surgical flap techniques, autologous fascia, and prosthetic mesh are not mutually exclusive but should be used in a complementary manner. Multidisciplinary collaboration and thorough preoperative evaluation are essential to achieve optimal clinical outcomes.