Abdominal wall reconstruction can be rewarding surgery for both the physician and the patient. Previous or multiple abdominal surgeries as well as radiation can effect wound healing on the abdominal wall following repair. Larger hernias can allow a significant portion of the small intestines and possibly the large intestine to herniate through the abdominal wall and into the underlying skin. Repairing the previously irradiated abdominal wall requires particular attention to previous abdominal scars to optimize vascular supply and prevent wound healing complications. In these abdomens which can be hostile to synthetic mesh products, an acellular dermal matrix such as Strattice can be used to construct a load sharing approach to the anterior abdominal wall with the intention of minimizing complications and optimizing chances for successful repair. Once the intestinal contents are appropriately placed back into the abdominal domain, a combination of component separation with release of the external obliques and underlay of Strattice acellular dermal matrix can restore a functional abdominal wall.