Lateral abdominal herniae are rare, they usually occur after trauma, vascular or renal surgery, their incidence is less than 2%. Since 1906 there are just about 250 reported cases and there are many treatment options, including laparoscopic approach, direct muscle approximation with sutures, mesh, suture anchors and, even, conservative treatment. We present the case of a 30 year old male who suffers a motorcycle crash that results in a posttraumatic flank hernia. He was treated with a delayed abdominal wall reconstruction using polypropylene mesh and a fascia lata graft. There is no algorithm or specific treatment for lateral abdominal herniae and, because of its low incidence, little is known about their evolution and long-term results of the distinct reconstruction techniques. It´s possible to reconstruct the abdomen wall early or delay it, depending on the abdominal cavity contamination and the patient´s general condition.

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Local flaps or based on a single perforator have great utility in reconstructive surgery, however, its use is complicated posterior midline due to the characteristics of the tissues, the keystone flap described in 2003 has become one of the main options for reconstruction due to safety, easy reproducibility, shorter surgical time, and shorter learning curve, there are three cases of posterior midline defects where the characteristics of the patient required a shorter recovery time with adequate functional and esthetic results.