Introduction Advances in the acute management of the severely injured and critically ill patients have had a significant impact in survival and have increased our exposure to complex repair of large abdominal wall defects. The purpose of this article was to review the long-term (5-year or greater) outcomes of reconstruction of abdominal wall defects and the different modalities and materials currently available in the management of this challenging clinical condition. Methods A review of published literature. Results Our review of literature, in English language from 1984 to May 2011, identified six studies. The minimum average follow-up of the studies examined was 63 months. The hernia recurrence rate ranged from 1.1 to 16% at 5 years. A 10-year cumulative recurrence rate of 63% has been reported for suture repair and a 32% for prosthetic repair in incisional hernia. Conclusions There is a need for long-term studies of complex abdominal wall reconstruction, using biologic prosthetics mesh.