Introduction: The optimal management of complex abdominal wall defects (CAWD) is still undefined. The purpose ofthis study is to evaluate the use of synthetic mesh to treat CAWD. Patients  and  methods:  Patients  with  CAWD  treated  by  polypropylene  mesh  (PP)  at  a university hospital between January 2005, and June 2012 were reviewed. The types of repair as well as clinical, operative, and follow-up data were analyzed. The primary outcome variables were surgical site occurrences (SSO) and hernia recurrence. Results:  One hundred fifty-three patients were included in this study. The average age was 56 years, with an average body mass index (BMI) of 32 kglm?Forty-six percent were women. A staged approach was needed in 28 patients (18.3%) with wound dehiscence and defects that could not be closed. The overall complication  rate was 31.3% (481153). The rate of SSO was 20.2%. The hernia recurrence  or bulge  was observed  in 11% (171153).  Factors  associated with SSO included EMf, bacterial contamination, diabetes mellitus, and emergency procedures. Hernia recurrence was significantly associated with female gender, size of the defect, BMI, liver cirrhosis and surgical SSO. Different techniques of synthetic mesh placement were not found to have a statistically significant difference predicting SSO or hernia recurrence. Conclusion: The reconstruction  of CAWD frequently requires composite and staged procedures. PP  mesh  can  be used  with  favorable  outcomes  even  in  contaminated  defects. Synthetic  meshes  that  become  infected  can  be  salvaged  with  local  wound  measures  and antibiotics. SSO is found to be significant predictors of hernia recurrence.