Component separation repair of large or complex abdominal wall defects
- John Cone, MD
John Cone, MD
- Professor, Department of Surgery
- University of Arkansas for Medical Sciences
An increasing number of patients have large or complex abdominal wall defects. Such defects may result from incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, necrotizing abdominal wall infections, or therapeutic open abdomen. The component separation technique, which was first described in 1990 for midline abdominal wall reconstruction, is a type of rectus abdominis muscle advancement flap that allows reconstruction of such large ventral defects. The advantages of the component separation technique are that it restores functional and structural integrity of the abdominal wall, provides stable soft tissue coverage, and optimizes aesthetic appearance.
Large or complex abdominal wall defects may result from incisional hernia related to multiple abdominal operations, surgical resection of the abdominal wall, necrotizing abdominal wall infections, or therapeutic open abdomen to manage abdominal compartment syndrome. Such defects can be associated with problems such as chronic back pain, respiratory compromise, and altered body image. Patients with symptoms related to these defects or incisional hernias should ideally be repaired. Whether to repair asymptomatic incisional hernias is reviewed separately. (See "Principles of abdominal wall closure" and "Incisional hernia".)
Large or complex abdominal wall defects are a particularly challenging surgical problem. Various methods of abdominal wall hernia repair (simple suture repair, mesh repair) using either open or laparoscopic approaches can be used to manage abdominal wall defects, which are most commonly related to incisional hernia. The relative merits of these hernia repairs are reviewed elsewhere. (See "Incisional hernia", section on 'Incisional hernia repair' and "Incisional hernia", section on 'Choice of repair'.)
The component separation technique, which was first described in 1990, is a very effective method for reconstructing large or complex midline abdominal wall defects in a manner that restores innervated muscle function without tension [1-3], often without the need for reinforcing mesh [4,5]. Indications for a component separation technique include the following:
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- HERNIA ASSESSMENT
- PREOPERATIVE EVALUATION AND PREPARATION
- ANATOMIC CONSIDERATIONS
- Abdominal wall musculature
- Skin and subcutaneous tissues
- COMPONENT SEPARATION TECHNIQUE
- General technique
- - Use of mesh
- - Presence of a stoma
- - Use of laparoscopy
- Placement of drains
- POSTOPERATIVE CARE AND FOLLOW-UP
- Recurrent hernia
- Functional results
- Surgical site infection
- Skin flap necrosis
- SUMMARY AND RECOMMENDATIONS