The Component Separation Technique (CST), a type of rectus abdominis muscle advancement flap, was first used to reconstitute the linea alba, reduce abdominal wall tension, and provide a dynamic abdominal wall in patients with large abdominal wall defects . CST allows reconstruction of a large defect without requiring a free distant transposition flap . Despite the relatively high frequency of recurrent abdominal wall incisional hernias, there is no consensus on the optimal repair [3,4]. The advantages of CST are that it restores structural support of the abdominal wall, provides stable soft tissue coverage, and optimizes esthetic appearance of complex abdominal wall defects and giant midline abdominal wall hernias .
The use of CST to reconstruct large and complex abdominal wall defects is discussed here. An overview of abdominal wall defects and reconstruction of sternal defects and mastectomy defects with rectus abdominis muscle flaps are reviewed elsewhere. (See "Overview of abdominal wall hernias in adults" and "Surgical management of sternal wound complications" and "Breast reconstruction: Preoperative assessment".)
Complex abdominal wall defects, including incisional abdominal wall hernias, are a challenging surgical problem. Incisional hernias occur in 10 to 23 percent of open abdominal laparotomies, with recurrence rates reported between 18 and 50 percent [6-8]. (See "Overview of abdominal wall hernias in adults".)
Despite this relatively high frequency of recurrent incisional hernias, there is no consensus on the optimal repair [3,4]. A large number of surgical repairs have been described, including primary suture repair and prosthetic material (mesh) repair, but neither is ideal . Primary repair is associated with a high recurrence rate and mesh repairs are associated with a higher infection rate than repairs without mesh. (See "Wound infection following repair of abdominal wall hernia".)
Other disadvantages of synthetic or biologic prosthetic materials include a lack of support for dynamic abdominal wall function, recurrence rates of 10 to 20 percent, and in cases where there is little soft tissue coverage, a high risk of prosthetic extrusion and an increased risk of infected mesh and enterocutaneous fistulae [10-12].