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A Novel Minimally Invasive Technique for Component Separation
Michael N Mirzabeigi MSIII, Ian L Valerio MD, Guy M Stofman MD FACS
University of Pittsburgh, Department of Plastic Surgery
2010-02-28
Presenter: Michael N Mirzabeigi MSIII
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
The stable and dynamic muscular support provided by the component separation technique has lead to lower rates of recurrence in complex abdominal hernia repair. Despite the success in reduction of hernia recurrence, local wound complications have been prevalent with this method of repair. Component separation, as initially described by Ramirez, necessitates extensive undermining of subcutaneous tissue, which can adversely interrupt the deep epigastric arcade of arterial perforators. The purpose of the study is to demonstrate a novel, minimally invasive method for component separation. A retrospective case series of five patients was reviewed. The technique utilized was as follows: 1) After completion of hernia reduction, bilateral 4-5cm transverse incisions were made lateral to the semilunar lines within the waistline 2) A 300cc balloon dissector was then inserted into the subcutaneous plane and advanced superiorly to the costal margin 3) Utilizing lighted fiberoptic retractors, the external oblique was then identified and incised under direct visualization 4) Bilateral myofasciocutaneous flaps were then created. 5) Adequate release of the flaps was achieved to allow for low-tension approximation of the rectus abdominis edges. The mean horizontal defect diameter was 20.4cm. No significant complications or recurrences have been observed. Follow-up has ranged from 6-15 months. By minimizing the size of the subcutaneous wounds created when raising large flaps, the method described in this study provides many of the established advantages traditionally seen in previously reported endoscopic separation of parts methods. However, unlike endoscopic techniques, this method stands as a more practical and cost-effective adaptation.
