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Disclosures
Research Grants
- W. L. Gore
- LifeCell
- Davol
1
7/2/2015
2
7/2/2015
3
7/2/2015
Component Separation
4
7/2/2015
5
7/2/2015
Component Separation
Rectus Muscle
- Upper 3 cm
- Middle 5 cm
- Lower 3 cm
External
Oblique
- Upper 2 cm
- Middle 4 cm
- Lower 2 cm
6
7/2/2015
Anterior Component
Separation
Pros Cons
Wide fascial Significant wound
advancement morbidity
Innervated / - Necrosis, ischemia,
vascularized repair infection, hematoma
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7/2/2015
When I use it
If skin won
wontt come to midline
Will create a skin flap anyways
The hernia is so big that the lateral
extent of the hernia sac is at the
external oblique
If I dont want to use mesh, violate the
retro rectus plane, or think an onlay is
acceptable
Patient
8
7/2/2015
Defect--15x20 cm
Defect
9
7/2/2015
Fascia Closed
10
7/2/2015
Onlay PP
Completed
11
7/2/2015
Follow up 3 m
Periumbilical Perforator
Sparing
12
7/2/2015
Periumbilical Perforator
Sparing
Periumbilical Perforator
Sparing
Advantages Disadvantages
Preserve main blood Large dead space
supply Communicates with
Similar advancement midline wound
Low tech Seroma and abscess
Easy to perform rates may not change
13
7/2/2015
avr
14
7/2/2015
Endoscopic Component
Separation
Pros
Cons
Direct access to lateral
Requires laparoscopic
compartment skill set
Avoids subcutaneous Achieves 85% of open
flap release
Avoids division of No flaps, can be
abdominal wall difficult to place mesh
perforators Learning curve
Decreases complexity
of postoperative wound
infections
15
7/2/2015
Retro-Rectus Repair
Retro-
Rives--Stoppa
Rives
How I do it
16
7/2/2015
17
7/2/2015
18
7/2/2015
When I use it
19
7/2/2015
20
7/2/2015
21
7/2/2015
22
7/2/2015
23
7/2/2015
47
24
7/2/2015
N=50
25 TAR with midline reconstruction
25 Lap ventral NO midline reconstruction
Radiographic evaluation Pre v Post
JACS 2013
25
7/2/2015
26
7/2/2015
N=13
Preoperative and 6 months
Postoperative Biodex
HerQLes Score
TAR / PCST
Surgery 2014
Isokinetic Dynamometry
27
7/2/2015
Isometric Dynamometry
HerQLes 50 0.016
28
7/2/2015
Laparoscopic Zealot
Exposure to reconstructive surgeons and
questioned the bridged repair
Open anterior component separation
advocate
Dissatisfied with wound morbidity
Endoscopic Component separation
Limited mesh placement options/ surgeon
adoption
Posterior component separation
57
Conclusion
29