Download PDF
Semin Plast Surg 2012; 26(01): 25-28
DOI: 10.1055/s-0032-1302462
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Component Separations

Lior Heller
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Colton H. McNichols
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Oscar M. Ramirez
2   Elite Surgical Center, Weston, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
23 February 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Component separation is a technique used to provide adequate coverage for midline abdominal wall defects such as a large ventral hernia. This surgical technique is based on subcutaneous lateral dissection, fasciotomy lateral to the rectus abdominis muscle, and dissection on the plane between external and internal oblique muscles with medial advancement of the block that includes the rectus muscle and its fascia. This release allows for medial advancement of the fascia and closure of up to 20-cm wide defects in the midline area. Since its original description, components separation technique underwent multiple modifications with the ultimate goal to decrease the morbidity associated with the traditional procedure. The extensive subcutaneous lateral dissection had been associated with ischemia of the midline skin edges, wound dehiscence, infection, and seroma. Although the current trend is to proceed with minimally invasive component separation and to reinforce the fascia with mesh, the basic principles of the techniques as described by Ramirez et al in 1990 have not changed over the years. Surgeons who deal with the management of abdominal wall defects are highly encouraged to include this technique in their collection of treatment options.

Keywords

component separation - abdominoplasty - abdominal wall hernia - abdominal wall defects - abdominal wall closure
 

  • References

  • 1 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (3) 519-526
    CrossrefPubMedSearch in Google Scholar
  • 2 DiBello Jr JN, Moore Jr JH. Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 1996; 98 (3) 464-469
    CrossrefPubMedSearch in Google Scholar
  • 3 Lowe JB, Garza JR, Bowman JL, Rohrich RJ, Strodel WE. Endoscopically assisted “components separation” for closure of abdominal wall defects. Plast Reconstr Surg 2000; 105 (2) 720-729, quiz 730
    CrossrefPubMedSearch in Google Scholar
  • 4 Shestak KC, Edington HJD, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 2000; 105 (2) 731-738, quiz 739
    CrossrefPubMedSearch in Google Scholar
  • 5 Girotto JA, Ko MJ, Redett R, Muehlberger T, Talamini M, Chang B. Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method. Ann Plast Surg 1999; 42 (4) 385-394, discussion 394–395
    CrossrefPubMedSearch in Google Scholar
  • 6 Cohen M, Morales Jr R, Fildes J, Barrett J. Staged reconstruction after gunshot wounds to the abdomen. Plast Reconstr Surg 2001; 108 (1) 83-92
    CrossrefPubMedSearch in Google Scholar
  • 7 Sukkar SM, Dumanian GA, Szczerba SM, Tellez MG. Challenging abdominal wall defects. Am J Surg 2001; 181 (2) 115-121
    CrossrefPubMedSearch in Google Scholar
  • 8 Saulis AS, Dumanian GA. Periumbilical rectus abdominis perforator preservation significantly reduces superficial wound complications in “separation of parts” hernia repairs. Plast Reconstr Surg 2002; 109 (7) 2275-2280, discussion 2281–2282
    CrossrefPubMedSearch in Google Scholar
  • 9 Maas SM, van Engeland M, Leeksma NG, Bleichrodt RP. A modification of the “components separation” technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg 1999; 189 (1) 138-140
    CrossrefPubMedSearch in Google Scholar
  • 10 Maas SM, De Vries RS, van Goor H, de Jong D, Bleichrodt RP. Endoscopically assisted “component separations technique” for the repair of complicated ventral hernias. J Am Coll Surg 2002; 194 (3) 388-390
    CrossrefPubMedSearch in Google Scholar
  • 11 Hultman CS, Pratt B, Cairns BA , et al. Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome. Ann Plast Surg 2005; 54 (3) 269-275, discussion 275
    PubMedSearch in Google Scholar
  • 12 Howdieshell TR, Proctor CD, Sternberg E, Cué JI, Mondy JS, Hawkins ML. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg 2004; 188 (3) 301-306
    CrossrefPubMedSearch in Google Scholar
  • 13 Jernigan TW, Fabian TC, Croce MA , et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 2003; 238 (3) 349-355, discussion 355–357
    PubMedSearch in Google Scholar
  • 14 Fabian TC, Croce MA, Pritchard FE , et al. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 1994; 219 (6) 643-650, discussion 651–653
    CrossrefPubMedSearch in Google Scholar