Abstract
Closure of large incisional hernias with the Components Separation Method (CSM) could be explained by medial-caudal rotation of the internal and transverse oblique muscles around their centres of origin. In eight human cadavers, the CSM was performed, and translation of the rectus abdominis muscle was measured. Mean unilateral translation of the rectus abdominis in the lateral-medial direction measured 2.2, 3.7, and 3.5 cm. This was 2.7, 4.5, and 4.0 cm after release of the posterior rectus sheath. Mean translation in a caudal direction was 0.5 cm, but seven cadavers showed a mean translation of 1 cm of the uppermost measuring point in a cranial direction. The hypothesis that rotation of separate tissue layers of the abdominal wall largely accounts for the translation effect of the CSM must be rejected. Release of the external oblique muscle produces more benefit to abdominal wall closure than release of the posterior rectus sheath.
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References
Ramirez OM, Ruas E, Dellon AL (1990) “Components Separation” Method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526
Dibello JN, Moore JH (1996) Sliding myofascial flap of the rectus abdominis muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 98:464–469
Girotto J, Ko M, Redett R, Muehlberger Th, Talamini M, Chang B (1999) Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method. Ann Plast Surg 42:385–395
Jacobsen WM, Petty PM, Bite U, Johnson CH (1997) Massive abdominal wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia. Plast Reconstr Surg 100:326–335
Shestak K, Edington H, Johnson R (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects. Plast Reconstr Surg 105:731–738
Thomas WO, Parry SW, Rodning CB (1993) Ventral/incisional abdominal herniorrhaphy by fascial partition/release. Plast Reconstr Surg 91:1080–1086
Van Geffen HJAA, Van Vroonhoven ThJMV (1997) Closure of large abdominal wall defects without synthetic material: the components separation method. Hernia 1:S51
de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, van Engeland MI, Bleichrodt RP (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196 (1):32–37
George CD, Ellis H (1986) The results of incisional hernia repair: a 12-year review. Ann R Coll Surg Engl 68:185–187
Mudge M, Hughes LE (1985) Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 72:70–71
Read RC, Yoder G (1989) Recent trends in the management of incisional herniation. Arch Surg 124:485–488
Campanelli G, Bastazza M, Rucca A, Senni Buratti M, Casirani R, Nicolosi M, Trivellini G, Pietri P (2000) Surgical treatment of incisional hernias with marked loss of substance. Hernia 4:202–205
Losanoff JE, Richman BW, Jones JW (2002) Temorary abdominal coverage of the open abdomen: frequently asked questions. J Am Coll Surg 195:105–115
Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545
Nahas FX, Ishida J, Gemperli R, Castro Ferreira M (1998) Abdominal wall closure after selective aponeurotic incision and undermining. Ann Plast Surg 41:606–617
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van Geffen, H., Simmermacher, R.K.J., Bosscha, K. et al. Anatomical considerations for surgery of the anterolateral abdominal wall. Hernia 8, 93–97 (2004). https://doi.org/10.1007/s10029-003-0191-4
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DOI: https://doi.org/10.1007/s10029-003-0191-4