Abdominal Wall Reconstruction with Mesh and Components Separation

Abstract

Incisional hernias in the abdominal wall are a by-product of multiple previous laparotomies. Unfortunately, the incidence of incisional hernias has risen, as we have progressed with new surgical techniques in the treatment of abdominal pathologies. Many methods have been attempted in the past to achieve a better and more durable repair, namely using components separation to bring the fascia into the midline, and reinforce incisional hernias with different mesh materials. The authors review the recent literature regarding the efficacy of these synthetic materials and biomaterials in incisional hernia repair, as well as share their experience in treating complex abdominal wall defects using components separation and biologic mesh.

The Direction of Optimal Skin Incisions Derived from Striae Distensae

“…27 Ultimate functional results and potential future reconstructive options are optimized when anatomical disregard is avoided. The convincing proof are Z-plasties, 5,6 where those scars following the main tension/ folding lines are minimal, whereas those perpendicular to the main tension lines often heal with hypertrophy in young patients (Fig.…”

“…General surgeons, however, continue to favor the traditional vertical midline incision in the overwhelming majority of their patients despite a risk of midline hernia occurrence of up to 17 percent in elderly, obese patients with multiple morbidities. 27 Small vertical scars can often easily be corrected by a horizontal excision (Fig. 11).…”

Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects?

“…Restoration of abdominal wall functionality can be achieved with the component separation technique. The expansion of the abdominal cavity can be done with progressive peneumoperitoneum, with the pharmacological blocking of the abdomen lateral musculature with the use of botulinum toxin or with the separation of components [6][7][8] . In view of all these peculiarities presented by bulky hernias, their treatment is still a challenge for surgeons 6 .…”

“…Among the techniques mentioned, the concomitant use of a mesh and the separation of abdominal wall components presents potential advantages, as the components separation allows that all goals in the hernia treatment are achieved, that is, restoration of abdominal wall function, expansion of the abdominal cavity and tension reduction. However, since in these cases the strength of the abdominal muscle fasciasis often reduced, the mesh reinforcement would be adequate 7 .The components separation, however, is associated with complications such as skin ischemia, dehiscence, surgical site infection and formation of seroma due to extensive dissection of the subcutaneous tissue. With this, this technique underwent modifications and alternatives of muscle separation were developed 5,7 .…”

Reconstruction of massive full‐thickness abdominal wall defect: successful treatment with nonabsorbable mesh, negative pressure wound therapy, and split‐skin grafting

“…The use of abdominal negative pressure wound therapy (NWPT) with plastic draping over the abdominal content has become standard of care in most centers 2, 3 as a temporary mean to get the abdominal walls retracted toward the midline, handling swollen soft tissue as well as edematic inner organs due to heavy infection, trauma, etc. 4, 5, 6. Reconstruction of the abdominal wall will normally entail use of mesh, and in the infected setting, acellular dermal matrix (ADM) has gained increasing usage, as ingrowth and adherence occur also in contaminated and even infected wounds 6.…”