Biomechanical Principles of Multipoint Suture Fixation for Abdominal Wall Reconstruction

Torre, Jorge de la

doi:10.34297/ajbsr.2020.07.001115

Cited by 1 publication

(2 citation statements)

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“…We hypothesize that the senior author's technique 18 is uniquely suited to address large defects of the post-OLT population. The core principle of the technique is to renew myofascial continuity via component separation and use multipoint suture fixation to supplement the restoration 17 . This allows for the preservation of the neurovasculature of the abdominal wall, distribution of the tension away from the site of repair, and dynamic muscular support while minimizing possible bowel injury.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the overall acceptance of open AWR techniques, there is a paucity of studies examining the safety and efficacy of the procedure in the OLT population. In our institution, the senior author uses open component separation with multipoint suture reinforcement of an overlay biologic mesh for ventral hernia repairs 17 . This particular AWR technique has previously shown to be successful in a high-risk patient population with complex defects 11,18–20 …”

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confidence: 99%

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Outcomes of Ventral Hernia Repair After Orthotopic Liver Transplant Using Component Separation and Onlay Biologic Mesh

Soto¹,

Zoog²,

Nolte³

et al. 2023

Ann Plast Surg

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IntroductionThe management of ventral hernias (VHs) after orthotopic liver transplant (OLT) can be uniquely challenging because of immunosuppression coupled with large laparotomy size that can compromise the quality of the abdominal wall. The component separation with multipoint suture onlay acellular dermis fixation technique has proven to be effective in high-risk abdominal wall reconstructions. The goal of this study was to elucidate the factors that affect safety and efficacy of VH repair in post-OLT patients.MethodsA retrospective review of 345 patients who underwent repair of VH with compartment separation and onlay acellular dermal matrix reinforcement from a single surgeon from 2012 to 2020 was conducted. Of these, 27 patients were identified with a history of OLT and were stratified based on whether the defect was a initial or recurrent hernia repair. The majority of patients had a standard chevron incision (70%). Data abstraction was performed for preoperative risk factors, hernia characteristics, surgical site complications, and postoperative course including hernia recurrence.ResultsA majority of cases in the study period were initial hernia repairs (59%) with no significant differences in the patient demographics and size of VH defects (190 ± 112.69 cm2). Comorbidities were similar between the groups with the exception of a significantly higher baseline creatinine levels and higher history of smoking in the recurrent hernia repair group (P < 0.05). Of the 27 cases, there were no demonstrable hernia recurrences noted and an overall 11% complication rate. Univariate analysis noted a statistically significant difference in surgical site complication rate (P = 0.017), with the initial hernia repair group having the lowest rate of surgical site complications.ConclusionsIn complex post-OLT patients with large VH, modified component separation with onlay acellular mesh was shown to have acceptable medium-term results. Further studies investigating the factors leading to postoperative complications are necessary to reduce recurrence in this evolving patient population.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%