The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited.

摘要: Reconstruction of massive abdominal wall defects has long been a vexing clinical problem. A landmark development for the autogenous tissue reconstruction these difficult wounds was introduction "components anatomic separation" technique by Ramirez et al. This method uses bilateral, innervated, bipedicle, rectus abdominis-transversus abdominis-internal oblique muscle flap complexes transposed medially to reconstruct central wall. Enamored with this concept, institution sought define limitations and complications quantify functional outcome use technique. During 4-year period (July 1991 1995), 22 patients underwent midline wounds. The varied in size from 6 14 cm width 10 24 height. Causes included removal infected synthetic mesh material (n = 7), recurrent hernia 4), split-thickness skin graft dense cicatrix parastomal 2), primary incisional trauma/enteric sepsis tumor resection (abdominal desmoid involving right abdominis muscle) 1). Twenty were treated mobilization both muscles, two one complex used. plane "separation" interface between external internal muscles. quantitative dynamic assessment performed using Cybex TEF machine, analysis truncal flexion strength being undertaken preoperatively at months after surgery. Patients achieved wound healing all cases operation. Minor superficial infection seroma one. One patient developed 8 postoperatively. There postoperative death caused multisystem organ failure. required addition achieve closure. case involved thin whose defect exceeded 16 width. no clinically apparent weakness abdomen over that present preoperatively. Analysis preoperative force generation revealed 40 percent increase tested on machine. Reoperation possible through reconstructed without untoward sequela. operation is an effective defects. It can be used either as mode closure or treat trauma, surgery, various diseases.