Closure of chronic abdominal wall defects: A long-term evaluation of the components separation method

Incisional hernias and abdominal wall defects are frequently iatrogenic pro blems that have been found to complicate as many as 11% of all abdominal op erations, Current techniques for closure of large, chronic abdominal wall d efects have limitations. The use of local musculofascial flaps rather than fascial patches (i.e., the tensor fascia lata) or synthetic material for th e repair of chronic abdominal wall defects is preferable, The superiority o f innervated muscle flaps that provide dynamic abdominal support has been d emonstrated, This report focuses on patients with chronic abdominal wall de fects in whom previous techniques have failed. An algorithmic approach to p lanned reconstruction is presented utilizing the "components separation" te chnique as its foundation. Thirty-seven patients who underwent abdominal re construction following this algorithm are reviewed and their clinical cours e is outlined, The components separation technique provides a compound inne rvated and vascularized muscle flap for dynamic support of the reconstructe d abdominal wall, The experience documented here and by others suggests tha t this technique is a safe and effective method for reconstructing the abdo minal wall in patients with recurrent herniation. Enterocutaneous fistulas, however, continue to present a challenge to the surgeon.