Open Anterior Component Separation
Since its original description in 1990, the anterior components separation technique for reconstruction of large and complex abdominal wall defects has evolved as an elegant and indispensible tool for surgeons across specialties. In contrast to historically used techniques which often involved placement of a large piece of spanning synthetic mesh to cover hernia defects, separation of components recreates the native physiology of the abdominal wall by restoring the normal anatomic relationship of the bilateral rectus sheaths. Refinements to Ramirez’s originally described procedure include mesh reinforcement of midline closure and minimal dissection techniques, which spare musculocutaneous perforators in the periumbilical region. Discussion among experts continues regarding the optimal type of mesh, position of mesh placement, and role of endoscopic and other minimally invasive methods for flap dissection. Herein the authors discuss these trends and controversies, and describe their personal technique and algorithm for application of the anterior components separation method.
KeywordsAnterior component separation Myofascial flap advancement Abdominal wall reconstruction Ventral hernia Incisional hernia Biologic mesh Synthetic mesh Technique Periumbilical perforator Algorithm
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