The Use of Component Separation to Aid in the Repair of Ventral Hernias/ Abdominal Wall Defects

Posted September 19, 2012 in Home

There are various types of hernias and locations with the most common type being ventral (abdominal) hernias. The hernia itself is created by a weakening of the abdominal wall, which results in either the protrusion of fatty tissues or abdominal organs through the resulting defect. Dependent on the size and etiology, the patient could require a procedure known as a component separation. This is to be used when the deficit is between 5 cm and 20 cm in ideal circumstances. This procedure utilizes a biologic graft which is placed under the defect on both sides(sandwich technique), in addition to rearranging the abdominal wall musculature to aid in achieving the goal of abdominal wall deficit closure. Secondarily, the dead space that is left has to be addressed in order to decrease the risk of fluid collection post-operatively with a form of panniculectomy/abdominoplasty. The procedural steps have been outlined in the following article:

Re-creating Form and Function: Repair of Ventral Hernias Using the Sandwich Technique

http://www.plasticsurgerypulsenews.com/7/

: Before Front View

: After Front View

: Before Side View

: After Side View

Case: This patient is a 45 year old male who was referred to my attention for an evaluation and repair of a large ventral hernia following traumatic injury. The component separation procedure was utilized with sandwich biologic grafts done in a multi-disciplinary approach with general surgery and plastic surgery simultaneously. After a thorough evaluation and physical examination, it was noted that he suffered from a large ventral hernia with a diameter of 26 cm. My surgical advice in conjunction with the hernia repair, component separation and biologic sandwich graft and abdominoplasty to aid in controlling the dead space was to be performed. The patient was initially asked to lose weight in preparation for abdominal wall reconstruction. Once the goal was met the procedure was scheduled.

Surgery: After defining the edges of the hernia defect, separation of the under surface of the anterior abdominal wall from the inter-peritoneal content safely is performed.

“The external oblique fascia is released longitudinally just lateral to the rectus abdominis muscle. A cautery device is used with a hemostat to gently incise the external oblique fascia in an avascular plane. The incisions are completed bilaterally, the bipedicled rectus muscle flap is released. There should be no buckling of the biologic mesh if appropriate tension is placed on the rectus muscle during the mesh repair. A No. 10 or larger flat Jackson Pratt or Blake drain should be placed between the mesh and the abdominal wall”

Pain pump catheters are typically placed when I perform the component separation with biologic grafting technique to aid in early post-operative analgesia and decrease need for narcotic medications. Upon completion of the abdominal wall reconstruction, a form of panniculectomy/ abdominoplasty “vertical/horizontal, inverted T or reverse abdominoplasty” is typically performed to decrease dead space and reduce post-operative fluid collection. In addition to hernia repair, restoration of torso function and symmetry of torso is a main objective and added benefit.

Patient Testimonial:

Feb 7, 2012
BACK INTO 34
I was referred to Dr. Chahin by Dr Scott Fields to surgically repair, “The biggest abdominal hernia he had ever scene.” Two surgeons had refused to attempt the surgery. He readily took up the challenge. After 6 1/2 hours of surgery the basketball, that was my stomach, was gone. After wearing nothing but sweats for 2 years, I can now get back into my 34″ jeans, and no longer have to explain when my alien love child will be born.The Doctor and his staff are all very professional and caring. They made me and my wife feel apart of their little family. We would most certainly recommend Dr. Chahin.

References:

“Re-creating Form and Function: Repair of Ventral Hernias Using the Sandwich Technique.” Plastic Surgery Pulse News. June/July Volume 3 Number 2. Pages 5-7.QMP. 09/07/2012 <http://www.plasticsurgerypulsenews.com/7/>