Plastic Surgery Research Council
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Presenter: Jeffrey H Kozlow, MD
Co-Authors: Lisiecki JL; Zhang PC; Rinkinen JR; Terjimanian MN; Brownley RC; Holcombe SA; Wang SC; Kuzon WM; Levi B
University of Michigan Medical School

Objective: The component separation technique (CST) is an important option for ventral hernia repair (VHR) in cases where mesh repair fails. However, there is a paucity of research describing the effects of this operation on the morphology of the abdominal architecture. In this study we apply the concept of analytic morphomics to describe the changes in morphology of the abdomen that take place after VHR by CST.

Methods: We identified 18 patients who underwent VHR by CST and received both pre-operative and post-operative CT scans between 2004 and 2009 in our clinical database. In all patients, the surgical technique involved musculofascial release of the external oblique muscle lateral to the linea semilunaris line. Using novel, semi-automated analytic morphomics, we identified the skin (Fig. 1, purple contour), fascia (Fig. 1, yellow contour), anterior vertebra to skin distance (Fig. 1, red arrow), and anterior vertebra to fascia distance (Fig. 1, blue arrow). Morphomic values were calculated from these landmarks and were compared between pre- and post-operative CT scans using paired T-tests.

Results: The average time from pre-operative scan to operation was 3.8 months; the average time from operation to post-operative scan was 1.8 months. While there was no significant decrease in anterior vertebra to skin distance in the post-operative group (p=0.059), there was a decrease in their anterior vertebra to fascia distance (p=0.004) and a concomitant increase in the ratio between the skin to fascia distance and the vertebra to skin distance (p=0.029).

Conclusion: The changes in the abdominal wall that result from VHR by CST manifest primarily as a decrease in the intra-fascial area of the abdominal wall, with a simultaneous increase in the thickness of the subcutaneous layer, leaving the total body thickness relatively unchanged. These changes in the abdominal wall may help explain the muscular changes observed as a result of this operation and demonstrate that this is a functional operation that restores fascial area.

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