Plastic Surgery Research Council
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Presenter: Sanjay Naran, MD
Co-Authors: Emilife P; Quigley M; Shakir S; Cray Jr J; Russavage J; Nguyen V
University of Pittsburgh

BACKGROUND: Components separation of the abdominal musculature is a mainstay for closing complicated midline and para-median abdominal wall defects. We set out to critically analyze our experience with this operative technique, and in doing so identify prognosticators that affect long-term clinical outcomes.

METHODS: We retrospectively reviewed all patients who underwent components separation by a single surgeon (JMR) between 2000-2010. Over 40 data points were collected for each patient and examined as to weather they affected long-term clinical outcomes. Demographics including BMI, co-morbidities, and operative details were collected. We documented major and minor complications including hernia recurrence, heamatoma, seroma, ischemia, infection, superficial wound breakdown, and DVT/PE.

RESULTS: Thus far, we have reviewed 311 patients. Our cohort is 51.5% male, with a mean age of 52.413.9 years, BMI of 33.18.0 kg/m2, and defect size of 189.4229.8 cm2. 97.1% had a prior abdominal surgery, and 38.5% had a prior mesh placement. 25.5% underwent concurrent intraoperative bowel enterotomies, and 1.7% required prosthetics for closure. Mean post-operative stay was 7.25.1 days, and average follow-up was 2.92.4 years. The recurrence rate was 20.9%. Post-operative complications included heamatoma (3.8%), seroma (8.4%), ischemia (1.3%), infection (9.2%), superficial wound breakdown (5.9%), and DVT/PE (3.3%). The presence of a respiratory co-morbidity (p=0.049) was associated with an increased risk of recurrence. The occurrence of any post-operative complication (p<0.001) significantly increased the likelihood of eventual recurrence. We found no association between adverse outcomes and BMI.

CONCLUSIONS: This study provides a comprehensive review of the largest single surgeon experience utilizing components separation to date. Patients with respiratory co-morbidities are significantly more likely to have a recurrence; however, in our cohort the components separation technique remains a reliable method of abdominal wall reconstruction even in the setting of co-morbidities thought to be associated with adverse outcomes.

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