[Reconstruction of abdominal-wall midline defects--The Abdominal-Wall Components Separation].
OBJECTIVE
The recurrence rate of midline defects like incisional hernias is high. Alloplastic material in sublay or onlay technique is often be used if the suture tension is to high for a primary closure. Free or pedicled musculocutaneous flaps transfer denervated muscle and lack dynamic resistance against the intraabdominal pressure. The separation of the lateral abdominal wall achieves autogenous, dynamic material for a tension free closure in small and moderate midline defects.


METHODS
In 1990 Ramirez described a technique, which separates parts of the lateral abdominal wall and advances it towards the midline. The innervation and blood supply of the advanced part is maintained. With this technique it is possible to close defects tension free with dynamic abdominal wall. 9 patients were treated with this technique and followed up.


RESULTS
Midline defects up to 16 cm at the waistline could be closed without tension. There were no major complications (one small delayed wound healing). There were no recurrences in a follow up time of 14.2 months.


CONCLUSIONS
The separation of parts of the lateral abdominal wall can achieve tension free closure of e.g. incisional hernias of small and moderate size. The advancement of the medial component provides well innervated muscle for dynamic resistance against the abdominal pressure.
Voigt
M
M
Abteilung für Plastische und Handchirurgie, Chirurgische Universitätsklinik, Freiburg, Germany.
Andree
C
C
Galla
T J
TJ
Walgenbach
K J
KJ
Stark
G B
GB
D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology