title: Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction.
abstract: BACKGROUND
  Ventral hernia repair can be challenging, particularly in patients with serious comorbidity. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) uses tunnel incisions for external oblique aponeurosis release. It preserves both the rectus abdominis myocutaneous perforator vessels that supply the overlying skin and the connection between the subcutaneous fat and anterior rectus sheath, thereby reducing subcutaneous dead space and potentially improving overlying skin flap vascularity. Inlay bioprosthetic mesh reinforces the musculofascial repair. This study evaluated surgical outcomes of the technique used to repair challenging ventral hernias in cancer patients.
  
  
  METHODS
  Data from all patients who underwent minimally invasive component separation with inlay bioprosthetic mesh abdominal wall reconstruction from 2007 to 2010 were analyzed. Surgical outcomes assessed included wound complications, hernia recurrence, and repair-site bulge/laxity.
  
  
  RESULTS
  Thirty-eight cancer patients (mean age, 63.3 years) considered at high risk for wound healing complications and hernia recurrence were included: 80 percent had preexisting medical comorbidities, 42 percent had infected or contaminated defects, and 26 percent had previous ventral hernia repairs. Despite the mean fascial defect size of 494 ± 229 cm2, only seven patients required a bridged repair. During a mean follow-up of 12.4 months, three patients (8 percent) required operative interventions, and nonoperative complications occurred in eight (21 percent). None developed a postoperative laxity/bulge; one (3 percent) had a hernia recurrence requiring operative repair.
  
  
  CONCLUSIONS
  Minimally invasive component separation with inlay bioprosthetic mesh yields acceptable early outcomes in complex patients, likely because it reduces subcutaneous dead space, preserves the vascularity of overlying skin, and reinforces the musculofascial repair with mesh.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
authors.forename: Kristin Turza
authors.initials: KT
authors.lastname: Campbell
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D014945:Wound Healing / Q000502:physiology