title: Outcome of components separation for contaminated complex abdominal wall defects.
abstract: BACKGROUND
  Contaminated large abdominal wall defects can pose a formidable challenge to the surgeon. This study compared the outcome of components separation (CS) for complex ventral defects with or without contamination.
  
  
  METHODS
  A retrospective review was conducted of all patients who underwent CS over an 8-year period. Pre-operative factors such as the presence/absence of contamination were analyzed for their effect on length of hospitalization, readmission rate, post-operative complications, re-intervention rate, and long-term recurrence.
  
  
  RESULTS
  A total of 34 patients was analyzed. There were 18 males (53%) with a mean age of 57 years. Mean body mass index was 31 kg/m(2). Seventeen patients (50%) had prior repair (mean 2.1 repairs per patient, median 2). Mean size of abdominal defect was 255 cm(2). Out of the 34 patients, 13 had infected or contaminated defects, including 5 patients with infected mesh. Length of stay was longer in the contaminated group (11.1 vs 3.1 days, P < 0.01). A higher complication rate was noted in the setting of contamination (77 vs 38%, P = 0.03). During a mean follow-up of 47 months, no difference was noted in the re-intervention rate (38 vs 29%, P = 0.70) or long-term recurrence rate of the defect (8 vs 5%, P = 1.0) (contaminated vs non-contaminated group, respectively).
  
  
  CONCLUSIONS
  CS is a good option for closure of large contaminated complex abdominal wall defects. Despite an increased risk of postoperative complications and longer hospitalization length, long-term outcomes are favorable.
authors.affiliation: Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, 3rd Floor, West Los Angeles, CA 90027, USA.
authors.forename: S
authors.initials: S
authors.lastname: Yegiyants
authors.forename: M
authors.initials: M
authors.lastname: Tam
authors.forename: D J
authors.initials: DJ
authors.lastname: Lee
authors.forename: M A
authors.initials: MA
authors.lastname: Abbas
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000150:complications*; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000150:complications / Q000382:microbiology; D005260:Female; D006555:Hernia, Ventral / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications*; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D013526:Surgical Mesh / Q000009:adverse effects / Q000382:microbiology*; D054047:Surgical Stomas / Q000009:adverse effects; D016896:Treatment Outcome