title: Violation of the rectus complex is not a contraindication to component separation for abdominal wall reconstruction.
abstract: BACKGROUND
  Component separation (CS) is an effective technique for reconstructing complex abdominal wall defects. Violation of the rectus abdominis complex is considered a contraindication for CS, but we hypothesized that patients have similar outcomes with or without rectus complex violation.
  
  
  METHODS
  We retrospectively studied all consecutive patients who underwent CS for abdominal wall reconstruction during 8 years and compared outcomes of patients with and without rectus violation. Primary outcomes measures included complications and hernia recurrence. Logistic regression analysis identified potential associations between patient, defect, and reconstructive characteristics and surgical outcomes.
  
  
  RESULTS
  One hundred sixty-nine patients were included: 115 (68%) with and 54 (32%) without rectus violation. Mean follow-up was 21.3 ± 14.5 months. Patient and defect characteristics were similar, except for the rectus violation group having a higher body mass index. Overall complication rates were similar in the violation (24.3%) and nonviolation (24.0%) groups, as were the respective rates of recurrent hernia (7.8% vs 9.2%; p = 0.79), abdominal bulge (3.5% vs 5.6%; p = 0.71), skin dehiscence (20.0% vs 22.2%; p = 0.74), skin necrosis (6.1% vs 3.7%; p = 0.72), cellulitis (7.8% vs 9.2%; p = 0.75), and abscess (12.3% vs 9.2%; p = 0.58). Regression analysis demonstrated body mass index to be the only factor predictive of complications.
  
  
  CONCLUSIONS
  CS surgical outcomes were similar whether or not the rectus complex was violated. To our knowledge, this study is the first to evaluate the effects of rectus violation on surgical outcomes in CS patients. Surgeons should not routinely avoid CS when the rectus complex is violated.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Houston,TX 77030, USA.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Chad M
authors.initials: CM
authors.lastname: Bailey
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D001705:Bioprosthesis; D015992:Body Mass Index; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome