title: Minimally invasive component separation results in fewer wound-healing complications than open component separation for large ventral hernia repairs.
abstract: BACKGROUND
  Minimally invasive component separation (CS) with inlay bioprosthetic mesh (MICSIB) is a recently developed technique for abdominal wall reconstruction that preserves the rectus abdominis perforators and minimizes subcutaneous dead space using limited-access tunneled incisions. We hypothesized that MICSIB would result in better surgical outcomes than conventional open CS.
  
  
  METHODS
  All consecutive patients who underwent CS (open or minimally invasive) with inlay bioprosthetic mesh for ventral hernia repair from 2005 to 2010 were included in a retrospective analysis of prospectively collected data. Surgical outcomes, including wound-healing complications, hernia recurrences, and abdominal bulge/laxity rates, were compared between patient groups based on the type of CS repair, either MICSIB or open.
  
  
  RESULTS
  Fifty-seven patients who underwent MICSIB and 50 who underwent open CS were included. Mean follow-ups were 15.2 ± 7.7 months and 20.7 ± 14.3 months, respectively. Mean fascial defect size was significantly larger in the MICSIB group (405.4 ± 193.6 cm(2) vs 273.8 ± 186.8 cm(2); p = 0.002). The incidences of skin dehiscence (11% vs 28%; p = 0.011), all wound-healing complications (14% vs 32%; p = 0.026), abdominal wall laxity/bulge (4% vs 14%; p = 0.056), and hernia recurrence (4% vs 8%; p = 0.3) were lower in the MICSIB group than in the open CS group.
  
  
  CONCLUSIONS
  MICSIB resulted in fewer wound-healing complications than did open CS used for complex abdominal wall reconstructions. These findings are likely attributable to the preservation of paramedian skin vascularity and reduction in subcutaneous dead space with MICSIB. MICSIB should be considered for complex abdominal wall reconstructions, particularly in patients at increased risk of wound-healing complications.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Ghali
authors.forename: Kristin C
authors.initials: KC
authors.lastname: Turza
authors.forename: Donald P
authors.initials: DP
authors.lastname: Baumann
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D013526:Surgical Mesh; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing