title: Multilayer myofascial-mesh repair for giant midline incisional hernias: a novel advantageous combination of old and new techniques.
abstract: BACKGROUND
  The components separation technique has been proposed as the best solution when facing large abdominal wall defects. In counterpart, this sometimes comes at the price of high rates of wound complications and recurrence. Moreover, the components separation method alone seems insufficient for huge defects, in which it is impossible to reapproximate the rectus muscles without tension. For these cases, we illustrate a novel operation using a modified components separation technique.
  
  
  METHODS
  Twenty-eight patients with giant midline incisional hernias were treated with a combination of the components separation (bilateral sliding rectus abdominis advancement flaps), an autologous multilayer repair, and a retromuscular mesh reinforcement.
  
  
  RESULTS
  Twenty-four (85%) patients have been analyzed. Transverse defect size ranged from 15 to 25 cm (average, 18.8 cm). Wound complications occurred in nine (37%) cases; three of them required drainage of a subcutaneous abscess. After a mean follow-up of 22 (range, 12-48) months, one (4%) recurrence was identified.
  
  
  CONCLUSIONS
  Multilayer myofascial-mesh repair was associated with a low recurrence rate, and wound complications were managed without issues. This approach is a reliable technique for most surgeons and may constitute a new part of the armamentarium for the repair of challenging defects.
authors.affiliation: Department of General and Digestive Surgery, La Mancha-Centro General Hospital, Avenida de la Constitución, 3, 13600, Alcázar de San Juan, Ciudad Real, Spain. salvelio@yahoo.es
authors.forename: Joaquín
authors.initials: J
authors.lastname: Picazo-Yeste
authors.forename: Antonio
authors.initials: A
authors.lastname: Morandeira-Rivas
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno-Sanz
mesh_terms: D000368:Aged; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome