title: Total Abdominal Wall Reconstruction with Component Separation, Reinforcement, and Vertical Abdominoplasty in Patients with Complex Ventral Hernias.
abstract: Large complex ventral hernias act as tissue expanders for skin and subcutaneous fat. The purpose of this study is to evaluate outcomes of total abdominal wall reconstruction with component separation, posterior reinforcement, and vertical abdominoplasty in patients with large complex ventral hernias. Between 2010 and 2014, 58 patients underwent total abdominal wall reconstruction with component separation, intra-abdominal reinforcement, and vertical abdominoplasty. Between 2010 and 2012, patients underwent the conventional technique of component separation, while a perforator-preserving technique was performed during 2013 and 2014. Reinforcement material used was either synthetic mesh in clean cases or biologic mesh if contamination was present. All of the excessive skin and subcutaneous fat was removed in a vertical fashion. Data were analyzed with Mann-Whitney's U test or Fisher's exact test, as indicated. There were 27 moderately complex and 31 majorly complex hernias. Mean hernia size was 16 × 12 cm. The mean size of the removed skin island was 21 × 12 cm. Patients with contamination during the repair had longer in-hospital stays. Overall the local wound complication rate was 24 %, and was lower with the perforator-preserving technique compared to the conventional technique of component separation (11 vs. 48 %; OR 0.13, CI 0.03-0.5; p = 0.003). The overall postoperative morbidity rate was higher in the presence of contamination, and in patients with lower preoperative serum albumin levels. Mean total follow-up was 14 months with a 1-year recurrence-free survival of 96 %.
  
  
  METHODS
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authors.affiliation: Plastic Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Col. Sección XVI, Tlalpan, 14000, Mexico City, Mexico. aedlms@hotmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Espinosa-de-Los-Monteros
authors.affiliation: Plastic Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Col. Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: Avendaño-Peza
authors.affiliation: Plastic Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Col. Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Zeniff
authors.initials: Z
authors.lastname: Gómez-Arcive
authors.affiliation: Plastic Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Col. Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Luis Alfonso
authors.initials: LA
authors.lastname: Martin-Del-Campo
authors.affiliation: Plastic Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Col. Sección XVI, Tlalpan, 14000, Mexico City, Mexico.
authors.forename: Jose-Adolfo
authors.initials: JA
authors.lastname: Navarro-Navarro
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D061645:Abdominoplasty / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
keywords: Abdominal wall reconstruction; Abdominoplasty; Ventral hernia