Quantitative Assessment of Tension Reduction at the Midline Closure During Abdominal Component Separation.
BACKGROUND
Abdominal component separation is used commonly for closure of midline abdominal wounds. The value of each step in reducing tension has not been studied. Our aim was to test whether component separation decreases tension in the midline closure and to quantify the value of each procedural step.


METHODS
Tension required to bring the rectus muscle to midline was measured using tensiometry after subcutaneous dissection (step 1), external oblique muscle release (step 2), separation of the internal and external oblique muscles (step 3), and internal oblique muscle release (step 4). Measurements were taken in the upper, middle, and lower thirds of the abdominal midline. Distance to midline was also measured after each surgical step. Tension (measured as percent change) and distance were analyzed using Student's t-test with significance set at p < 0.05.


RESULTS
In 41 hemi-abdominal defects, tension decreased in middle, upper, and lower thirds of the abdomen by 22.5%, 24.3%, and 34.8% after step 1; 33.4%, 31.8%, and 39.8% after step 2; 26.5%, 22.2%, and 27.4% after step 3; and 33.2%, 28.2%, and 23.5% after step 4. Mean distance change was 0.97 cm, 1.97 cm, 2.22 cm, and 2.59 cm after steps 1 to 4, respectively.


CONCLUSIONS
This study shows through a quantitative measure of tension that all steps of the component separation procedure decrease wound tension to variable degrees, with the release of the external and internal oblique muscles being the more effective steps. An internal oblique release is a useful and simple adjunct to the classical component separation procedure.
Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospital and Clinics, Madison, WI Cairo University Hospitals, Cairo, Egypt.
Ahmed M
AM
Afifi
Emily
E
Hartmann
Ahmed
A
Talaat
Ashraf Abo
AA
Alfotooh
Omar S
OS
Omar
Sayed
S
Mareei
Ruston
R
Sanchez
Steve J
SJ
Kempton
D000009:Abdominal Muscles / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002102:Cadaver; D002648:Child; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013718:Tensile Strength; D055815:Young Adult