The open perforator sparing anterior component separation

Abstract

Hernia surgery, and intra-abdominal surgery in general, have been accompanied by an increased risk of complications, largely due to a combination of operative complexity and obesity. Advances in care following major abdominal trauma, infections and complex abdominal procedures has led to the advent of several techniques that can allow dependable closure of these wider, more difficult defects. Anterior component separation (ACS) is a well-established technique used to achieve fascial closure in complex abdominal wall reconstruction (AWR). Wound related complications in the traditional ACS procedure have been reported to occur in 24%-50% of cases. In a quest to reduce complications and improve wound healing rates, methods have evolved in order to limit the anatomical injury caused by lateral elevation of flaps in the conventional techniques. These techniques involve preservation of the abdominal wall perforators. Thus ensuring appropriate perfusion of the overlying skin flaps. Perforator-sparing techniques have become increasingly important as they reflect greater understanding of how pre-operative planning can aid reduction of surgical risk, wound infection and improve wound healing in patients with complex abdominal wall hernias.