J. Zakhary1,2, C. A. Sedano1, C. D. Killingsworth1, L. O. Vásconez2, J. I. De La Torre1,2 1University Of Alabama At Birmingham,Plastic Surgery,Birmingham, AL, USA 2Birmingham V.A. Medical Center,Plastic Surgery,Birmingham, AL, USA
Introduction: Incisional hernias are a common problem for which the optimal surgical technique has yet to be established. Several key advances in the mangement of incisional hernias have contributed to a decrease in recurrence rates, including the use of mesh for tension free colsure, laparoscopic approaches, component separation and acellular dermal matrix. The published recurrence rates for primary repair of hernias (25-60%) open componenet separation (14-27%) and laparoscopic repair (4-19%) do not usually include long term outcomes.
Methods: A retropsective chart review was perfromed for a abdominal wall reconstructive procedures utilizing component separation by a single surgeon over a six year period. Data abstraction was perfromed by review of patient electronic health records for preoperative risk factors, hernia characteristics and postoperative course. Operative notes were reviewed for specific technical details. In addition, patients completed a phone interview and survey to establish long term outcomes. All patients had a minimum follow-up time of three years or until recurrence.
Results: A total of 81 consecutive patients were evaluated. Thirteen patients were excluded for insufficient follow-up Of the remaining patients, all underwent reconstruction using a component separation and in most cases had acellular demal matric reinfrocement. The median followup time was 40 months. The average hernia size was 223 cm2. Factors associated with recurrence included the inability to establish myofacial continuity (p= 0.018), contaminated field (p= 0.07) and prior failed hernia reconstruction (p= 0.10). Of the patients in whom successful components separation with myofascial continuty was perfromed, the recurrence rate was 10%.
Conclusion: The inability to restore myofascial continuity is a critical risk factor for recurrence. Long term recurrence rate seen in this patient population is well within the range of published outcomes. Incisional hernia reconstruction in a contaminated field is a risk factor for recurrence even with the use of acellular dermal matrix for reinfrocement. Postoperative wound complicatins, most commonly seroma or skin ischemia occured at a significant rate, These complications may be avoided by minimally invasive approaches and require further evaluation.