Introduction: Massive abdominal wall reconstruction remains a complex and frustrating challenge to both general and plastic surgeons. After primary repair, recurrent herniation is reported to occur up to 50 percent of cases. In attempts to restore abdominal wall integrity, many patients undergo surgical repair with prosthetic mesh. Although prosthetic mesh repair has lowered the reported hernia recurrence rate to between 10 and 20 percent, the introduction of an synthetic material poses significant clinical risks to the patient, including wound infection, enterocutaneous fistula formation, small bowel obstruction, and extrusion. Autogenous tissue repair using "components separation" of the myofascial layer of the abdominal wall theoretically reduces much of these dreaded complications. Despite the apparent advantages of this technique, many in the surgical community have not adopted this approach as the procedure of choice for the repair of complex abdominal wall defects. Methods: This institution has sought to retrospectively analyze the reconstructive success (ie., hernia recurrence and complication rate) of the "component separation" method and identify risk factors for the development of subsequent hernia recurrence. We report a nine year experience (November 1991 to 1999) . The study group consisted of 52 men and women with abdominal hernia defects as large as 540 cm2. The mean age mean age was 49. 26 patients had a history of prior abdominal hernia repair. Length of follow up ranged from 1 to 123 months, with a mean follow-up of 38 months. Reconstructions involving synthetic mesh/patch overlay were omitted from this investigation. Results: Overall recurrence rate for herniation was 23 percent (12/52). Of the recurrences, 58 percent (7/12) were among the group with prior abdominal hernia repair. Additional complications such as wound breakdown and seroma formation occurred at rates of 15 percent and 11.5 percent, respectively. There were no mortalities related to the procedure. Conclusions: Successful reconstruction of complex abdominal defects remains a vexing surgical problem. Although the "component separation" method has been described in the literature, no large series to date has been reported. Retrospective analysis of the "component separation" method is ongoing at this institution to establish the efficacy of this relatively new and underutilized repair.
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