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Background: Separation of the components of abdominal wall is widely used for closure of complex abdominal wounds since the original studies by Oscar Ramirez in 1981. We propose that adding transversalis fascia scoring to a standard component separation can provide additional midline advancement of the anterior rectus sheath. We have investigated our results in this study utilizing a cadaver model.
Methods: We used five cadavers to investigate the results of our proposed new method. The age, sex, time of death and presence of abdominal scars of the cadaver were noted. A standard component separation, as originally described by Dr. Ramirez, was performed. The medial advancement of the anterior rectus sheath was recorded at three points along the leading edge of the anterior rectus sheath bilaterally: 7 cm proximal to umbilicus (superior), umbilicus (middle), and 7 cm distal to umbilicus (inferior). The advancement was recorded in centimeteres using a hand held scale (Protégé®), while applying a constant load of 5 lb. Measurements were performed independently by two of the investigators. A mean value was calculated for obtained measurements for every point. Then, scoring of transversalis fascia using three parallel lines to midline, advancing lateral to medial, spaced 1 cm apart was performed. Medial advancement of anterior rectus sheath was again recorded at the previously used points.
Results: Performing component separation alone provided a mean of 2.4 cm, 3.4 cm, and 3.2 cm advancement at superior, middle, and inferior points, respectively. After transversalis fascia scoring was performed mean advancement measurements were: 3.1 cm, 4.3 cm, and 4.0 cm for superior, middle and inferior points respectively. Transversalis fascia scoring provides additional 37.0%, 31.1%, and 23.8% advancement at each point when compared to component separation alone.
Conclusion: Our results demonstrate that adding transversalis fascia scoring in a controlled standard fashion to component separation can provide greater medial advancement of anterior rectus sheath. We find our results to be promising and plan further clinical studies to follow.
