In 1990, Drs. Oscar M. Ramirez, Ernesto J. Ruas, and A. Lee Dellon while working at John Hopkins University School of Medicine introduced the “Components Separation Technique (CST),” a technique used by plastic surgeons to help close extremely large defects of the abdominal wall (massive abdominal hernias) without the use of prosthetic material (or mesh). The basis of the technique includes enlargement of the abdominal wall surface by separation and advancement of the muscular layers. In this way, defects of up to 20 cm at the waistline can be bridged. During a traditional ventral abdominal hernia repair, a large piece of mesh is commonly sewn underneath or into the edge of the hernia defect on the edge of the rectus abdominus muscle. In the components separation technique, the muscular layers of the abdominal wall are separated from each other and advanced toward the middle of the area of the hernia in order to bridge the gap. This commonly eliminates the need for placement of prosthetic mesh which has a greater risk of becoming infected. However, this procedure will sometimes require the addition of a piece of Alloderm or other regenerative tissue matrix in order to add strength to the repair. Many patients have had life-changing results from this operation.
Non-absorbable mesh placement:
There are many different types of mesh to use for hernia repair, the choice of which is based on the specific clinical situation, the type and size of hernia defect as well as the risk of infection. The surgeons at the Rox Hernia Center have been involved in research that evaluates mesh with respect to infection rate, discomfort and recurrence rates. The surgeons of RHC are proud of their ability to make informed decisions regarding this very important aspect of hernia repair.
- AlloDerm® Regenerative Tissue Matrix allows for a strong reinforcement of hernia defects during challenging hernia and abdominal wall reconstruction procedures. Alloderm is made from donated human (cadaver) skin tissue that is subjected to a unique non-damaging process which allows the body to undergo its own tissue regeneration process. This donated human skin tissue is supplied by US AATB-compliant tissue banks and is aseptically processed using LifeCell’s proprietary technique to remove the outer layer of skin (epidermis) as well as other cells that can lead to tissue rejection and graft failure. The result is an intact acellular dermal matrix of natural biological components that promotes rapid blood vessel ingrowth into the new tissues. Following proper healing, Alloderm actually becomes incorporated into the tissues at the site of insertion.
- Strattice™ Reconstructive Tissue Matrix (referred to as Strattice) is used in many of our combined hernia repair operations. Strattice, a type of acellular dermal product, is a sterile reconstructive tissue matrix that supports tissue regeneration. Derived from porcine dermis, it undergoes LifeCell’s non-damaging proprietary processing that removes cells and significantly reduces the key component believed to play a major role in the rejection response to animal-derived grafts. It comes in different sizes and your Rox Hernia Center surgeon will choose the optimal size based upon the defect being corrected.
- Cook Biodesign graft is a non-dermis, non-cross–linked biologic graft technology. Biodesign is constructed from porcine intestinal submucosa and therefore has strong tensile strength that is not found in other biologic grafts. Biodesign is designed to reduce hernia recurrence by giving the body a solid matrix and way to remodel strong, vascularized patient tissue, without long-term complications.
Endoscopic Components Separation Technique
The newest technological advance combines the efficacy of the traditional Components Separation Technique with the Minimally Invasive Surgery approach to managing complex ventral incisional hernias. The Endoscopic Components Separation Technique allows for reconstitution of the integrity of the abdominal wall musculature without the need for wide undermining of the skin and fascial flaps. In some patients, this will help to minimize the morbidity seen with wound healing.