Component Separation: Extending the Boundaries beyond Abdominal Reconstruction

Abstract

Sir: We read with interest the article by Eric Halvorson, “On the Origins of Components Separation,”1 and the fascinating historical perspective. We agree with the author that the method of abdominal hernia repair known as components separation, described by Ramirez et al.2 in 1990, has enjoyed widespread popularity because of the sound anatomical principles it uses. The component separation principle has been applied mainly to abdominal wall reconstruction. Based on similar principles, we have extended this concept of component separation beyond the realms of abdominal wall reconstruction to a complex hand trauma case and recently published our results.3 Complex injuries involving joints, soft tissues, and tendons require customized reconstructive solutions to retain and optimize hand function. We used the concept of component separation of an injured index finger as the donor area for two flaps based on two different vascular supplies to reconstruct a complex bone, joint, and soft-tissue thumb defect, which resulted in a high level of patient satisfaction and a return to heavy manual work.3 The opportunity for emergency joint reconstruction using heterodigital joints from a “finger bank” that is nonreplicable, nonconservable, or nonfunctional is rarely encountered. Component separation provides a salvage to give the best possible outcome in these cases and can be used successfully in the more severe forms of compound loss, providing not only the joint but also the extensor tendon, skin, and bone. Component separation of the donor digit is a useful technique for harvesting composite flaps when the three-dimensional wound geometry does not permit transfer of one flap as a monobloc. We believe that the sound anatomical principles of component separation also have a role beyond the realms of abdominal hernia repair. Anuj Mishra, M.R.C.S. Ian Josty, F.R.C.S.Plast. Welsh Center for Plastic Surgery Swansea, United Kingdom