Difficult abdominal wall closure: component separation versus partition technique

Abstract

Partition technique and component separation techniques are natural methods of fascia-fascia closure. We present our experiences and research the differences between the two techniques. From January 2006 to August 2013, 41 patients with complex abdominal wall defects reconstructed with partition (N = 18) or component separation technique (N = 23) alone were enrolled into this study. The related data including gender, age, size of defect, operation time, hospital stay, duration of follow-up, comorbidities, body mass index (BMI) and complications were collected. Nonparametric Mann-Whitney test was used to evaluate the differences between the two groups in continuous data; Chi-square test was used to assess the categorical data. The mean defect size of patients with partition technique (N = 18) was 12.55 cm (range 8.2-18.9 cm) with 148.63 min for average operation time, 8.66 days for hospital stay, and 28.8 months for mean follow-up. There were nine cases with postoperative complications (three cases with skin and soft tissue necrosis; two cases with fascia dehiscence; and three cases with wound infection). One case with fascia dehiscence suffered from pneumonia simultaneously. Four cases received secondary operation (fascia repair and split-thickness skin graft), and the other four cases healed spontaneously with mild wound debridement. The mean defect size of the patients with component separation (N = 23) technique was 9.45 cm (range 5.7-12.6 cm) with 143.27 min for average operation time, 7.43 days for hospital stay, and 34.33 months for mean follow-up. One case with skin and soft tissue necrosis underwent reconstruction with split-thickness skin graft and debridement. Two cases with wound infection healed spontaneously with mild wound debridement. There were no significant differences in gender, age, operation time, hospital stay, duration of follow-up, comorbidities, BMI and long-term postoperative complications between the two groups, except for size of defect and short-term postoperative complications. The partition technique could close larger abdominal fascia defects than component separation technique, but simultaneously run the higher opportunities for short-term postoperative complications.