In 1990 Ramirez, Ruas, and Dellon 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(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.
Anatomy of repair of abdominal hernias
The diagram in this post shows a cross-sectional view of the layers of the abdominal wall. This includes the well-know rectus abdominus muscle (RA) as well as the skin, underlyling fat, external oblique muscle (EO), internal oblique muscle (IO) and transversus abdominus muscle (TA). 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 the risk of becoming infected. However, sometimes this procedure will require the addition of a pieced of Alloderm or other matrix in order to add strength to the repair.