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Repair of External Oblique Tendon During Component Separation Prevents Atrophy of External Oblique Muscles
Sean C. Figy, MD, Raymond M. Dunn, MD, Mitchell A. Cahan, MD, Adib R. Karam, MD.
The University of Massachusetts Medical School, Worcester, MA, USA.

PURPOSE: Midline abdominal muscle closure (component separation) may be optimal for abdominal wall reconstructions (AWR). Recent reports indicate that release of the external oblique (EO) from its insertion results in EO muscular atrophy with a hypertrophy of the remaining abdominal muscles. Traditional EO release with mesh onlay does not repair the released EO muscle tendon (flap donor site). Our surgical approach utilizes a bridging onlay mesh repairing the cut ends of the EO, effectively creating a tendon interposition repair. We hypothesize that repair of this musculo-tendinous unit will maintain EO muscle integrity.
METHODS: Retrospective analysis of patients undergoing AWR with EO release and mesh overlay interposition repair from 2007-2013 was undertaken to evaluate the effects of EO repair on muscle anatomy. Eighteen of 88 patients who underwent AWR had both preoperative and postoperative CT scans for comparison of muscle measurements. The rectus abdominus was measured in the AP and transverse dimension. The thickness of the EO, internal oblique, and transversus abdominus was measured at 5cm, 10cm and 15 cm from the linea semilunaris and a Region of Interest area (ROI) was calculated for the EO.
RESULTS: The preoperative ROI of the EO were 14.08 ± 8.6cm2 and 15.03± 8.6cm2 and postoperatively 17.56± 14.9cm2 and 15.3± 5.5cm2. No significant differences were found between any of the preoperative and postoperative muscles measurements.
CONCLUSION: This is the first report documenting that repair of the EO insertion maintains muscles mass after component separation. These results may influence technique selection in certain cases of AWR.


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