PMID- 29713832
OWN - NLM
STAT- MEDLINE
DCOM- 20190409
LR  - 20190409
IS  - 1248-9204 (Electronic)
IS  - 1248-9204 (Linking)
VI  - 22
IP  - 4
DP  - 2018 Aug
TI  - Assessment of myofascial medialization following posterior component separation 
      via transversus abdominis muscle release in a cadaveric model.
PG  - 637-644
LID - 10.1007/s10029-018-1771-7 [doi]
AB  - PURPOSE: Posterior component separation (PCS) via the transversus abdominis 
      release (TAR) procedure continues to gain popularity. However, neither the 
      physiologic basis nor the extent of myofascial medialization after TAR is 
      established. We aimed to assess both anterior and posterior rectus fascia (AF and 
      PF) medialization following each step of the TAR procedure. METHODS: Ten fresh 
      cadavers underwent PCS via TAR. Steps included midline laparotomy (MLL), 
      retrorectus dissection (RRD), incision of the posterior rectus sheath (IPL), 
      transversus abdominis muscle division (TAD), and retromuscular dissection (RMD). 
      Medial advancement of AF and PF was measured following application of 2.5, 
      5.0 lb, and maximal tension to the fascial edge. Values are represented as mean 
      advancement past midline in centimeters. RESULTS: MLL allowed advancement of 2.5, 
      3.7, and 4.9 cm. RRD provided advancement of 4.1, 5.9, and 7.6 cm for AF and 4.4, 
      6.2, and 7.5 cm for PF. IPL provided advancement of 4.2, 6.1, and 8.0 cm for AF 
      and 4.6, 6.6, and 8.3 cm for PF. TAD provided advancement of 4.5, 6.6, and 8.6 cm 
      for AF and 5.3, 7.5, and 9.5 cm for PF. RMD provided advancement of 5.5, 7.9, and 
      9.9 cm for AF and 6.9, 9.6, and 11.2 cm for PF. Overall, the complete TAR 
      procedure provided AF advancement of 102% and PF advancement of 129%, over 
      baseline. CONCLUSIONS: The TAR procedure provides for substantial medial 
      advancement of both anterior and posterior myofascial components of the abdominal 
      wall. Retromuscular dissection deep to the divided transversus abdominis muscle 
      appears to be the key step of the procedure, allowing for effective 
      reconstruction of very wide ( approximately  20 cm) defects.
FAU - Majumder, A
AU  - Majumder A
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, 11100 
      Euclid Avenue, Cleveland, OH, 44106, USA. arnab.uhhs@gmail.com.
FAU - Miller, H J
AU  - Miller HJ
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, 11100 
      Euclid Avenue, Cleveland, OH, 44106, USA.
FAU - Del Campo, L M
AU  - Del Campo LM
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, 11100 
      Euclid Avenue, Cleveland, OH, 44106, USA.
FAU - Soltanian, H
AU  - Soltanian H
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, 11100 
      Euclid Avenue, Cleveland, OH, 44106, USA.
FAU - Novitsky, Y W
AU  - Novitsky YW
AD  - Department of Surgery, University Hospitals Cleveland Medical Center, 11100 
      Euclid Avenue, Cleveland, OH, 44106, USA.
LA  - eng
PT  - Journal Article
DEP - 20180430
PL  - France
TA  - Hernia
JT  - Hernia : the journal of hernias and abdominal wall surgery
JID - 9715168
SB  - IM
CIN - Am J Surg. 2020 Apr;219(4):728-729. PMID: 31153583
MH  - Abdominal Muscles/*surgery
MH  - Abdominal Wall/surgery
MH  - Cadaver
MH  - Dissection/methods
MH  - Fascia
MH  - Female
MH  - Hernia, Ventral/*surgery
MH  - Herniorrhaphy/*methods
MH  - Humans
MH  - Laparotomy
MH  - Male
OTO - NOTNLM
OT  - Cadaveric
OT  - Myofascial advancement
OT  - Posterior component separation
OT  - TAR
OT  - Transversus abdominis release
OT  - Ventral hernia repair
EDAT- 2018/05/02 06:00
MHDA- 2019/04/10 06:00
CRDT- 2018/05/02 06:00
PHST- 2017/12/10 00:00 [received]
PHST- 2018/04/17 00:00 [accepted]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2019/04/10 06:00 [medline]
PHST- 2018/05/02 06:00 [entrez]
AID - 10.1007/s10029-018-1771-7 [pii]
AID - 10.1007/s10029-018-1771-7 [doi]
PST - ppublish
SO  - Hernia. 2018 Aug;22(4):637-644. doi: 10.1007/s10029-018-1771-7. Epub 2018 Apr 30.