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Repair of External Oblique tendon during Component Separation prevents atrophy of External Oblique Muscles
Sean C. Figy, MD, Mitchell A. Cahan, MD, Adib R. Karam, MD, Raymond M. Dunn, MD.
The University of Massachusetts Medical School, Worcester, MA, USA.

Background: Establishment of functional 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 on the linea semilunaris results in EO muscular atrophy with a compensatory hypertrophy of the remaining abdominal muscles. Traditional EO release with mesh onlay does not repair the released EO muscle tendon (flap donor sites). Our surgical approach utilizes a bridging onlay mesh repairing the cut ends of the EO, effectively creating a tendon interposition repair and re-establishing the function of the transected EO. We hypothesized that repair of this musculo-tendinous unit will maintain EO muscle integrity
Methods: A retrospective analysis patients undergoing AWR with EO release and overlay interposition repair with mesh by a single surgeon from 2007-2013 was undertaken to evaluate the effects of EO repair on muscle anatomy. Sixteen 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.
Conclusions: This is the first report documenting that repair of the EO insertion maintains muscles mass after component separation. This may influence the technique selections in certain cases of AWR and warrants further investigation to understand functional abdominal wall implications of these findings.

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