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• W2624507742 abstract "Sir: We would like to thank our Italian colleagues for their thoughtful comments about our technical overview and for adding their modification of a similar method. We would like to make a few comments about their modification in comparison with the transversus abdominis release we described.1 First, one of the advantages of transversus abdominis release is the elimination of all skin flaps with the preservation of the periumbilical perforator vessels. Although low horizontal incisions can be created, thought must be given to the devascularization of large lipocutaneous flaps with any repair. In the event that we have significant redundant scar or a large lipocutaneous flap in the midline as a result of the hernia, we will perform a midline (vertical) panniculectomy without undermining over the anterior rectus sheath. Second, the use of self-gripping mesh is appealing for its potential to eliminate transfascial sutures, which are a clear source of pain in hernia patients. We typically choose large-pore, monofilament polypropylene for our repairs. This mesh is not only less expensive than self-gripping mesh, but is available in larger sizes to provide wide defect overlap. Also, the mesh described by Gazzola et al. is multifilament. Many surgeons express concern about using such meshes in higher Ventral Hernia Working Group grade patients.2 For smaller defects, transfascial sutures may not be necessary if the midline can be closed without tension. For a retrorectus repair only (without transversus abdominis release), we often eliminate the use of transfascial sutures. For larger hernias that warrant transversus abdominis release, we use the transfascial sutures to assist the medialization of the rectus muscles by placing the mesh under physiologic tension. In this manner, they are not used to prevent mesh migration, but rather to permit full reapproximation of the linea alba. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Dr. Pauli is a speaker for Cook outside the submitted work. Christine M. Jones, M.D.Division of Plastic Surgery Joshua S. Winder, M.D.Division of Minimally Invasive and Bariatric Surgery John D. Potochny, M.D.Division of Plastic Surgery Eric M. Pauli, M.D.Division of Minimally Invasive and Bariatric SurgeryPenn State Hershey Medical CenterHershey, Pa." @default.
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• W2624507742 date "2016-09-01" @default.
• W2624507742 modified "2023-10-17" @default.
• W2624507742 title "Reply: Posterior Component Separation with Transversus Abdominis Release: Technique, Utility, and Outcomes in Complex Abdominal Wall Reconstruction" @default.
• W2624507742 cites W1993888273 @default.
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• W2624507742 doi "https://doi.org/10.1097/prs.0000000000002454" @default.
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