Perforator Sparing Components Separation

Directed by Mike Boctor

Michael J Boctor, BS, Simon Moradian, MD, Gregory A. Dumanian, MD

Traditional components separation with sliding myofascial rectus flaps creates massively undermined skin flaps, increasing the risk of wound complications. Lateral incisions enable access to the semilunar line with minimal undermining, allowing for preservation of periumbilical perforators. This technique has demonstrated a statistically significant decrease in wound complications (20% ⇢ 2%).

Incision — 6 cm Inferior to the lowest aspect of rib cage

Identify — Leading edge of external oblique

Release — extended Above the rib cage superiorly

Blunt Dissection — towards the ASIS

Release — Extended to the symphysis pubis inferiorly

Tunnel — Suprapubic From midline

Hook — the cut edge of the external oblique

Pull — to Midline

Complete – RELEASE WITH A FINAL CUT

Repeat — bilaterally