Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study
Authors: Wolfgang Reinpold
Marc Alexander Renter
Dietmar Eucker
Hans Martin Schardey
Mohamed Aly
Halil Dag
Ferdinand Köckerling
Henning Niebuhr
Christian Peiper
Thomas Aufenberg
Jakob Eichelter
Journal: Frontiers in Surgery (2021)
Discipline: CLINICAL MEDICINE
Keywords: Fasciotens; abdominal wall hernia; component separation; giant hernia; incisional hernia
Affiliations: Hanse Hernia Centre, Hamburg, Germany., Clinic for Surgery, St. Elisabeth Hospital, Cologne, Germany., Clinic for Surgery, Groß Sand Hospital, Hamburg, Germany., Clinic for General, Visceral and Thoracic Surgery, Protestant Hospital, Hamm, Germany., Clinic for General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Hausham, Germany., Clinic for General and Visceral Surgery, St. Josef Hospital, Moers, Germany., Clinic for General, Visceral and Thoracic Surgery, Landshut-Achdorf Hospital, Landshut, Germany., Clinic for General, Visceral, Thoracic and Vascular Surgery, Canton Hospital Basel-Land, Liestal, Switzerland., Clinic for General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau, Berlin, Germany., Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.

Abstract:  Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods. Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020. Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5-44 cm). After application of diagonal-anterior traction &gt;10 kg for an average duration of 32.3 min (range 30-40 min), the fascial distance decreased by 9.8 cm (1-26 cm) to an average 7.5 cm (range 2-19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique. Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods. 

Retracted: No

PubPeer comments:
 Based on these results, as well as good experience with the Fasciotensu00ae Abdomen traction method used for the open abdomen, there seems to be an indication to apply this technique to complex hernia repair (6). 6. Fung SN, Vaghiri S, Ashmawy H*, Kropil F, Rehders A, Knoefel WT. Fasciotensu00ae Abdomen ICU: Novel device prevents abdominal wall retraction and facilitates early abdominal wall closure of septic open abdomen, Lupine Publisher. Surg Case Studies Open Access J. (2017) 2643-6760:354u2013358. doi: 10.32474 SCSOAJ.2019.04.000177 Outlets published by Lupine are generally considered as predatory unreliable sources. [link1] [link2] . Besides, the DOI of reference 6 is not resolving to anything as of today, March 19, 2022. ![file] Finally, could the authors please name the source of funding (if any) for the research presented in this paper? , 
 #1 To be charitable about it, the authors have cited a paid press release. ,