, Volume 17, Issue 3, pp 397–402 | Cite as

The use of indocyanine green angiography to prevent wound complications in ventral hernia repair with open components separation technique

  • H. D. Wang
  • D. P. SinghEmail author
Case Report


Large ventral hernias can be managed with open components separation technique and onlay mesh reinforcement with low hernia recurrence rates. However, disruption of the perforating vessels to the medial skin flaps results in high rates of wound complications after the operation. An aggressive wound protocol including debridement of tissue with poor perfusion is needed to minimize complications. ICG angiography, a novel technology designed to detect tissue perfusion, can assist in this effort by identifying the ischemic areas to help guide the extent of debridement. This report presents a case in which ICG angiography–assisted open components separation was performed.


Ventral hernia Components separation Indocyanine green Angiography 


Conflict of interest

Devinder Singh is a consultant for LifeCell Corporation. Howard Wang has no conflicts of interest to disclose.

Supplementary material

Online Resource 1 intra-operative perfusion mapping by ICG videoangiography demonstrating well-perfused tissue indicated by presence of fluorescence and ischemic areas indicated by lack of fluorescence. Supplementary material 1 (MPEG 11705 kb)


  1. 1.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71PubMedCrossRefGoogle Scholar
  2. 2.
    Poole GV Jr (1985) Mechanical factors in abdominal wound closure: the prevention of fascial dehiscence. Surgery 97:631–640PubMedGoogle Scholar
  3. 3.
    Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585PubMedGoogle Scholar
  4. 4.
    Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526PubMedCrossRefGoogle Scholar
  5. 5.
    Ko JH, Wang EC, Salvav DM, Paul BC, Dumanian GA (2009) Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg 144:1047–1055PubMedCrossRefGoogle Scholar
  6. 6.
    Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vasconez LO (2007) Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg 58:264–267PubMedCrossRefGoogle Scholar
  7. 7.
    Girotto JA, Ko MJ, Redett R, Muehlberger T, Talamini M, Chang B (1999) Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method. Ann Plast Surg 42:385–394PubMedCrossRefGoogle Scholar
  8. 8.
    Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558PubMedCrossRefGoogle Scholar
  9. 9.
    Huger WE Jr (1979) The anatomic rationale for abdominal lipectomy. Am Surg 45:612–617PubMedGoogle Scholar
  10. 10.
    Olivier WA, Hazen A, Levine JP, Soltanian H, Chung S, Gurtner GC (2003) Reliable assessment of skin flap viability using orthogonal polarization imaging. Plast Reconstr Surg 112:547–555PubMedCrossRefGoogle Scholar
  11. 11.
    Pollock H, Pollock T (2000) Progressive tension sutures—a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 105:2583–2586PubMedCrossRefGoogle Scholar
  12. 12.
    Harth KC, Rosen MJ (2010) Endoscopic versus open component separation in complex abdominal wall reconstruction. Am J Surg 199:342–347PubMedCrossRefGoogle Scholar
  13. 13.
    Butler CE, Campbell KT (2011) Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg 128:698–709PubMedCrossRefGoogle Scholar
  14. 14.
    Komorowska-Timek E, Gurtner GC (2010) Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complication in immediate breast reconstruction. Plast Reconstr Surg 125:1065–1073PubMedCrossRefGoogle Scholar
  15. 15.
    Giunta RE, Holzbach T, Taskov C, Holm PS, Brill T, Busch R, Gansbacher B, Biemer E (2005) Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 58(5):695–701PubMedCrossRefGoogle Scholar
  16. 16.
    Holm C, Mayr M, Hofter E, Becker A, Pfeiffer UJ, Muhlbauer W (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55(8):635–644PubMedCrossRefGoogle Scholar
  17. 17.
    Iqbal CW, Pham TH, Joseph A, Mai J, Thompson Gb, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Division of Plastic SurgeryUniversity of Maryland School of MedicineBaltimoreUSA

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