How I Do It: Madrid posterior component separation in 10 steps, with special consideration of its anatomy

• Published in: Langenbeck's archives of surgery Vol. 409; no. 1
• Main Authors: De Luca, Marcello, López-Monclús, Javier, Muñoz-Rodríguez, Joaquin Manuel, Blázquez Hernando, Luis Alberto, Robin Valle de Lersundi, Alvaro, Medina Pedrique, Manuel, Román-García de León, Laura, Avilés Oliveros, Adriana, García-Ureña, Miguel Ángel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 16.11.2024
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Research Highlight; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Hernia repair; Abdominal wall reconstruction; Transversus abdominis release; Anatomical landmarks; Madrid posterior component separation; Surgical technique
• ISSN: 1435-2451
• DOI: 10.1007/s00423-024-03528-0

Purpose The Madrid Posterior Component Separation technique (Madrid PCS) is an approach for abdominal wall reconstruction that leverages anatomical landmarks to optimize outcomes. This manuscript describes ten essential steps for performing the Madrid PCS, focusing on technique, safety, and efficiency. Methods A comprehensive step-by-step approach is outlined, beginning with the initial incision and adhesiolysis, progressing through retromuscular dissection, and concluding with lateral release and subxiphoid dissection. Emphasis is placed on key anatomical landmarks, tissue planes, and surgical maneuvers critical for each phase. Detailed tips and tricks, challenging scenarios, and potential risks are provided to enhance the reproducibility and safety of the procedure. Results Applying these ten steps provides an organized and methodical approach to the Madrid PCS. The focus on anatomical landmarks minimizes the risk of complications such as nerve injury, peritoneal tears, and inadvertent organ damage, while ensuring for the optimal placement of prosthetic materials. Conclusion Adherence to these ten steps, based on anatomical landmarks, significantly improves the safety and effectiveness of the Madrid PCS technique. By understanding the nuances of the procedure, surgeons can achieve consistent and reproducible results in complex abdominal wall reconstructions.