Components separation. Back to back: From Anatomy knowledge to Surgery and from Surgical experience to Anatomy

The reconstruction of the abdominal wall is one of the paradigms of how anatomical knowledge is applied to surgery and how from surgical experience can go back to anatomy to apply it in new and more effective techniques. The fundamental basis of hernia repair procedures has been always the restoration of the regional anatomy, achieving it by simple closure till myoplasty. The introduction of prostheses seemed to be the solution to almost all problems related to the closure of pathological defects in the abdominal wall. Surgical experience has shown that the isolated use of prosthesis is often insufficient to resolve all situations. Therefore, in recent years the use of prosthetic material has been associated to myofascial plasty with the aim of redistributing the tension in the abdominal wall, facilitating closure and at the same time preserving its integrity and full function. These autoplasties, called "anatomical separation of components" in their anterior and posterior versions, have been established as the method of choice in the surgical treatment of complex inci-sional hernias in which the simple use of prosthesis may be insufficient. In this article the anatomical basis of such repairs are described as well as the most relevant technical aspects to be taken into account in performing them.