Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A.

INTRODUCTION

Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA.

METHODS

A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts.

RESULTS

Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m2; defect size 211.5 ± 165.6 cm2), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;p < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;p = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm2;p = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(p < 0.05).

CONCLUSION

Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.