ABSTRACT
This chapter discusses the role and technique of anterior components separation, and explores variations aimed to minimise wound morbidity. It examines the outcomes of anterior component separation (ACS). The ACS technique for large ventral hernias became popular in the 1990s and 2000s and is still widely practised as it is undoubtedly easier to perform than the posterior component separation technique which came to the fore in 2012, and the anterior approach undoubtedly continues to have a place in the armamentarium of the surgeon managing complex abdominal wall hernias. A standard ACS was performed raising up the extensive lipocutaneous flaps on both sides to allow division of the external oblique aponeurosis to allow the anterior sheaths to meet in the midline. The primary concern with ACS is the necessity to raise extensive skin flaps that destroy the perforating blood supply to the skin with the attendant risks of skin necrosis and other wound complications.
