Ramirez component separation technique - general and visceral surgery

Mark the landmarks with a skin marker before incising the skin. The landmarks include:

• Costal arch
• Symphysis pubis
• Hernial orifice
• Possible course of the skin incision

After marking the landmarks and settling on the mesh size to be used, incise the skin from the xyphoid process to the symphysis pubis, taking down all scar tissue and excess skin.

Carefully dissect the skin to be excised, including any subcutaneous tissue present, off the deeper tissue. This may be effected with dissecting scissors or by electrocautery. Special care must be taken not to injure any adherent intestinal loops.