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Objective: Reconstruction of traumatic ventral hernias often requires additional techniques to the abdominal wall component separation, such as the use of interpositional reconstruction with an acellular dermal matrix or other mesh to bridge the defect., Methods: We have developed a new value termed the "Component Separation Index" to evaluate ventral hernia defects. Choosing a fixed point on a preoperative axial computed tomographic scan (aorta) and the medial leading edges of the rectus abdominus muscles, we determined the angle of diastasis of the hernia. This angle is divided by 360° giving a relative value of the transverse defect size as compared to the estimated circular body habitus for that specific patient. A retrospective review of 36 cases of ventral hernia repairs was performed. The Component Separation Index was calculated from the preoperative computed tomographic scans obtained before repair. Group 1 (n = 18) required component separation for closure. Group 2 (n = 18) required component separation and placement of interpositional mesh to span the hernia defect., Results: The Component Separation Index values were then compared using the student t test for each group. The mean Component Separation Index for group 1 was 0.11 with standard deviation of 0.06. The mean Component Separation Index for group 2 was 0.21 with standard deviation of 0.04 (P < .0001). As this value approaches 0.21, the likelihood of an interpositional repair in addition to component separation becomes much greater., Conclusions: While there is no substitute for clinical acumen when evaluating these defects, objective measurements can provide a valuable additional tool for the surgeon facing these challenging cases.

Introduction: Many medical disciplines, such as emergency medicine, trauma surgery, dermatology, psychiatry, family practice, and dentistry have documented attempts at assessing the level of bioterrorism preparedness in their communities. Currently, there is neither such an assessment nor an existing review of potential bioterrorism agents as they relate to plastic surgery. Therefore, the purpose of this article is to present plastic surgeons with a review of potential bioterrorism agents., Methods: A review of the literature on bioterrorism agents and online resources of the Centers for Disease Control and Prevention was conducted. Category A agents were identified and specific attention was paid to the management issues that plastic surgeons might face in the event that these agents are used in an attack., Results: Disease entities reviewed were smallpox, anthrax, plague, viral hemorrhagic fever, tularemia, and botulism. For each agent, we presented the microbiology, pathophysiology, clinical presentation, potential for weaponization, medical management, and surgical issues related to the plastic surgeon., Conclusion: This article is the first attempt at addressing preparedness for bioterrorism in the plastic surgery community. Many other fields have already started a similar process. This article represents a first step in developing evidence-based consensus guidelines and recommendations for the management of biological terrorism for plastic surgeons.