Open along midline and enter peritoneum. 

Divide intra-abdminal adhesions

Clear tissue off the anterior rectus sheath 4cm laterally to get onto the external obliques

Preserve perforators

Identify lateral border of rectus muscle (the semi-lunaris) and then clear off another few centimetres further laterally, but leave perforators intact

MAKE VERTICAL SPLIT IN EXTERNAL OBLIQUE APONEUROSES 2CM LATERAL TO SEMI-LUNARIS: once the plane is entered, you should be able to place a finger into the plane and continue the vertical incision. Continue this from the costal margin to the inguinal ligament. This will give 7cm of medial movement

RECTO-RECTUS is the best place, but if this is not possible, place the biological mesh intra-abdominally. To secure the mesh, take bites through the rectus muscle, through the mesh and back out through the muscle. Place multiple of these on both sides and then parachute it down into place. (Keep a large swab between mesh and bowel to protect the bowel and remove it just before tying the last few sutures.)

Irrigate the mesh with warm saline before closing the now mobilised rectus muscles in the midline, covering the mesh. 

Place drains after removing the excess skin and then close.