Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications.
BACKGROUND
The use of polypropylene mesh in the reconstruction of trunk defects increases complication rates when the mesh is placed directly over viscera or the operative site has been irradiated or contaminated with bacteria. An alternative is AlloDerm (decellularized human cadaveric dermis), which becomes vascularized and remodeled into autologous tissue after implantation. When used for fascial reconstruction, AlloDerm forms a strong repair, causes minimal abdominal adhesions, and resists infection.


METHODS
We did a retrospective study of cancer patients at increased risk for mesh-related complications who underwent trunk reconstruction with AlloDerm over a 1-year period. Risk factors included unavoidable placement of mesh directly over the bowel or lung, perioperative irradiation, and/or bacterial contamination of the defect. The indications, defect characteristics, reconstructive techniques, complications, and surgical outcomes were evaluated.


RESULTS
Thirteen patients were included in the study. Indications for reconstruction were oncologic resection, resection of enterocutaneous fistula, and/or ventral hernia repair. Seven patients had bacterial contamination at the operative site and seven patients received perioperative radiation. The mean musculofascial defect size was 435 cm. AlloDerm was placed directly over the bowel or lung in all patients. Nine patients required flap reconstruction, including 14 pedicled and two free flaps. The mean follow-up was 6.4 months. Complications occurred in six patients, however, there were no clinically evident mesh infections, hernias, or bulges.


CONCLUSIONS
AlloDerm successfully can be used in reconstructions for large, complex pelvic, chest, and abdominal wall defects even when placed directly over viscera and when the operative field is irradiated and/or contaminated with bacteria.
Butler
Charles E
CE
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. cbutler@mdanderson.org
Langstein
Howard N
HN
Kronowitz
Steven J
SJ
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003094:Collagen / Q000627:therapeutic use*; D003108:Colonic Diseases / Q000601:surgery; D017577:Cutaneous Fistula / Q000601:surgery; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies; D049291:Seroma / Q000601:surgery; D017768:Skin, Artificial; D013526:Surgical Mesh; D013536:Suture Techniques; D035441:Thoracic Wall / Q000601:surgery*
C440568:Alloderm; D003094:Collagen