title: The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success.
abstract: BACKGROUND
  Contaminated abdominal wall fascial defects present a challenging problem. The use of human acellular dermal matrix (AlloDerm; LifeCell Corp., Branchburg, NJ) provides a novel method of primary closure of abdominal wall defects in this setting. The aim of the current study was to determine what factors predicted fascial wall failure as determined by the presence of hernia on follow-up exam after AlloDerm placement.
  
  
  METHODS
  All patients who underwent surgery for contaminated abdominal wall fascial defects with placement of AlloDerm from June 2003 to September 2005 at a tertiary care Veterans Affairs hospital were included in the analysis. Patients were followed until hernia recurrence or last clinic visit.
  
  
  RESULTS
  Eighteen patients had AlloDerm placed for contaminated fascial defects and all were included in the analysis. Primary wound closure was performed on 12/18 (67%) patients, with 6/18 (33%) patients initially left with open wounds. Patients with open wounds were treated with wound vacuum-assisted closure (VAC) devices (4/6) or saline dressings (2/6). Overall ventral hernia recurrence rate was 50% (9/18) with an average follow up of 9.1 months. Patients who had primary wound closure at the completion of the operation had a 33% (4/12) recurrence rate. Patients who did not have primary wound closure had an 83.3% (5/6) recurrence rate. The significant difference shows (P = .03) that open wound status predicts recurrence. The average size of AlloDerm sheets used was 164.0 cm2 in the closed group and 146.2 cm2 in the primary open wound group (P = .64). Average cost per patient was 4680 dollars for AlloDerm.
  
  
  CONCLUSIONS
  These data suggest that an open wound in the postoperative period after AlloDerm placement for treatment of contaminated fascial defects is associated with a high probability of hernia recurrence. Our data do not support the use of this expensive material unless there is a good chance of having a closed wound.
authors.affiliation: Department of Surgery, Palo Alto Veterans Health Care System, Palo Alto, CA, USA. robschuster@hotmail.com
authors.forename: Rob
authors.initials: R
authors.lastname: Schuster
authors.forename: Jaskanwal
authors.initials: J
authors.lastname: Singh
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
mesh_terms: D034861:Abdominal Wall; D000368:Aged; D003094:Collagen / Q000627:therapeutic use*; D005205:Fascia / Q000293:injuries*; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy; D008297:Male; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D017768:Skin, Artificial; D013530:Surgical Wound Infection / Q000628:therapy
chemical_list: C440568:Alloderm; D003094:Collagen