title: Acellular dermal allograft for ventral hernia repair in the compromised surgical field.
abstract: A ventral hernia and a contaminated surgical field are a difficult surgical combination. We hypothesize that acellular human dermis (AHD) can be a suitable biological tissue alternative in the repair of a ventral hernia. The study involved a retrospective review of the use of AHD in the repair of ventral hernia from 2001-2004. Inclusion criteria included a ventral hernia repair in a clean-contaminated (CC) or contaminated-dirty (CD) surgical field. The primary outcome of the study was wound infection and mesh removal. Patients were stratified into CC and CD, and management of a wound infection [medically managed (MM) or surgically managed (SM)]. Seventy-five patients met the study criteria. The most common comorbidity was hypertension (45.3%). There was one death in the study (from multiple organ dysfunction syndrome). The overall wound infection rate was 33.3 per cent: 11 MM (14.7%) and 14 SM (18.7%). The average length of stay was 16.7 days (+/-20.8) with a mean follow-up of 275 (+/-209) days. Subgroup analysis: CC (n = 64) had 9 wound infections that were MM (14.1%) and 12 wound infections that were SM (18.8%); CD (n = 11) had 2 wound infections that were MM (18.2%) and 2 wound infections that were SM (18.2%). Five of 14 SM (35.7%) wound infections required removal of the mesh. Wound infection in the contaminated surgical field occurred 33.3 per cent of the time. Some (18.7%) of the cases required SM management, and 35.7 per cent of these required removal of the AHD.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Guy
authors.forename: Marshall B
authors.initials: MB
authors.lastname: Berkes
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
authors.forename: Richard S
authors.initials: RS
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen