Use of human and porcine dermal-derived bioprostheses in complex abdominal wall reconstructions: a literature review and case report.
The goal of abdominal wall reconstruction is to restore and maintain abdominal domain. A PubMed(R) review of the literature (including "old" MEDLINE through February 2007) suggests that bioprosthetic materials are increasingly used to facilitate complex abdominal wall reconstruction. Reported results (eight case reports/series involving 137 patients) are encouraging. The most commonly reported complications are wound seroma (18 patients, 13%), skin dehiscence with graft exposure without herniation (six, 4.4%), superficial and deep wound infections (five, 3.6%), hernia recurrence (four, 2.9%), graft failure with dehiscence (two), hematoma (two), enterocutaneous fistula (one), and flap necrosis (one). Two recent cases are reported herein. In one, a 46-year-old woman required open abdominal management after gastric remnant perforation following a Roux-en-Y gastric bypass procedure. Porcine dermal collagen combined with cutaneous flaps was used for definitive abdominal wall reconstruction. The patient's condition improved postoperatively and she was well 5 months after discharge from the hospital. In the second, a 54-year-old woman underwent repair of an abdominal wall defect following resection of a large leiomyosarcoma. Human acellular dermis combined with myocutaneous flaps was used to reconstruct the abdominal wall defect. The patient's recovery was uncomplicated and 20 weeks following surgery she was doing well with no evidence of recurrence or hernia. The results reported to date and the outcomes presented here suggest that bioprosthetic materials are safe and effective for repair of large abdominal wall defects. Prospective, randomized, controlled studies are needed to compare the safety and efficacy of other reconstructive techniques as well as human and porcine dermal-derived bioprostheses.
Baillie
Daniel R
DR
Department of Surgery, St. Luke's Hospital and Health Network, Bethlehem, PA, USA.
Stawicki
S Peter
SP
Eustance
Nicole
N
Warsaw
David
D
Desai
Darius
D
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D046449:Hernia, Abdominal / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods / Q000451:nursing; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D017592:Skin Care / Q000379:methods / Q000451:nursing; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013552:Swine; D014945:Wound Healing