Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects.
BACKGROUND
Elective or emergency reconstruction of abdominal wall defects (AWD) is often difficult. Various techniques have been proposed for reconstructing AWD, including the use of synthetic implants. Porcine acellular dermal collagen (Permacol(TM)) is a biologic implant (PADCI) derived from porcine dermis. We report our experience with the use of PADCI in the management of large AWD in both emergency and elective surgery.


METHODS
Twenty consecutive patients with chronic AWD (CAWD) arising from large incisional hernia or acute AWD (AAWD) arising from visceral edema or tumor resection were studied prospectively. After musculofascial mobilization, the AWD was closed using sheets (10 x 15 cm) of PADCI as an "underlay" interposition graft. Patients were followed up to a median of 18 months postoperatively.


RESULTS
All 20 defects were closed without tension using PADCI. Eight and 12 patients had reconstruction for large AAWD and CAWD, respectively. The mean size of the defects was 180 cm(2) (range = 96-850 cm(2)). The median number of PADCI used to repair the defects was one sheet (range = 1-7). Twelve patients (60%) had an uneventful recovery and were discharged within seven days. One patient (5%) died from multiple-organ failure. Seven patients (35%) developed a complication (two seromas, two minor wound infections, one wound hematoma, one skin edge necrosis, one superficial wound dehiscence, and wound sinus). Overall there were three recurrences (15%).


CONCLUSIONS
PADCI has the potential for reconstruction of large acute and chronic abdominal wall defects. Medium-term recurrence rate is comparable to synthetic mesh repairs.
Department of Surgery, Mid-Western Regional Hospital Limerick, University of Limerick, Limerick, Ireland. faisal.shaikh@ul.ie
Faisal M
FM
Shaikh
Subhasis K
SK
Giri
Shaukat
S
Durrani
David
D
Waldron
Pierce A
PA
Grace
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D004487:Edema / Q000150:complications; D005260:Female; D046449:Hernia, Abdominal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D012008:Recurrence; D014781:Viscera / Q000473:pathology
D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen