title: Multi-institutional experience using human acellular dermal matrix for ventral hernia repair in a compromised surgical field.
abstract: BACKGROUND
  A complex ventral hernia repair (CVHR) involves a compromised surgical field where gastrointestinal, biliary, and genitourinary procedures are performed. Complex ventral hernia is a significant problem in trauma, emergency, and elective general surgery in which prosthetic material is contraindicated. In this clinical scenario, primary fascia closure carries a 50% risk of developing a hernia. The other option is a planned ventral hernia with delayed repair.
  
  
  OBJECTIVE
  Human acellular dermal matrix is a suitable implant for CVHR in a compromised surgical field.
  
  
  METHODS
  Multi-institutional, 5-year retrospective review.
  
  
  METHODS
  Four academic medical centers.
  
  
  METHODS
  Each center obtained institutional review board approval. Patients included in the review had undergone CVHR with human acellular dermal matrix. Data collected included age, body mass index (calculated as weight in kilograms divided by height in meters squared), comorbidities, size of fascial defect, wound classification, hospital length of stay, length of follow-up, and mortality. Primary outcomes were surgical site infection, fistula recurrence, and hernia recurrence. Both chi2 and logistic regression analyses were performed.
  
  
  RESULTS
  Two hundred forty patients met the study criteria. Their mean (SD) age was 52.2 (15.0) years, and 132 (55.0%) were men. The most common comorbidity was hypertension (115 patients [47.9%]), and the mean defect size was 201 cm2. The mean hospital length of stay was 17.2 days, and the mean follow-up was 317 days. The overall mortality was 2.9%. The hernia recurrence rate was 17.1% (41 patients). Repair of a fistula or stoma was associated with hernia recurrence (P = .03) and with fistula recurrence (P < .001). Logistic regression analysis demonstrated surgical site infection and body mass index of greater than 30 to be independent risks of hernia recurrence.
  
  
  CONCLUSIONS
  Human acellular dermal matrix is a suitable alternative for CVHR in a compromised surgical field. The hernia recurrence rate with human acellular dermal matrix in a compromised surgical field is less than that seen with primary repair, offering additional and improved surgical options for CVHR in this group of patients. Stoma or fistula takedown at the time of CVHR continues to be associated with significant complications.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 404 Medical Arts Bldg 1211, 21st Ave S, Nashville, TN 37212, USA. jose.diaz@vanderbilt.edu
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.forename: Anne M
authors.initials: AM
authors.lastname: Conquest
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ferzoco
authors.forename: Daniel
authors.initials: D
authors.lastname: Vargo
authors.forename: Preston
authors.initials: P
authors.lastname: Miller
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Wu
authors.forename: Rafe
authors.initials: R
authors.lastname: Donahue
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D003094:Collagen; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017768:Skin, Artificial; D013530:Surgical Wound Infection / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; D003094:Collagen