title: Complex abdominal wall hernias: a new classification system and approach to management based on review of 133 consecutive patients.
abstract: BACKGROUND
  Plastic surgeons are increasingly involved in the repair of complex ventral hernias. Although this typically involves recurrent incisional hernias, operative strategies can be applied to most abdominal wall defects, including chronic wounds with or without exposed mesh, enterocutaneous fistulas, or hernias associated with significant pannus formation.
  
  
  METHODS
  This is a retrospective review of a single institution/single surgeon experience of complex ventral hernia repair performed over a 5-year period. Patients were classified into different hernia types based on their characteristics and underwent hernia repair according to the presented algorithm.
  
  
  RESULTS
  A total of 133 patients underwent a complex ventral hernia repair between January 2005 and September 2009. The separation of components technique was used in the majority of cases. Permanent or biologic mesh was added in select patients. Adjunctive procedures were performed as indicated. The majority of short-term (less than 1 year) recurrences occurred in patients expected to have impaired wound healing due to comorbid conditions. In these patients, the recurrence rate was reduced when autologous repair was reinforced with mesh.
  
  
  CONCLUSIONS
  Autologous tissue is the preferred method for reconstruction of complex ventral hernias. In certain instances, such as contamination, use of an acellular dermal matrix mesh is added as a temporizing measure. A subset of patients who will be prone to recurrence remains. Long-term follow-up is needed to confirm reliable and reproducible results.
authors: Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Josef G
authors: JG
authors: Hadeed
authors: Mark D
authors: MD
authors: Walsh
authors: Theodore N
authors: TN
authors: Pappas
authors: Ivo A
authors: IA
authors: Pestana
authors: Douglas S
authors: DS
authors: Tyler
authors: Howard
authors: H
authors: Levinson
authors: Christopher
authors: C
authors: Mantyh
authors: Danny O
authors: DO
authors: Jacobs
authors: Sandhya A
authors: SA
authors: Lagoo-Deenadalayan
authors: Detlev
authors: D
authors: Erdmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000145:classification* / Q000601:surgery*; D006555:Hernia, Ventral / Q000145:classification / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D013526:Surgical Mesh; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult