title: A decade of ventral incisional hernia repairs with biologic acellular dermal matrix:  what have we learned?
abstract: BACKGROUND
  Innovative types of biologic mesh have provided new alternatives to ventral incisional hernia repair, especially in the face of contamination. The authors studied the experience and outcomes of patients who underwent repair of a ventral incisional hernia with biologic mesh.
  
  
  METHODS
  Online database and detailed reference searches were conducted. Studies chosen for review had a sample size of at least 40 patients, level IV evidence at most, and a Methodological Index for Nonrandomized Studies index of at least 10. Indications for use of biologic mesh, type of mesh, patient comorbidities, and surgical techniques were also noted.
  
  
  RESULTS
  Eight studies fulfilled the search criteria and included 635 patients using AlloDerm, Surgisis, and Strattice biologic tissue matrices. In one study, indications and surgical techniques were standardized, and follow-up was prospective. In the other seven studies, indications, surgical techniques, and follow-up were assessed retrospectively. The mean patient age, when reported, was 55.7 years. Body mass index ranged from 30 to 35 kg/m2 in 44 percent of the reported patients. In seven of the eight studies [565 patients (89 percent)], the mean follow-up was 25.8 months and the mean hernia recurrence rate was 21 percent. Complication rate exceeded 20 percent in most studies.
  
  
  CONCLUSIONS
  Biologic tissue matrices are mostly used in contaminated fields, which has allowed for a one-stage repair with no or little subsequent mesh removal. Ventral incisional hernia repair with these matrices continues to be plagued by a high recurrence rate and complications. Prospective randomized trials are needed to properly direct practice in the use of these meshes and evaluate their ultimate value.
authors.affiliation: Boston, Mass. From the Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Medicine.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Kissane
authors.forename: Kamal M F
authors.initials: KMF
authors.lastname: Itani
mesh_terms: D062088:Acellular Dermis; D002986:Clinical Trials as Topic; D003094:Collagen / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005109:Extracellular Matrix; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D054457:Tissue Scaffolds; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: C440568:Alloderm; C422414:Permacol; C568444:strattice; D003094:Collagen