title: Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction.
abstract: BACKGROUND
  Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects.
  
  
  METHODS
  This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analysed. The average follow-up took 2 years.
  
  
  RESULTS
  Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh.
  
  
  CONCLUSIONS
  Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.
authors.affiliation: Faculty of Medicine, University of Nis, NiS, Serbia. stojjadm@gmail.com
authors.forename: Danilo
authors.initials: D
authors.lastname: Stojiljković
authors.forename: Predrag
authors.initials: P
authors.lastname: Kovacević
authors.forename: Milan
authors.initials: M
authors.lastname: Visnjić
authors.forename: Irena
authors.initials: I
authors.lastname: Janković
authors.forename: Goran
authors.initials: G
authors.lastname: Stevanović
authors.forename: Predrag
authors.initials: P
authors.lastname: Stojiljković
authors.forename: Marija
authors.initials: M
authors.lastname: Stojiljković
authors.forename: Milan
authors.initials: M
authors.lastname: Trenkić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Golubović
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Ignjatović
authors.forename: Zorica
authors.initials: Z
authors.lastname: Dimitrijević
authors.forename: Tatjana
authors.initials: T
authors.lastname: Kovacević
authors.forename: Biljana
authors.initials: B
authors.lastname: Stosić
authors.forename: Natasa
authors.initials: N
authors.lastname: Bagur
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation; D013526:Surgical Mesh