Non-crosslinked porcine-derived acellular dermal matrix for the management of complex ventral abdominal wall hernias: a report of 45 cases.
OBJECTIVE
Ventral abdominal wall hernias are common and repair is frequently associated with complications and recurrence. Although non-crosslinked intact porcine-derived acellular dermal matrix (PADM) has been used successfully in the repair of complex ventral hernias, there is currently no consensus regarding the type of mesh and surgical techniques to use in these patients. This report provides added support for PADM use in complex ventral hernias.


METHODS
In a consecutive series of adult patients (2008-2011), complex ventral abdominal wall hernias (primary and incisional) were repaired with PADM by a single surgeon. Patient comorbidities, repair procedures, and postoperative recovery, recurrence, and complications were noted.


RESULTS
Forty-four patients (mean age, 57.5 years) underwent 45 single-stage ventral abdominal wall hernia repairs (3 primary; 42 incisional). Previously placed synthetic mesh was removed in 17 cases. In 40 cases, primary fascial closure was achieved; in 5 cases, PADM was used as a bridge. Vacuum-assisted closure (VAC) was used for 38/45 cases: 19 closed incisions, 16 cases using the "French fry" technique, and 3 cases with open incisions. Mean hospital stay was 8.2 days (range, 3-32) and mean follow-up was 17 months (range, 1-48). There were 4 (8.9 %) hernia recurrences, 3 requiring additional repair and 1 requiring PADM explantation. There were 3 (6.7 %) skin dehiscences, 4 (8.9 %) deep wound infections requiring drainage, and 5 (11.1 %) seromas (4 self-limited, 1 requiring drainage).


CONCLUSIONS
Non-crosslinked intact PADM yielded favorable early outcomes when used to repair complex ventral abdominal wall hernias in high-risk patients.
Suburban Surgical Associates, 555 N. New Ballas Rd., Ste. 265, St. Louis, MO, 63141, USA, omarg@ssainc.net.
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Guerra
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Maclin
D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013552:Swine