title: Improved outcomes in the management of high-risk incisional hernias utilizing biological mesh and soft-tissue reconstruction: a single center experience.
abstract: BACKGROUND
  Repair of incisional hernias is complex in the setting of previous/current infection, loss of domain and bowel involvement, and is often on the background of significant co-morbidities. Reported repair techniques are associated with significant morbidity and led our unit to develop a novel technique for complex incisional hernia repair.
  
  
  METHODS
  A retrospective case notes review of all high-risk (Ventral Hernia Working Group grade 2-4) incisional hernia repairs was undertaken. Standardized repair involved resection of attenuated soft tissue and hernia sac (bioburden reduction), component separation (where necessary), intra-peritoneal Strattice™ biological mesh insertion, midline fascial closure, and soft-tissue reconstruction, performed in combination with a plastic surgeon as a single-stage procedure.
  
  
  RESULTS
  A total of 58 patients underwent hernia repair between February 2009 and September 2012 (median age 59 years; 59 % female). Eleven patients (19 %) were grade 4, 19 (33 %) were grade 3, and 28 (48 %) were grade 2. Nineteen (33 %) were recurrent hernias, and midline fascial closure was achieved in 52 (90 %). Early complications included 15 (26 %) surgical-site occurrences, three (5 %) respiratory complications, two (3 %) cardiac complications, and two (3 %) urinary tract infections. Follow-up has revealed three (5 %) asymptomatic hernia recurrences and no patients requiring mesh explantation.
  
  
  CONCLUSIONS
  This technique was associated with a low risk of surgical site occurrences and hernia recurrence, with no requirements for mesh explantation. Repair of such complex incisional hernias remains challenging, and further randomized controlled trials are required to elucidate the optimal method of closure and mesh type.
authors.affiliation: Department of Surgery and Interventional Science, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK, jamesskipworth@doctors.org.uk.
authors.forename: J R A
authors.initials: JR
authors.lastname: Skipworth
authors.forename: S
authors.initials: S
authors.lastname: Vyas
authors.forename: L
authors.initials: L
authors.lastname: Uppal
authors.forename: D
authors.initials: D
authors.lastname: Floyd
authors.forename: A
authors.initials: A
authors.lastname: Shankar
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials