title: A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields.
abstract: BACKGROUND
  Guidelines recommend the use of bioprosthetics for abdominal wall reinforcement in contaminated fields, but the evidence supporting the use of biologic over synthetic non-absorbable prosthetics for this indication is poor. Therefore, the objective was to perform a systematic review of outcomes after synthetic non-absorbable and biologic prosthetics for ventral hernia repair or prophylaxis in contaminated fields.
  
  
  METHODS
  The systematic literature search identified all articles published up to 2013 that reported outcomes after abdominal wall reinforcement using synthetic non-absorbable or biologic prosthetics in contaminated fields. Studies were included if they included at least 10 cases (excluding inguinal and parastomal hernias). Quality assessment was performed using the MINORS instrument. The main outcomes measures were the incidence of wound infection and hernia at follow-up. Weighted pooled proportions were calculated using a random effects model.
  
  
  RESULTS
  A total of 32 studies met the inclusion criteria and were included for synthesis. Mean sample size was 41.4 (range 10-190), and duration of follow-up was >1 year in 72 % of studies. Overall quality was low (mean 6.2, range 1-12). Pooled wound infection rates were 31.6 % (95 % CI 14.5-48.7) with biologic and 6.4 % (95 % CI 3.4-9.4) with synthetic non-absorbable prosthetics in clean-contaminated cases, with similar hernia rates. In contaminated and/or dirty fields, wound infection rates were similar, but pooled hernia rates were 27.2 % (95 % CI 9.5-44.9) with biologic and 3.2 % (95 % CI 0.0-11.0) with synthetic non-absorbable. Other outcomes were comparable.
  
  
  CONCLUSIONS
  The available evidence is limited, but does not support the superiority of biologic over synthetic non-absorbable prosthetics in contaminated fields.
authors.affiliation: Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, E19-125, Montreal, QC, H3G 1A4, Canada, larry.lee@mail.mcgill.ca.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.forename: Juan
authors.initials: J
authors.lastname: Mata
authors.forename: Tara
authors.initials: T
authors.lastname: Landry
authors.forename: Kosar A
authors.initials: KA
authors.lastname: Khwaja
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D001705:Bioprosthesis; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control