title: Immediate, Multistaged Approach to Infected Synthetic Mesh: Outcomes After Abdominal Wall Reconstruction With Porcine Acellular Dermal Matrix.
abstract: BACKGROUND
  Infection of synthetic mesh after abdominal wall hernia repair is a complex problem. The purpose of this study was to determine whether a staged approach to abdominal wall reconstruction (AWR) using a porcine acellular dermal matrix (PADM) is beneficial in the setting of infected synthetic mesh.
  
  
  METHODS
  The authors performed a retrospective review of 27 patients who underwent immediate, staged complex AWR using PADM from 2007 to 2012.
  
  
  RESULTS
  After a component separation, primary fascial closure was achieved in 21/27 (78%) patients, whereas 6/22 (22%) received a bridged hernia repair with PADM. Wound-related complications developed in 7/27 (26%) patients including wound dehiscence 6/27 (22%), surgical site infection 5/27 (19%), and hematoma 1/27 (4%). The hernia recurrence rate observed by 32 months was 19%. A bridged hernia repair and the development of a postoperative infection were associated with hernia recurrence, P<0.05.
  
  
  CONCLUSIONS
  A 2-stage approach to AWR with PADM can provide a safe and effective solution for patients with infected synthetic mesh.
authors.affiliation: From the Departments of *Plastic Surgery, and †General Surgery, Georgetown University Hospital, Washington, DC.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Albino
authors.forename: Ketan M
authors.initials: KM
authors.lastname: Patel
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Nahabedian
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.forename: Parag
authors.initials: P
authors.lastname: Bhanot
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000209:etiology / Q000601:surgery*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000601:surgery*; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D013552:Swine; D016896:Treatment Outcome