title: Complex ventral hernia repair with a human acellular dermal matrix.
abstract: OBJECTIVE
  The ideal approach to complex ventral hernia repair is frequently debated. Differences in processing techniques among biologic materials may impact hernia repair outcomes. This study evaluates the outcomes of hernia repair with a terminally sterilized human acellular dermal matrix (TS-HADM) (AlloMax(®) Surgical Graft, by C. R. Bard/Davol, Inc., Warwick, RI, USA) treated with low-dose gamma irradiation.
  
  
  METHODS
  A single-arm multi-center retrospective observational study of patients undergoing hernia repair with TS-HADM was performed. Data analyses were exploratory only; no formal hypothesis testing was pre-specified.
  
  
  RESULTS
  Seventy-eight patients (43F, 35M) underwent incisional hernia repair with a TS-HADM. Mean follow-up was 20.5 months. Preoperative characteristics include age of 56.6 ± 11.1 years, BMI 36.7 ± 9.9 kg/m(2), and mean hernia defect size 187 cm(2). Sixty-five patients underwent component separation technique (CST) with a reinforcing graft. Overall, 21.8% developed recurrences. Recurrences occurred in 15% of patients repaired with CST. Major wound complications occurred in 31% of patients overall. Based upon CDC surgical wound classification, major wound complications were seen in 26, 40, 56, and 50% of Class 1, 2, 3, and 4 wounds, respectively. No grafts required removal.
  
  
  CONCLUSIONS
  Hernia recurrences are not uncommon following complex abdominal wall reconstruction. Improved outcomes are seen when a TS-HADM is utilized as reinforcement to primary fascial closure.
authors.affiliation: Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, C-226 UKMC, Lexington, KY, 40536, USA, jsroth2@email.uky.edu.
authors.forename: J S
authors.initials: JS
authors.lastname: Roth
authors.forename: C
authors.initials: C
authors.lastname: Brathwaite
authors.forename: K
authors.initials: K
authors.lastname: Hacker
authors.forename: K
authors.initials: K
authors.lastname: Fisher
authors.forename: J
authors.initials: J
authors.lastname: King
mesh_terms: D062088:Acellular Dermis / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D005260:Female; D005720:Gamma Rays; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013242:Sterilization / Q000379:methods
chemical_list: D001672:Biocompatible Materials
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