title: Does the use of an acellular dermal graft in abdominal closure after rectus flap harvest impact the occurrence of post-operative hernia?
abstract: OBJECTIVE
  Patients with rectus free flap harvest extending below the arcuate line are predisposed to postoperative hernia formation. As such, many authors have advocated the use of closure adjuncts to increase the integrity of the closure and prevent hernia or abdominal wall bulging.
  
  
  METHODS
  Busy level 1 public trauma center in metropolitan Fort Worth, Texas
  
  
  METHODS
  Following harvest of the rectus free flap, 48 patients underwent primary closure; 24 of these patients had defects extending below the arcuate line. Forty patients were closed with an acellular dermal graft; 22 of these patients had defects extending below the arcuate line.
  
  
  METHODS
  Postoperative hernia formation and local infection rate were examined in a minimum follow-up period of 1 year.
  
  
  RESULTS
  Regardless of closure method, no hernias were observed in the postoperative period. Using an unpaired t test and an alpha value of 0.05, there was no statistically significant difference in the infection rate between the two groups.
  
  
  CONCLUSIONS
  Following rectus abdominis myocutaneous free flap harvest, the use of an acellular dermal graft in abdominal wall closure may not be of any further advantage in the prevention of hernia.
  
  
  METHODS
  Retrospective (Level III).
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA. msaman309@gmail.edu.
authors.forename: Masoud
authors.initials: M
authors.lastname: Saman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary, 310 East 14th ST, 6th Floor, New York, NY, 10003, USA. skadakia@nyee.edu.
authors.forename: Sameep
authors.initials: S
authors.lastname: Kadakia
authors.affiliation: Otolaryngology and Facial Plastic Surgery, John Peter Smith Health Network, Fort Worth, TX, USA. yducic@sbcglobal.net.|Baylor Neuroscience Skull Base Program, Fort Worth, TX, USA. yducic@sbcglobal.net.|Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania ave, suite 100, Fort Worth, TX, 76104, USA. yducic@sbcglobal.net.
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006547:Hernia / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D017568:Rectus Abdominis; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000009:adverse effects*; D055815:Young Adult
keywords: Acellular dermal graft; Arcuate; Flap; Hernia; Rectus