title: An Evidence-Based Model for the Successful Treatment of Flank and Lateral Abdominal Wall Hernias.
abstract: BACKGROUND
  Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall.
  
  
  METHODS
  A retrospective analysis was carried out on patients presenting for open repair of a lateral wall defect performed by a single surgeon. Over a 5-year period, there were 29 consecutive patients with a mean follow-up period of 21.2 months. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and complications (e.g., recurrence/bulge, seroma, hematoma, wound infection, persistent pain, skin breakdown, and fascial dehiscence) were collected.
  
  
  RESULTS
  Patients who underwent flank hernia repairs using an inlay/underlay nonbridged technique with the use of acellular dermal matrix had low recurrence and overall complication rates. Only one patient (3.4 percent) had a recurrence at follow-up, and another patient (3.4 percent) had developed a bulge.
  
  
  CONCLUSIONS
  The authors' data indicate successful results when their technique is applied. Proper patient selection is essential, along with a thorough understanding of anatomy and techniques for successful reconstruction. The authors recommend using an inlay (preferred) or underlay repair with acellular dermal matrix to reinforce the surrounding musculofascial closure. This technique, in conjunction with the authors' holistic abdominal wall reconstruction protocol, has optimized outcomes and identified a successful multidisciplinary strategy for the reconstruction of lateral wall defects.
  
  
  METHODS
  Therapeutic, IV.
authors.forename: Ronnie A
authors.initials: RA
authors.lastname: Pezeshk
authors.forename: Benson J
authors.initials: BJ
authors.lastname: Pulikkottil
authors.forename: Steven H
authors.initials: SH
authors.lastname: Bailey
authors.forename: Nathaniel E
authors.initials: NE
authors.lastname: Schaffer
authors.forename: Edward M
authors.initials: EM
authors.lastname: Reece
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Thornton
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gupta
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Hoxworth
mesh_terms: D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D021501:Flank Pain / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017768:Skin, Artificial; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*