title: Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs.
abstract: BACKGROUND
  Despite improved operative techniques, open ventral hernia repair (VHR) surgery in high-risk, potentially contaminated patients remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in patients with grade 2 hernias is associated with lower surgical site occurrence (SSO) and surgical site infection (SSI) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in patients with grade 3 hernias.
  
  
  METHODS
  A 4-year retrospective review (2011-2014) was conducted of all consecutive, modified ventral hernia working group (VHWG) grade 3 hernia repairs with HVAC closure performed by a single surgeon (FEE) at a single institution. Operative data and 90-day outcomes were evaluated. Overall outcomes (e.g., recurrence, reoperation, mortality) were reviewed for the study group.
  
  
  RESULTS
  A total of 117 patients with an average age of 56.7 ± 11.9 years were classified as grade 3 hernias and underwent open VHR with subsequent HVAC closure. Fifty patients were male (42.7 %), the mean BMI was 35.2 (±9.5), and 60.7 % had a history of prior hernia repair. The average fascial defect size was 201.5 (±167.3) cm(2) and the mean length of stay was 14.2 (±9.3) days. Ninety-day outcomes showed an SSO rate of 20.7 % and an SSI rate of 5.2 %. The overall hernia recurrence rate was 4.2 % (n=6) with a mean follow-up of 11 ± 7.3 months.
  
  
  CONCLUSIONS
  Modified VHWG grade 3 ventral hernias are associated with significant morbidity. In our series utilizing the HVAC system after VHR, the observed rate of SSO and SSI compared favorably to reported series. Further prospective cost-effective studies are warranted to validate these findings.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Rodriguez-Unda
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Soares
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Saïd C
authors.initials: SC
authors.lastname: Azoury
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Baltodano
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Burce
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Cornell
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Carisa M
authors.initials: CM
authors.lastname: Cooney
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. feckhau2@jhmi.edu.
authors.forename: Frederic E
authors.initials: FE
authors.lastname: Eckhauser
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
keywords: Grade 3 hernia; Negative pressure wound therapy; Surgical site infection; Vacuum-assisted closure; Ventral hernia; abdominal wall reconstruction