title: Porcine acellular dermal matrix (PADM) vascularises after exposure in open necrotic wounds seen after complex hernia repair.
abstract: Biological alternatives to synthetic meshes are increasingly utilised in complex abdominal wall reconstruction. There is a lack of evidence demonstrating that non-cross-linked porcine acellular dermal matrix vascularizes and integrates with human tissue in suboptimal wound conditions. We aimed to evaluate these properties in Strattice™ (Life Cell Inc., Branchburg, NJ) following ventral hernia repair. A retrospective review of patients with high-risk ventral hernia repair utilising Strattice™ as an onlay after open component separation was conducted. Patients with postoperative wound exploration and exposure of the onlay were included in this review. One patient underwent punch biopsy for histological analysis. Eleven patients with wound complications necessitating postoperative debridement and exposure of Strattice™ onlay were identified. The onlay was partially debrided in two cases, and one case required complete excision. Vascularisation was clinically evident in 10 of 11 cases (91%) as demonstrated by the presence of granulation tissue and/or the ability to support a skin graft. Histological analysis of one onlay 3 months postoperatively showed neovascularisation and collagen remodelling with minimal inflammatory response. Strattice™ demonstrated resistance to rejection, ability to undergo vascularisation and incorporation into host tissues in sub-optimal wound conditions following ventral hernia repair.
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Arvind U
authors.initials: AU
authors.lastname: Gowda
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.|Department of Plastic Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA.
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jamil A
authors.initials: JA
authors.lastname: Matthews
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.|Department of Plastic Surgery, The Johns Hopkins University Hospital, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sabino
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stromberg
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Hamid R
authors.initials: HR
authors.lastname: Zahiri
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Pinczewski
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Luther H
authors.initials: LH
authors.lastname: Holton
authors.affiliation: Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
authors.affiliation: Division of Plastic Surgery, Anne Arundel Medical Center, Annapolis, MD, USA. Dsingh@aahs.org.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation; D062088:Acellular Dermis / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology* / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D013552:Swine; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Abdominal wall; Components separation; Hernia; Porcine acellular dermal matrix; Strattice