title: [The role of autografts in the treatment of complicated incisional hernias].
abstract: BACKGROUND
  Complicated incisional hernias (at least one time recurrent and/or multilocular and/or infected synthetic mesh) still represent a significant problem.
  
  
  OBJECTIVE
  Presentation of operating techniques desribed so far, as well as publication of a novel procedure and results invented by the authors.
  
  
  METHODS
  Between 01/2011 and 09/2015, 41 patients with recurrent and/or infected incisional hernias with or without entero- and subcutaneous fistulas were operated using the method of the s.c. double-layer autologous tension free dermal flap technique. An accurate follow-up method and a continuous registration of the results was conducted in case of every patient. The body mass index (BMI) and presence of diabetes mellitus (DM) were distinguished factors out of the patients' clinical data. Surgical complications, bulking or laxity, recurrence and the patients' satisfactory index - among other things - were recorded considering the procedure. Patients' clinical data and results: Average age was 59.2 years (13 male / 28 female) in the cohort. 1, 2, 3 times recurrent incisional hernias had 12, 23, 6 patients, respectively. Average BMI was 32,1 kg/m2. 12 patients were treated with type II diabetes. 13 patients had entero- or subcutaneous fistulas and/or infected synthetic meshes at the time of operations. Average follow-up time was 32 months (2-58 months). Seroma formation was registered in 13 cases (31.7%). Fistula formation was registered in one case (2.4%). Bulking formation or laxity was observed in 3 patients (7.3%) and recurrence was noticed in 3 patients (7.3%), 13, 17 and 19 months later in the postoperative period. All the entero- and subcutaneous fistulas developed prior to the last procedure were completely healed. There was no lethal outcome.
  
  
  CONCLUSIONS
  The method developed by the authors is recommended and suitable for the solution to complicated and/or infected incisional abdominal wall hernias especially in cases of obese (BMI ≥ 25 kg/m(2)) and diabetic, high risk patients. After acquiring the precise operative technique, the method is safe, feasible and it comes along with lower complication and recurrence rate, compared to other applied and well established ones. Further clinical trials need to be conducted in the future in order to be evaluated definetely this procedure.
authors.affiliation: Klinikai Központ, Sebészeti Klinika, Debreceni Egyetem 4032 Debrecen, Móricz Zsigmond krt. 22.
authors.forename: Gábor
authors.initials: G
authors.lastname: Martis
authors.affiliation: Klinikai Központ, Sebészeti Klinika, Debreceni Egyetem 4032 Debrecen, Móricz Zsigmond krt. 22.
authors.forename: László
authors.initials: L
authors.lastname: Damjanovich
mesh_terms: D064592:Autografts; D015992:Body Mass Index; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069290:Incisional Hernia / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D017060:Patient Satisfaction; D012008:Recurrence; D012307:Risk Factors; D049291:Seroma / Q000209:etiology; D016038:Skin Transplantation / Q000009:adverse effects; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
keywords: autologous dermal flap; compromitted synthetic mesh; fertőzött szintetikus háló; hosszú távú eredmények; incisional hernia; incisionalis sérv; kiújulás; long-term results