title: Synthetic versus Biologic Mesh in Single-Stage Repair of Complex Abdominal Wall Defects in a Contaminated Field.
abstract: BACKGROUND
  Synthetic meshes have been used with varying rates of success in a contaminated setting, although their use is not widely accepted because of concerns for infection. A biologic mesh (BM) is assumed to be more resistant to infection than a synthetic mesh; however, sparse clinical data support this theory. The hypothesis for this study: Uncoated polypropylene synthetic mesh (USM) can be used to obtain a durable repair in the setting of a contaminated abdominal wall reconstruction (AWR) in a single-stage procedure with comparable infectious outcomes to a biologic mesh repair.
  
  
  METHODS
  We performed a retrospective chart review on contaminated AWR, comparing 34 BM with 24 USM with infection as the primary outcome of interest. Secondary outcomes were re-admission and re-operation. We also investigated the microbial isolates that were cultured.
  
  
  RESULTS
  Mesh groups were similar in their demographics, duration of surgery, previous mesh, surgical site class, and source of contamination. Length of stay was 4 d longer in BM, p = 0.01. Overall infection rate was 50% for BM vs. 29.2% for USM, p = 0.18. Treatment in case of infection was similar across both groups. Gram positive bacteria comprised 39% of BM microbiology vs. 63% for USM. Re-admission rate was 52.9% for BM versus 45.8% for USM, p > 0.5. The BMs re-admitted for surgical site infection/abdominal abscess were 38.9% versus 55.6% for USM. No USM were re-admitted for seroma versus 33.3% of BM, p = 0.06. Re-operation rate was 26.5% for BM versus 33.3% for USM, p > 0.5. Procedures performed at re-operation were similar between groups. Regression analysis did not demonstrate an association between mesh type and our outcomes.
  
  
  CONCLUSIONS
  Our results show that synthetic meshes are not inferior to biologic meshes in contaminated AWR. This is important in view of the tremendous cost disparity between these two products and the questionable ability of biologic mesh to offer a durable hernia repair.
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Jad
authors.initials: J
authors.lastname: Chamieh
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Wen Hui
authors.initials: WH
authors.lastname: Tan
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramirez
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Eden
authors.initials: E
authors.lastname: Nohra
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Apakama
authors.affiliation: Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri.
authors.forename: William
authors.initials: W
authors.lastname: Symons
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D001688:Biological Products; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D011126:Polypropylenes; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D001688:Biological Products; D011126:Polypropylenes