Use of human acellular dermal matrix for hernia repair: friend or foe?

Abstract

BACKGROUND:

Surgeons continue to search for the ideal prosthetic material to repair complex abdominal wall hernias. Recently, a new biologic material was introduced into the surgeon's arsenal. The purpose of this study is to review a single institution's experience with the use of human acellular dermal matrix (HADM [AlloDerm]) for repair of hernias.

METHODS:

This was a retrospective review of all patients who received HADM for repair of an abdominal wall hernia. Patient demographics, comorbidities, wound contamination, operative technique, complications, and hernia recurrence were analyzed.

RESULTS:

Between May 2004 and October 2007, HADM was implanted in a total of 46 patients undergoing repair of a ventral hernia. The average age was 54 years (range, 26-77), with an average American Society of Anesthesiologists classification of 2.5 (range, 1-4). Indications for use of HADM included complex ventral hernia repair (n = 34), mesh infection/enterocutaneous fistula (n = 10), and peritonitis (n = 2). The incidences of comorbidities were hypertension in 47%, diabetes mellitus in 16%, and coronary artery disease in 11%. The majority (87%; n = 40) of the procedures were performed on an elective basis. Seventeen procedures were performed in contaminated wounds. The HADM was placed as reinforcement to the hernia repair in 26 patients and as a "bridge" between the fascial edges in 20 patients. The average follow-up was 12.1 months. Wound complications were frequent at 54%. There were 6 recurrent hernias and 8 patients with eventration of the bioprosthesis so that the recurrent hernia rate was 30%. None of the recurrences were associated with a postoperative wound infection. The majority (88%) of patients who developed eventration of the HADM had a repair using the bioprosthesis to "bridge" an abdominal wall defect. Hernia recurrence and eventration were not associated with use of HADM in a contaminated/infected wound.

CONCLUSIONS:

HADM is a suitable prosthesis for repair of complex and routine abdominal wall defects. This bioprosthesis can incorporate into contaminated tissue without becoming infected. Eventration occurs when HADM is utilized as a fascial replacement rather than as a reinforcement.

• Authors: Raymond Candage, Keith Jones, Fred A Luchette, James M Sinacore, Darl Vandevender, R Lawrence Reed 2nd
• Journal: Surgery (Surgery) Vol. 144 Issue 4 Pg. 703-9; discussion 709-11 (Oct 2008) ISSN: 1532-7361 [Electronic] United States
• PMID: 18847657 (Publication Type: Journal Article)

Chemical References

• Alloderm
• Collagen

Topics

• Adult
• Aged
• Cohort Studies
• Collagen (therapeutic use)
• Female
• Follow-Up Studies
• Hernia, Abdominal (diagnosis, surgery)
• Hernia, Ventral (diagnosis, surgery)
• Humans
• Laparotomy (methods)
• Length of Stay
• Male
• Middle Aged
• Pain, Postoperative (physiopathology)
• Probability
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Surgical Mesh
• Surgical Wound Infection (diagnosis, epidemiology)
• Tensile Strength
• Treatment Outcome
• Wound Healing