Various methods have been employed to reconstruct complex abdominal wall defects. Structural prosthetic materials such as
polypropylene mesh and ePTFE (expanded
polytetrafluoroethylene) have been widely used to close these large fascial defects, however, complications with
infection and adhesions have led to the recent use of more biocompatible implants.
Permacol (acellular porcine dermis) is used as a dermal scaffold, which eventually becomes vascularised and remodelled to reconstruct the abdominal wall in these complex patients. A retrospective review was performed of all patients who underwent consecutive abdominal wall reconstruction with
Permacol at our institution in the year 2006. Twenty-eight patients were identified and included in our study. Factors evaluated were: body mass index, relevant co-morbidities, aetiology of
hernia,
hernia defect size based on CT scan and intraoperative measurement, size of
Permacol implant, length of
hospital stay, and postoperative complications. Surgical technique was standardised among six surgeons and involved a single layer of acellular porcine dermis as a subfascial 'underlay' graft under moderate tension upon maximal
hernia reduction.
Tissue expanders were not required for skin closure. Out of 28 patients, 12 were male and 16 were female. Mean intraoperative
hernia size was 150 cm(2) (range of 10 cm(2) to 600 cm(2)). Mean age was 55 years with an average body mass index (BMI) of 34 (largest BMI of 61.4). Defects were attributed to either a previous
laparotomy incision or open abdomen. Mean
hospital stay was 9.67 days. At a mean follow-up of sixteen months, there were three recurrent
hernias (10.7%) based on physical examination and postoperative CT scan evaluation. One patient developed a superficial
wound dehiscence which was successfully treated with local
wound care and one patient developed a
cellulitis which was successfully treated with
antibiotic therapy. Four patients (14.3%) developed a chronic, non-infected fluid collection lasting >one month all of which resolved. No patient required removal of the implant due to
infection.
Permacol can be successfully used in the reconstruction of both small and large
ventral hernias. This biodegradable matrix serves as a safe and useful alternative to both synthetic mesh and
AlloDerm.