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.
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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)
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Chemical References |
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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
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