Repair of large contaminated
ventral hernias is always challenging because of massive loss of muscular and fascial tissues, high risk of surgical
infection and recurrence, and
contraindication to use of a permanent
prosthesis. This study reviewed retrospectively data of 35 patients with contaminated large
ventral hernias who received repair using acellular dermal matrix combined with a component separation technique from 2009 to 2011. Twenty-one males and 14 females were identified with a mean age of 45.5 ± 12.5 years and a mean body mass index of 22.5 ± 5.8 kg/m(2). Simultaneously, nine patients underwent bowel
fistula resection, 13 patients underwent
ostomy takedown, five patients underwent recurrent
colon cancer dissection, and eight patients underwent infectious permanent mesh removal and
wound débridement. Mean defect size was 125.0 ± 23.5 cm(2). The aponeurosis of the external oblique muscle was transected and separated from internal oblique muscle to reach abdominal closure. Acellular dermal matrix was placed in an onlay fashion and mean mesh size was 300.0 ± 65.0 cm(2). Thirty-five patients had a mean follow-up period of 36.5 ± 12.5 months.
Wound bleeding and partial dehiscence occurred at 36 hours postoperatively. Five patients reported abdominal wall
pain during the first postoperative month. Five patients developed
surgical site infection. Four patients were detected to develop
seroma with volume more than 20 mL by B-ultrasound examination. No recurrence and chronic
foreign body sensation were followed up. Use of acellular dermal matrix combined with a component separation technique is safe and efficient management for repair of contaminated large
ventral hernia, in which permanent
prosthesis placement is contraindicated.