A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Abstract

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on permacol implants in patients with a cAWD. our data suggest that permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods

“…[162][163][164] In addition, acellular dermal meshes may produce infection, seroma, wound dehiscence in the short-term and mesh infection and recurrence complications in the long-term, as well as hernia recurrences. 165,166 Therefore, although this type of repair can produce satisfactory results in some cases, it is far from being a definitive method of hernia repair. 167,168 To tailor the degradation speed of the mesh and increase its stability to enzymatic decomposition, chemical crosslinking reactions can be carried out, using…”

Prosthetic Meshes for Hernia Repair: State of Art, Classification, Antimicrobial Approaches, and Fabrication Methods

“…As such, some surgeons only use this type of mesh for the repair of complex defects of the abdominal wall [157][158][159]. In addition, acellular dermal meshes may produce infection, seroma, wound dehiscence in the short-term and mesh infection and recurrence complications in the long-term, as well as hernia recurrences [160,161]. Therefore, although this type of repair can produce satisfactory results in some cases, it is far from being a definitive method of hernia repair.…”

A novel surgical solution to impossible fascial closure due to contaminated abdominal cavities: A case report

“…Due to previous laparotomies, the abdominal wall fascia could not be approximated without tension and fascial edges still could not reach one another during closure [7] . Moreover, due to the contamination of the abdomen with secretions, it was not possible to insert a synthetic mesh for abdominal closure based on the high risk of infection (it is important to note that biological mesh is also very expensive and not routinely available to surgeons in lower socioeconomic nations) [8] , [9] . To address this issue, this new abdominal wall defect (which was more limited than the first one) was covered by ipsilateral skin flaps as a novel procedure (please refer to Fig.…”