Complex ventral hernia repair with a human acellular dermal matrix

Abstract

PurposeThe ideal approach to complex ventral hernia repair is frequently debated. Differences in processing techniques among biologic materials may impact hernia repair outcomes. This study evaluates the outcomes of hernia repair with a terminally sterilized human acellular dermal matrix (TS-HADM) (AlloMax® Surgical Graft, by C. R. Bard/Davol, Inc., Warwick, RI, USA) treated with low-dose gamma irradiation.MethodsA single-arm multi-center retrospective observational study of patients undergoing hernia repair with TS-HADM was performed. Data analyses were exploratory only; no formal hypothesis testing was pre-specified.ResultsSeventy-eight patients (43F, 35M) underwent incisional hernia repair with a TS-HADM. Mean follow-up was 20.5 months. Preoperative characteristics include age of 56.6 ± 11.1 years, BMI 36.7 ± 9.9 kg/m2, and mean hernia defect size 187 cm2. Sixty-five patients underwent component separation technique (CST) with a reinforcing graft. Overall, 21.8 % developed recurrences. Recurrences occurred in 15 % of patients repaired with CST. Major wound complications occurred in 31 % of patients overall. Based upon CDC surgical wound classification, major wound complications were seen in 26, 40, 56, and 50 % of Class 1, 2, 3, and 4 wounds, respectively. No grafts required removal.ConclusionsHernia recurrences are not uncommon following complex abdominal wall reconstruction. Improved outcomes are seen when a TS-HADM is utilized as reinforcement to primary fascial closure.

Component Separation or Mesh Repair for Ventral Hernia Repair - The Role of Mesh in Covering all the Abdominal Wall in the Component Repair

“…A cellular dermal matrix has been also suggested in this cases to resist to infection as well as porcine [3,17]. Open component separation, which allows autologous tissue repair with approximation of a midline fascia in patients with complex hernias, creates large skin flaps that prevent the visualization of epigastric vessels; this problem notwithstanding recurrence rates is similar for open and laparoscopic techniques [14,15,17]. Although there is a trend towards laparoscopic surgery the laparoscopic repair does not resolve the matter of the ventral hernia's being a problem with the abdominal wall [18][19][20][21][22][23].…”

“…The open intraperitoneal technique is appropriate for complex incisional hernias occurring in obese patients, but is contraindicated when laparoscopic access has been obtained; minimal access was shown to be feasible in patients with a larger mesh of 15 cm [14][15][16]. A cellular dermal matrix has been also suggested in this cases to resist to infection as well as porcine [3,17]. Open component separation, which allows autologous tissue repair with approximation of a midline fascia in patients with complex hernias, creates large skin flaps that prevent the visualization of epigastric vessels; this problem notwithstanding recurrence rates is similar for open and laparoscopic techniques [14,15,17].…”

Scarring vs. functional healing: Matrix-based strategies to regulate tissue repair

“…Numerous materials derived from decellularized tissues are used clinically to repair tissue in diverse applications including plastic and reconstructive, dental, orthopaedics, and cardiovascular procedures among others. The most extensive clinical use of ECM scaffolds is for hernia repair, where xenogeneic and allogeneic decellularized tissues like Surgisis ® , Allomax ® , and AlloDerm ® , are considered to have improved performance characteristics over synthetic mesh materials [139–142]. Decellularized tissues have also aided in the repair of critically sized skin defects.…”

Prevention of patch infection after abdominal external hernia repair

“…A recent study has used human acellular dermal matrices (HADMs) for repairing [1]. HADMs feature strong anti-infection ability and are suitable for patients at a high risk of infection [13]. However, HADMs have few sources, are expensive, and are difficult to promote [1].…”