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Surgery. 2008 Oct;144(4):703-9; discussion 709-11. doi: 10.1016/j.surg.2008.06.018. Epub 2008 Aug 29.

Use of human acellular dermal matrix for hernia repair: friend or foe?

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1
Divisions of General Surgery and Plastic Surgery, Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.

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.

PMID:
18847657
DOI:
10.1016/j.surg.2008.06.018
[Indexed for MEDLINE]
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