Acellular dermal matrix in the management of high-risk abdominal wall defects

Abstract 

Background

Ventral hernia repair in the face of a contaminated field or with questionable skin coverage requires either complex abdominal wall flaps or a staged repair. The development of biologic prostheses has altered the approach to these difficult clinical problems.

Methods

The study population consisted of human acellular dermal matrix (HADM) implantation into wounds considered high risk, defined as either infected or with poor skin coverage. Patient demographics, preoperative risk factors and infection data, postoperative wound complications, and long-term results were collected.

Results

Twenty-nine patients were identified in whom ADM was implanted into high-risk hernia defects. Forty-five percent developed a postoperative wound occurrence, with 31% requiring the wound to be either treated open or with a percutaneous drain. Ninety-six percent went on to heal without event. The follow-up evaluation averaged 182 days. Eighty-nine percent were repaired successfully with one surgery. Three recurrences have been identified.

Conclusions

The use of ADM allowed for successful primary closure in 90% of patients with intermediate- to long-term follow-up evaluation. A postoperative wound occurrence rate of 45% shows the use of this material in resisting infection. ADM can be used in ventral hernia repair in high-risk wounds with a high degree of success.

Keywords: Ventral hernia, Biologic prosthesis, Acellular dermal matrix