Use of a non–cross-linked porcine dermal scaffold in abdominal wall reconstruction

Abstract 

Background

Reconstruction of complex abdominal wall defects is challenging. The use of prosthetic mesh can be associated with surgical site infection, fistula formation, and adhesions. This study presents our experience using a non–cross-linked porcine dermal scaffold (NCPDS) in abdominal wall reconstruction.

Methods

Patients undergoing abdominal wall reconstruction with NCPDS between May 2006 and January 2008 underwent a retrospective chart review. Demographics, indications for NCPDS placement, surgical technique, complications, and follow-up data were evaluated.

Results

Sixteen patients were identified in whom NCPDS was implanted into complex abdominal wall defects. These included 13 planned and 3 emergency surgeries. Indications for surgery included delayed reconstruction of giant ventral hernia secondary to decompressive laparotomy and open management of abdominal trauma, recurrence of large incisional hernia, temporary coverage of open abdomen secondary to intra-abdominal catastrophes, and open abdominal closure owing to compartment syndrome secondary to necrotizing fasciitis. In all, NCPDS was positioned in a subfascial underlay technique. Forty-four percent required a combination of components separation and NCPDS insertion. At a mean follow-up period of 16.5 months, the majority had desirable outcomes. Complications included seroma (21%), superficial wound dehiscence (7%), recurrence (7%), and infection (7%). Two patients died from multiorgan failure unrelated to NCPDS placement. The material only had to be removed in 1 patient because of wound infection and superficial wound dehiscence.

Conclusions

NCPDS seems to be a safe and effective alternative to prosthetic mesh in the reconstruction of complicated abdominal wall defects.

Keywords: Abdominal wall reconstruction, Biological scaffolds, Non–cross-linked porcine dermis, Hernia repair