15 research outputs found
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Use of human acellular dermal matrix for hernia repair: friend or foe?
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.
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.
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.
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
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A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions
PURPOSE: We used an evidence-based approach to determine if the promotions and claims of superiority of biologic mesh over synthetic mesh use in ventral hernia repairs (VHRs) under contaminated conditions were sound and valid. METHODS: We searched the Medline database to specifically identify review articles relating to biologic mesh and VHR and critically reviewed these studies using an evidence-based approach. RESULTS: For the past forty-five years, four clinical reviews and one systematic review have included biologic meshes as part of a larger discussion on available prosthetics for VHR. All reviews supported biologic mesh use, especially in the setting of contaminated fields. Yet the primary literature included in these reviews and served as the basis for these conclusions consisted entirely of case series and case reports, which have the lowest level of evidence in determining scientific validity. Furthermore the FDA has neither cleared nor approved this particular use. CONCLUSIONS: The cumulative data regarding biologic mesh use in VHRs under contaminated conditions does not support the claim that it is better than synthetic mesh used under the same conditions. The highly promoted and at least moderately utilized practice of placing biologic mesh in contamination is being done outside of the original intended use, and a re-evaluation of or possible moratorium on biologic mesh use in hernia surgery is seriously warranted. Alternatively, an industry-sponsored national registry of patients in whom ventral hernia repairs involved biologic mesh would substantively add to our understanding regarding how these intriguing biomaterials are being used and their overall clinical efficacy