Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional ExperienceReport as inadecuate




Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional Experience - Download this document for free, or read online. Document in PDF available to download.

World Journal of Surgery

, Volume 41, Issue 8, pp 1993–1999

First Online: 06 March 2017

Abstract

BackgroundData on the use of biologic mesh in abdominal wall repair in complex cases remain sparse. Aim of this study was to evaluate a non-cross-linked porcine acellular dermal matrix for repair of complex contaminated abdominal wall defects.

MethodsRetrospective observational cohort study of consecutive patients undergoing abdominal wall repair with use of Strattice™ Reconstructive Tissue Matrix LifeCell Corporation, Oxford, UK between January 2011 and February 2015 at two National Intestinal Failure Units.

ResultsEighty patients were identified. Indications for abdominal wall repair included enterocutaneous fistula takedown n = 50, infected synthetic mesh removal n = 9, restoration of continuity or creation of a stoma with concomitant ventral hernia repair n = 12, and others n = 9. The median defect area was 143.0 cm interquartile range or IQR 70.0–256.0 cm. All had a grade III or IV hernia. Component separation technique CST was performed in 54 patients 68%. Complete fascial closure was not possible despite CST and biologic mesh-assisted traction bridged repair in 20 patients 25%. In-hospital mortality was 1%. Thirty-six patients 45% developed a wound infection. None required mesh removal. Of 76 patients with a median clinical follow-up of 7 months IQR 4–15 available for analysis, 10 patients 13% developed a hernia recurrence, of whom 3 had undergone bridged repairs. Seven patients developed a postoperative recurrent fistula 9%.

ConclusionRepair of challenging and contaminated abdominal wall defects can be done effectively with non-cross-linked biologic mesh and component separation technique without the need for mesh removal despite wound infections.

The paper is based on data previously presented to a scientific meeting of the European Society of Coloproctology, Dublin, Ireland, September 2015.

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Author: J. J. Atema - E. J. Furnée - Y. Maeda - J. Warusavitarne - P. J. Tanis - W. A. Bemelman - C. J. Vaizey - M. A. Boer

Source: https://link.springer.com/article/10.1007/s00268-017-3962-2



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