Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. ACTA ACUST UNITED AC. 2008;65:349-353. [PMID: 18695470 DOI: 10.1097/ta.0b013e31817fb782]

Abdominal wall repair using human acellular dermal matrix: a follow-up study

BACKGROUND

The role of acellular dermal matrix (ADM) in abdominal wall reconstruction (AWR) is unclear. The aim of this study was to review the management, complications, and long-term outcomes of AWR using ADM in a large surgical cohort.

METHODS

Retrospective chart review of patients undergoing AWR using ADM from 2004 to 2007 was performed. Demographic data, comorbidities, complications, and long-term outcomes were collected.

RESULTS

There were 77 cases in 68 patients with mean age of 61.1 +/- 1.4 years. The most common indication was infected fascia (n = 19 [25%]). Wound closure was achieved in 75% of the cases via primary (n = 26 [45%]), secondary intention (n = 17 [29%]), or skin graft (n = 15 [26%]). Nonprimary closure was achieved in 5.7 +/- .7 months. There were 32 perioperative (39%) and 33 long-term (43%) complications. Over a mean follow-up period of 13.2 +/- 1.5 months, the hernia recurrence rate was 27% (n = 21).

CONCLUSION

Although ADM is a viable option in AWR, the high hernia recurrence rate warrants a continued search for alternative biologic materials to improve outcomes.

Human peritoneal membrane reduces the formation of intra-abdominal adhesions in ventral hernia repair: experimental study in a chronic hernia rat model

BACKGROUND

Adhesions leading to intestinal obstructions and fistulae are severe complications related to the intraperitoneal placement of synthetic meshes. This study evaluated the efficacy of human peritoneal membrane (HPM) in a chronic hernia repair rat model as an anti-adhesive solution for preventing the development of intra-abdominal adhesions.

MATERIALS AND METHODS

The mechanical properties of HPM and human fascia lata (HFL) were evaluated prior to in vivo implantation. Twenty rats underwent midline laparotomy, which led to the development of chronic hernias 28 d later. Then, animals underwent incisional hernia repair in an underlay fashion (n=5/mesh group) with compressed poly(tetra-fluoro-ethylene) (cPTFE), onto which HPM or HFL were affixed pre-repair, along with two additional controls. The extent and tenacity of intra-abdominal adhesions were determined through qualitative gross evaluations and quantitative tensiometry at 30 d post-repair. The host tissue response was evaluated histologically.

RESULTS

In hydrated state, the elastic properties of HPM were superior to HFL. Repairs with HPM had significantly less surface area covered by adhesions, with significantly lower tenacity compared with all other groups. Furthermore, intra-abdominal adhesions developed in the presence of HPM were associated with omentum only, and were distributed around the perimeter of the exposed cPTFE. HPM served as an active tissue remodeling template, replacing the traditional foreign body encapsulation with an anatomically and physiologically superior outcome.

CONCLUSIONS

HPM significantly reduces the extent and tenacity of intra-abdominal adhesion formation, and represents a bioprosthetic template that encourages structural and functional neo peritonealization.