Use of human acellular dermal matrix for hernia repair

Friend or foe?

Raymond Candage, Keith Jones, Fred A. Luchette, James M. Sinacore, Darl Vandevender, R. Lawrence Reed

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)703-711
Number of pages9
JournalSurgery
Volume144
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Acellular Dermis
Herniorrhaphy
Abdominal Wall
Hernia
Bioprosthesis
Abdominal Hernia
Ventral Hernia
Wounds and Injuries
Recurrence
Comorbidity
Intestinal Fistula
Surgical Wound Infection
Peritonitis
Prostheses and Implants
Coronary Artery Disease
Diabetes Mellitus
Demography
Hypertension
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Candage, R., Jones, K., Luchette, F. A., Sinacore, J. M., Vandevender, D., & Reed, R. L. (2008). Use of human acellular dermal matrix for hernia repair: Friend or foe? Surgery, 144(4), 703-711. https://doi.org/10.1016/j.surg.2008.06.018

Use of human acellular dermal matrix for hernia repair : Friend or foe? / Candage, Raymond; Jones, Keith; Luchette, Fred A.; Sinacore, James M.; Vandevender, Darl; Reed, R. Lawrence.

In: Surgery, Vol. 144, No. 4, 10.2008, p. 703-711.

Research output: Contribution to journalArticle

Candage, R, Jones, K, Luchette, FA, Sinacore, JM, Vandevender, D & Reed, RL 2008, 'Use of human acellular dermal matrix for hernia repair: Friend or foe?', Surgery, vol. 144, no. 4, pp. 703-711. https://doi.org/10.1016/j.surg.2008.06.018
Candage R, Jones K, Luchette FA, Sinacore JM, Vandevender D, Reed RL. Use of human acellular dermal matrix for hernia repair: Friend or foe? Surgery. 2008 Oct;144(4):703-711. https://doi.org/10.1016/j.surg.2008.06.018
Candage, Raymond ; Jones, Keith ; Luchette, Fred A. ; Sinacore, James M. ; Vandevender, Darl ; Reed, R. Lawrence. / Use of human acellular dermal matrix for hernia repair : Friend or foe?. In: Surgery. 2008 ; Vol. 144, No. 4. pp. 703-711.
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title = "Use of human acellular dermal matrix for hernia repair: Friend or foe?",
abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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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N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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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