A preliminary comparison study of two noncrosslinked biologic meshes used in complex ventral hernia repairs

Combined use of composite mesh and acellular dermal matrix graft for abdominal wall repair following tumour resection

BACKGROUND

Surgeries for sarcomas in the abdominal wall require wide resections, often radical en bloc resections, which generate major defects involving a very complex repair. The combined use of porcine dermal xenografts, together with composite meshes, may assist in the repair of these defects with minimal complications.

METHOD

We present a series of 19 patients (10 males and 9 females), with a mean age of 53.2 years (range: 11-86 years) treated in the Sarcoma Unit of the Virgen de la Arrixaca University Hospital from January 2015 to December 2021. Histopathologically, there were four chondrosarcomas (21%), three Ewing sarcomas (15.7%), two desmoid tumours (10.5%), two undifferentiated pleomorphic sarcomas (10.5%), two well-differentiated liposarcomas (10.5%), two leiomyosarcomas (10.5%), one synovial sarcoma, one dermatofibrosarcoma protuberans, one fibromyxoid sarcoma (or Evans tumour), and one metastasis from an adenocarcinoma of unknown origin. All the patients were resected following surgical oncology principles and reconstructed by means of the combined use of a composite mesh acting as a neoperitoneum and a porcine dermal xenograft acting as an abdominal neofascia.

RESULTS

The mean size of the defects generated after surgery for tumour excision was 262.8 cm2 (range: 150-600 cm2). After a mean follow-up of 38 months, six patients (31.5%) developed complications-two cases of wound dehiscence, one case of surgical wound infection, one case of graft partial necrosis, one case of anastomotic leak and one death due to multiorgan failure secondary to massive bronchoaspiration.

CONCLUSION

Surgeries for sarcomas of the abdominal wall require wide oncological resections, which generate major abdominal wall defects. The repair of these defects by means of the combined use of synthetic and biological meshes is a technique associated with minimal complications and excellent medium-term results.

Combined Double-breasted Full-thickness Abdominal Flap Plication and Acellular Dermal Matrix in Prune-belly Syndrome Reconstruction

Background

Reconstruction of the abdominal wall in patients with prune-belly syndrome (PBS) following previous intra-abdominal procedures is a challenging problem with a high incidence of revision due to persistent bulging or herniation. The abdominal wall flaccidity not only produces a severe psychological and aesthetic discomfort for the patient but often determines functional disabilities, including inability to cough properly, impaired bowel and bladder function, and delay in posture and balance.

Methods

The authors describe three cases of reconstruction of abdominal wall using a modified double-breasted abdominoplasty fascial plication with additional acellular dermal matrix interposition and review the literature for innovations in the use of abdominal repair for reconstruction of these difficult cases.

Results

Three children with PBS at a mean age of 7.3 years achieved successful reconstruction of the abdominal wall, using the modified double-breasted abdominoplasty fascial plication with acellular dermal matrix interposition. Patients underwent previous procedures, including orchiopexy in two patients and bilateral nephrectomy in one patient. No postoperative complications have been found, apart from superficial skin dehiscence along the abdominal incision treated conservatively in one child. At mean follow-up of 42 months (range 28-56 months), no patient presented incisional hernia, persistent or recurrent fascial laxity with abdominal bulging. All patients achieved significant aesthetic and functional improvements, including children's ability to cough, spontaneous gain of abdominal tonus, balance, and ambulation.

Conclusion

Modification of the original vertical, two-layer plications of the deficient abdominal interposing biological mesh has the purpose of improving strength, aesthetics, and function of the abdominal wall in pediatric patients with PBS.

Outcomes of Abdominal Wall Reconstruction with a Bovine versus a Porcine Acellular Dermal Matrix: A Propensity Score-Matched Analysis

BACKGROUND

Abdominal wall reconstruction (AWR) is one of the most commonly performed procedures, yet large comparative studies comparing outcomes of AWR using bovine acellular dermal matrix (BADM) and porcine acellular dermal matrix (PADM) are lacking.

METHODS

In this retrospective cohort study of patients who underwent AWR from March of 2005 to June of 2019, the primary comparative outcome measure was hernia recurrence with BADM versus PADM. The secondary outcome was the incidence of surgical-site occurrence (SSO) and surgical-site infection. A propensity score matching approach was applied to compare the clinical outcomes between the two study groups.

RESULTS

The authors identified 725 patients who underwent AWR using BADM (50.5%) or PADM (49.5%). Their mean ± SD age was 59.8 ± 11.5 years, mean body mass index was 31.4 ± 6.7 kg/m 2 , and mean follow-up time was 42 ± 29 months. With propensity score matching, 219 matched pairs were identified. Hernia recurrence rates in BADM (11.4%) and PADM (13.7%) groups did not differ significantly ( P = 0.793). SSO (26.5% versus 29.2%; P = 0.518) and SSI (13.2% versus 11%; P = 0.456) rates did not differ significantly in the PADM and BADM groups, respectively. Conditional logistic regression model and marginal Cox proportional hazards regression model determined that type of acellular dermal matrix was not significantly associated with SSOs (adjusted OR, 1.11; 95% CI, 0.74 to 1.70; P = 0.589) or hernia recurrence (adjusted hazard ratio, 0.85; 95% CI, 0.50 to 1.42; P = 0.52).

CONCLUSIONS

Both BADMs and PADMs provide durable, long-term outcomes. The hernia recurrence and postoperative surgical complication rates were not significantly different between BADM and PADM.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Dermal Matrices: Do We Always Know What Is Going On?

The use of dermal matrices in abdominal wall reconstruction has gained increased attention over time, particularly in contaminated fields. One of their advantages is the greater capacity to resist infection. We report a case of a 36-year-old man, with congenital bladder exstrophy and neobladder reconstruction during childhood. He presented to us with an abdominal hernia associated with a vesicocutaneous fistula. We used a bovine-derived dermal matrix (SurgiMend®, TEI Biosciences, MA, USA) for reinforcement of the abdominal repair considering its laboratory-proven mechanical superiority regarding strength. The early postoperative period was complicated by an infection that led to mesh disintegration and the need for surgical revision. We believe that matrix digestion by bacterial enzymes culminated in rapid breakdown of the product. Further investigations are warranted to determine optimal selection criteria and indications of bioprosthesis in contaminated wounds. Surgeons should be cautious when selecting a biologic mesh in these cases, favoring meshes with a better integration profile.

Semiresorbable biologic hybrid meshes for ventral abdominal hernia repair in potentially contaminated settings: lower risk of recurrence

In case of potential contamination, implantation of synthetic meshes in hernia and abdominal wall surgery is problematic due to a higher risk of mesh infection. As an alternative, a variety of different biologic meshes have been used. However, relevant data comparing outcome after implantation of these meshes are lacking. Between January 2012 and October 2021, biologic meshes were used for reconstruction of the abdominal wall in 71 patients with preoperative or intraoperative abdominal contamination. In this retrospective study, semiresorbable biologic hybrid meshes (BHM) and completely resorbable meshes (CRM) were compared and analyzed using a Castor EDC database. In 28 patients, semiresorbable biologic hybrid meshes were used; in 43 patients, completely resorbable meshes were used. Both groups showed no difference in age, gender, BMI, operation duration, hernia size and Charlson comorbidity index. The risk degree of surgical-site occurrences was graded according to the Ventral Hernia Working Group (VHWG) classification, and the median value was 3 (range 2-4) in the BHM group and 3 (range 2-4) in the CRM group. Hernia recurrence within 24 months after hernia repair was significantly lower in the BHM group (3.6% vs. 28.9%; p = 0.03), while postoperative complication rate, with respect to seromas in need of therapy (61.4% vs. 55.5%, p = 0.43) and operative revision (28.6% vs. 16.3%, p = 0.22) was not different in either group. Biologic hybrid meshes can be used safely in case of possible contamination. BHM seems to reduce the risk of hernia recurrence compared to completely resorbable biologic meshes, but this has to be investigated further.

Comparison of outcomes of ventral hernia repair using different meshes: a systematic review and network meta-analysis

PURPOSE

We conducted a network meta-analysis to evaluate potential differences in patient outcomes when different meshes, especially biological meshes, were used for ventral hernia repair.

METHODS

PubMed, Embase, Cochrane Library, and Clinical Trials.gov databases were searched for studies comparing biological meshes with biological or synthetic meshes for ventral hernia repair. The outcomes were hernia recurrence rate, surgical site infection, and seroma. We performed a two-step network meta-analysis to investigate the outcomes of several biological meshes: non-cross-linked human acellular dermal matrix (NCHADM), non-cross-linked porcine ADM (NCPADM), non-cross-linked bovine ADM (NCBADM), cross-linked porcine ADM (CPADM), and porcine small intestinal submucosa (PSIS).

RESULTS

From 6304 publications, 23 studies involving 2603 patients were finally included. We found no differences between meshes in recurrence at 1-year follow-up and in surgical site infection rate. NCBADM was associated with the lowest recurrence rate and the lowest surgical site infection rate. NCHADM implantation was associated with the lowest rate of seroma. PSIS was associated with a higher risk of seroma than NCHADM (pooled risk ratio 3.89, 95% confidence interval 1.13-13.39) and NCPADM (RR 3.42, 95% CI 1.29-9.06).

CONCLUSIONS

Our network meta-analysis found no differences in recurrence rate or surgical site infection among different biological meshes. The incidence of postoperative seroma was higher with PSIS than with acellular dermal matrices. We observed large heterogeneity in the studies of ventral hernia repair using biological meshes, and, therefore, well-designed randomized clinical trials are needed.

Management of Aesthetical and Functional Complications after Total Parotidectomy. First Long-Term Experiences with Dermal Matrix Surgimend ® in Patient Affected by Malignant Parotid Tumors

Background

This is an observational cohort study on patients affected by malignant parotid tumors treated with total parotidectomy. The aim of our work is to analyze and compare the effects and complications after parotidectomy, using or not SurgiMend ®.

Methods

40 patients were retrospectively enrolled between September 2014 and June 2020. Basing on the placement of SurgiMend ® for parotid lodge reconstruction, the samples were divided into two groups. Thus, the incidence rate of complications after the surgical procedure was analyzed between the two groups.

Results

Patients in whom SurgiMend ® was used reported a lower rate of complications. The ANOVA test (p = 0.05) revealed a significant difference of Vancouver Scar Scale (VSS) between the two groups, representation as vascularity and pigmentation improvement, changing scar color, scar height reduction, and increased pliability.

Conclusion

Although many techniques are available to fill the parotidectomy defect, improve facial contour and prevent Frey’s syndrome, the use of SurgiMend ® matrix is one of most effective and reliable method to address these complications, with the advantage of decreased operative time due to not require an additional surgical donor site.

Bovine versus porcine acellular dermal matrix for abdominal wall herniorrhaphy or bridging

BACKGROUND

The management of complicated ventral hernias (CVH), namely ventral hernias in actively or recently infected/contaminated operative fields, and open abdomens in which the native fascia cannot be primarily reapproximated, pose a surgical challenge. Fetal Bovine and Porcine Acellular Dermal Matrix (BADM and PADM) biologic meshes are being increasingly used in these scenarios. A comparison, however, of clinically relevant outcomes between the two is lacking. With this investigation, we aim to review and compare clinically relevant outcomes in patients that underwent abdominal wall herniorrhaphy with either BADM or PADM at a tertiary urban academic institution over a 5-year period.

METHODS

Patients who had a BADM or PADM implanted during CVH over a 5-year period at a tertiary urban academic hospital were identified. Baseline clinical and hernia characteristics, as well as postoperative outcomes were compared after a retrospective chart review. Phone interviews were also conducted to assess for recurrence, followed by in-person visits as indicated. Cox Proportional Hazard regression was fitted to identify risk factors for recurrence.

RESULTS

Of the 140 patients who underwent biologic mesh implantation for CVH, 109 were for ventral hernia repair and 31 for open abdomen bridging. Mean age was 52.7 ± 14.2 and males constituted 57.9% of our sample, while 25.1% had undergone > 5 prior abdominal operations. Thirty percent were active smokers, and another 30% required emergency surgery. Only immunosuppression was a risk factor for recurrence [HR 13.3 (1.04-169.2), p = 0.047] on Cox Proportional Hazard regression, while mesh selection had no effect.

CONCLUSIONS

Both BADM and PADM meshes perform well in CVH, with satisfactory recurrence rates, only slightly higher compared to traditional synthetic mesh repairs.

Systematic review and meta-analysis of risk factors for Mesh infection following Abdominal Wall Hernia Repair Surgery

BACKGROUND

Surgical Mesh Infection (SMI) after Abdominal Wall Hernia Repair (AWHR) represents a catastrophic complication. We performed a systematic review and meta-analysis to analyze the risk factors for SMI in the context of AWHR.

METHODS

PubMed, Embase, Scielo, and LILACS were searched without language or time restrictions from inception until June 2021. Articles evaluating the association between demographic, clinical, laboratory and surgical characteristics with SMI in AWHR were included.

RESULTS

23 studies were evaluated, comprising a total of 118,790 patients (98% males; mean age 56.5 years) with a mesh infection pooled prevalence of 4%. Significant risk factors for SMI were type 2 diabetes mellitus, obesity, smoking history, steroids use, ASA III/IV, laparotomy vs laparoscopy, emergency surgery, duration of surgery and onlay mesh position vs sublay. The quality of evidence was regarded as very low-moderate.

CONCLUSION

Several factors, highlighting sociodemographic characteristics, comorbidities, and the clinical scenario, may increase the risk of developing mesh infections in AWHR. The recognition and mitigation of these may significantly reduce mesh infection rates in this context.

Bioprosthetic Versus Synthetic Mesh: Analysis of Tissue Adherence and Revascularization in an Experimental Animal Model

Supplemental Digital Content is available in the text.

Background:

Both synthetic and bioprosthetic meshes play important roles in surgical procedures such as ventral hernia repair. Although sometimes used interchangeably, these devices have inherently different properties. We therefore sought to better understand how these materials interact with the host environment to optimize surgical techniques and to improve outcomes.

Methods:

Synthetic mesh (polypropylene, Prolene) or bioprosthetic mesh (acellular fetal/neonatal bovine dermis, SurgiMend) was implanted intraperitoneally into rats lateral to a ventral incision in a novel intra-abdominal implant model. Two variables were modified with each material: (1) tight or loose tissue apposition, altered by modifying suture placement; and (2) abdominal wall injury, altered by selective abrasion of the peritoneal lining. After 5 weeks, the meshes and abdominal wall were evaluated grossly and histologically. The analysis focused on the degree of inflammatory response, neovascularization, and mesh adherence to the surrounding tissues.

Results:

Synthetic mesh adhered to the abdominal wall and visceral organs, regardless of the degree of apposition or tissue injury, due to a foreign body–mediated inflammatory reaction. In areas of noninjured peritoneal lining, SurgiMend was adherent peri-suture. Neovascularization entered the mesh from these apposition points and spread outward. In areas of denuded peritoneal lining, the adherent and vascularized areas were significantly greater and not merely coincident with suture placement.

Conclusions:

The inflammatory and wound healing responses with bioprosthetic mesh seem fundamentally different from synthetic mesh. Understanding these differences may lead to varied outcomes in adherence and vascularization of the materials, and ultimately the efficacy of hernia repair. Additionally, these differences highlight the need for further basic research to optimize mesh selection for surgical technique.

Bovine fetal collagen reinforcement in a small animal model of hernia with component repair

BACKGROUND

Component separation is a surgical strategy used to achieve abdominal wall reconstruction for patients with significant ventral hernias. With an increasing number of variations in procedural techniques and materials, the development of a small animal model of this surgery would allow for the controlled evaluation of variables with analytics not available in human clinical studies. To test this model, we investigated the reinforcement of these component repairs in rats with a bovine fetal collagen (BFC) scaffold.

METHODS

Fifty Sprague Dawley rats were randomized into either component repair alone or BFC reinforced component repair. At time points up to 1 y, these groups were evaluated for hernia formation, strength of repair, strength of mesh-muscle interface, and histology of the repair site.

RESULTS

Anterior component separation was achievable and reproducible in this small animal model. Significantly fewer hernias were found in BFC reinforced repairs. The change in transverse abdominal length was lower for reinforced repairs indicating less external oblique retraction, and reinforced repairs were consistently stronger than controls through 1 y. BFC was revascularized and repopulated with host cells but not rapidly degraded.

CONCLUSIONS

This small animal model of hernia repair with anterior component separation was effective in evaluating the reinforcement of a hernia repair with mesh. It may be useful in future work for the controlled, comparative investigation of different repair techniques and mesh materials in anterior component separation hernia repairs. Additionally, bovine fetal collagen was found to effectively reinforce component repairs and undergo an assimilation process including rapid revascularization and repopulation with host cells followed by gradual extracellular matrix remodeling.

Biologic versus Synthetic Mesh Reinforcement: What are the Pros and Cons?

Preserving patients' native tissues has posed many challenges for surgeons. Increased life expectancy is leading to a proportionately older surgical population with weaker tissues. The growing population of morbidly obese patients in addition to those with multiple comorbidities which influence the native strength and perfusion of tissues compounds the surgeon's challenge. Certainly, there is a rising demand for materials to replace or augment a patient's native tissue when it has been compromised. Over time, the number of products available has increased substantially. The ideal substitute, however, is debatable. The manufacturing and processing of these materials has become more complex and this has resulted in a significant increase in cost. The composition of the mesh, clinical scenario, and operative technique all interact to impact the long-term results. Surgeons require a thorough understanding of these products to guide proper selection and use, to ensure optimal outcomes for patients, and to properly steward financial resources. This review will outline the properties of commonly used materials, highlighting the strength and weakness of each. It will then discuss recommendations regarding mesh selection, coding, and reimbursement. While general principles and trends can be highlighted, further studies of biologic versus synthetic meshes are clearly necessary.

A systematic review of outcomes following repair of complex ventral incisional hernias with biologic mesh

Repair of contaminated/infected ventral incisional hernias is marked by high rates of recurrence, complications, and/or explantation of synthetic mesh. Biologic mesh products are recommended for repair to permit reconstruction and reduce complications. A systematic review of PubMed, EMBASE, and Cochrane databases identified English-language articles reporting postoperative outcomes (e.g., hernia recurrence, infection, mesh explantation) in patients undergoing contaminated/infected ventral incisional herniorrhaphy. Eleven studies met inclusion criteria and contained quantitative outcome data. All were retrospective chart reviews of biologic mesh use (mostly human acellular dermal matrix). Hernia recurrence and wound infection rates were highly variable and inconsistently reported across studies. Mesh explantation was rarely reported. Outcome variability is likely owing to heterogenous patient populations, surgical technique variations, and follow-up duration. Biologic mesh use in contaminated/infected herniorrhaphy was marked by low reported rates of secondary surgeries for infected mesh removal. Data from large, well-controlled, prospective trials with biologic mesh products are needed.

A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields

BACKGROUND

Guidelines recommend the use of bioprosthetics for abdominal wall reinforcement in contaminated fields, but the evidence supporting the use of biologic over synthetic non-absorbable prosthetics for this indication is poor. Therefore, the objective was to perform a systematic review of outcomes after synthetic non-absorbable and biologic prosthetics for ventral hernia repair or prophylaxis in contaminated fields.

METHODS

The systematic literature search identified all articles published up to 2013 that reported outcomes after abdominal wall reinforcement using synthetic non-absorbable or biologic prosthetics in contaminated fields. Studies were included if they included at least 10 cases (excluding inguinal and parastomal hernias). Quality assessment was performed using the MINORS instrument. The main outcomes measures were the incidence of wound infection and hernia at follow-up. Weighted pooled proportions were calculated using a random effects model.

RESULTS

A total of 32 studies met the inclusion criteria and were included for synthesis. Mean sample size was 41.4 (range 10-190), and duration of follow-up was >1 year in 72 % of studies. Overall quality was low (mean 6.2, range 1-12). Pooled wound infection rates were 31.6 % (95 % CI 14.5-48.7) with biologic and 6.4 % (95 % CI 3.4-9.4) with synthetic non-absorbable prosthetics in clean-contaminated cases, with similar hernia rates. In contaminated and/or dirty fields, wound infection rates were similar, but pooled hernia rates were 27.2 % (95 % CI 9.5-44.9) with biologic and 3.2 % (95 % CI 0.0-11.0) with synthetic non-absorbable. Other outcomes were comparable.

CONCLUSIONS

The available evidence is limited, but does not support the superiority of biologic over synthetic non-absorbable prosthetics in contaminated fields.

The single fascial incision modification of the "open-book" component separation repair: a 15-year experience

PURPOSE

Complex abdominal wall hernias can be challenging for the reconstructive surgeon. The use of autologous tissue is preferable when possible. The authors review their 15-year experience regarding the "open-book" technique of ventral hernia repair. This repair entails a single fascial incision releasing the external oblique and concurrently incorporates the anterior rectus sheath as a turnover flap for abdominal wall reconstruction. This modification allows large defects to be closed with autologous tissue alone in a 2-layer fascial repair in a vest-over-pants fashion in a simple, straightforward surgical approach.

METHODS

A 15-year, single-surgeon retrospective review was conducted of 35 consecutive select patients who underwent component separation using the open-book variation. Hospital and office-based charts were reviewed. Complications were recorded as either major (hernia recurrence or any complication requiring readmission or reoperation) or minor (treated on an outpatient basis). Individual complications included hernia recurrence, infection, seroma, hematoma, and skin necrosis.

RESULTS

Sixty-three percent of the patients in the study had, at minimum, 1 recognized comorbidity before reconstructive surgery. Only 2 (6%) of 35 patients experienced hernia recurrence during the course of the 15 years. The minor complication rate was 8/35 (23%), including infection (5; 14%), skin necrosis (5; 14%), and hematoma (1; 3%). The major complication rate was 5/35 (14%), including hernia recurrence (2; 6%), infection (2; 6%), skin necrosis (2; 6%), and hematoma (1; 3%). Factors associated with a statistically significant increased rate of overall complications included chronic obstructive pulmonary disease (80%; P = 0.03) and hypertension (39%; P = 0.04). The average length of follow-up was 16 (3) months.

CONCLUSIONS

Our series suggests that with appropriate patient selection, this technique is associated with a low hernia recurrence rate when compared to the published literature. Additionally, the major complication rate is acceptable given these patients' many comorbidities and complicated surgical history. The presence of chronic obstructive pulmonary disease and/or hypertension was found to be statistically associated with an increased complication rate. The single fascial incision modification of the open-book component separation technique is an effective addition to the reconstructive surgeons' armamentarium in the management of these patients.

Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations

BACKGROUND

Mesh implantation during abdominal wall reconstruction decreases rates of ventral hernia recurrence and has become the dominant method of repair. The authors provide a comprehensive comparison of surgical outcomes and complications by location of mesh placement following ventral hernia repair with onlay, interposition, retrorectus, or underlay mesh.

METHODS

A systematic search of the English literature published from 1996 to 2012 in the PubMed, MEDLINE, and Cochrane library databases was conducted to identify patients who underwent abdominal wall reconstruction using either prosthetic or biological mesh for ventral hernia repair. Demographic information was obtained from each study.

RESULTS

Sixty-two relevant articles were included with 5824 patients treated with mesh repair of a ventral hernia between 1996 and 2012. Mesh position included onlay (19.6 percent), underlay (60.7 percent), interposition (6.4 percent), and retrorectus (12.4 percent). Prosthetic mesh was used in 80 percent of repairs and biological mesh in 20 percent. The weighted mean incidences of early events were as follows: wound complications, 19 percent; wound infections, 8 percent; seroma or hematoma formation, 11 percent; and reoperation, 10 percent. The weighted mean incidences of late complications included 8 percent for hernia recurrence and 2 percent for mesh explantation. Recurrence rates were highest for onlay (17 percent) or interposition (17 percent) reinforcement. The infection rate was also highest in the interposition cohort (25 percent). Seroma rates were lowest following a retrorectus repair (4 percent).

CONCLUSIONS

Mesh reinforcement of a ventral hernia repair is safe and efficacious, but the location of the reinforcement appears to influence outcomes. Underlay or retrorectus mesh placement is associated with lower recurrence rates.

Bioprosthetic tissue matrices in complex abdominal wall reconstruction

Background:

Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction.

Methods:

We reviewed the peer-reviewed literature on the use of bioprosthetic mesh in human subjects. Basic science articles and large retrospective and prospective reviews were included in author’s analysis. The clinical performance and characteristics of 13 bioprosthetic tissue matrices were evaluated.

Results:

The majority of the products evaluated perform well in contaminated fields, where the risk of wound-healing difficulties is high. Clinical outcomes, which included infection, reherniation, and bulge formation, were variable, and the majority of the studies had a mean follow-up of less than 24 months.

Conclusions:

Although bioprosthetic matrix has a multitude of indications within the growing field of abdominal wall reconstruction, the functionality, regenerative capacity, and long-term fate of these products have yet to be fully established. Furthermore, the clinical performance, indications, and contraindications for each type of matrix need to be fully evaluated in long-term outcome studies.

Total heterotopic ossification of an acellular dermal matrix used for abdominal wall reconstruction

Heterotopic ossification is an observable phenomenon in the setting of abdominal wounds, estimated to effect 25% of all patients after midline abdominal surgery. The development of acellular dermal matrices has revolutionised the approach in repairing abdominal hernias, especially for potentially contaminated wounds. We describe a case of heterotopic bone formation incorporating the whole of an acellular dermal matrix in a patient on chronic steroid therapy.