Noncrosslinked Porcine-derived Acellular Dermal Matrix for Single-stage Complex Abdominal Wall Herniorrhaphy after Removal of Infected Synthetic Mesh: A Retrospective Review

Abstract

This retrospective case review details the use of noncrosslinked intact porcine-derived acellular dermal matrix (PADM) for incisional herniorrhaphy in patients with infected synthetic mesh. A consecutive series of adult patients underwent single-stage ventral herniorrhaphy involving removal of infected synthetic mesh and repair with PADM by a single surgeon (2009 to 2011). Comorbidities, repair procedures, postoperative complications, and hernia recurrence were noted. Of the 13 patients (mean age, 60 years; female, n = 8), seven (54%) were obese and six (46%) had chronic obstructive pulmonary disease/emphysema. Most synthetic mesh infections were polymicrobial (n = 7, 46%) or associated with Staphylococcus aureus (n = 4 [31%]). Six patients had undergone two or more previous repairs. With single-stage herniorrhaphy using PADM, primary fascial closure was achieved in 11 patients; bridged closure was required in two patients. Mean (median) duration of hospital stay was 12 (7) days and follow-up was 23 (22) months. There was one wound infection (drained surgically, PADM remained in place) and one seroma (resolved without intervention) observed during follow-up. There were two hernia recurrences, both in patients who received PADM as bridged repair. PADM yielded favorable outcomes when used for single-stage repair of complex ventral hernias in high-risk patients with infected synthetic mesh.