Biological Implant for Complex Abdominal Wall Reconstruction: A Single Institution Experience and Review of Literature

Abstract

Biological materials have the potential to reduce morbidity and improve outcome of definitive repair of CAWR.

A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

“…A literature review on biological meshes found that Permacol is one of the most studied mesh types in the published literature 28 , especially in the context of CAWD repair. These studies, however, are mainly retrospective, single institution case series 5,9,[12][13][14][28][29][30][31][32][33][34] with only three multicenter retrospective studies 3,15,22 and one cross-sectional study 21 published to date. Our series of 60 patients represents the first large, multi-centre Italian study on Permacol mesh implants in patients with CAWD.…”

“…In our study, 93.3% of the patients were modified VHWG grade 2-3, reflecting the high rate of comorbidities and CAWDs with a contaminated surgical field. In patients with VHWG grade 1 (6.7%), a biological mesh was www.nature.com/scientificreports www.nature.com/scientificreports/ indicated due to the presence of a defect >10 cm, multiple previous repair attempts or multiple defects, as indicated by CAWD characteristics 5 .…”

“…The surgical technique can have an impact on clinical outcomes. Giordano et al found that independent of the mesh position, fascial closure is the only significant factor that affects hernia recurrence, with a higher recurrence rate when closure is not achieved (18.2% versus 5.4%) 5,15 . In our cohort, we achieved fascial closure in 53.3% patients, but this did not significantly impact the complication or recurrence rate (despite the fascia not being closed in 52.4% patients with complications and 60% of patients with recurrences).…”

“…The bridge technique is associated with an increased recurrence rate. Bridging defects with a biological mesh leads to stretching and laxity and can, therefore, result in failure of the repair, or at least in a bulging 5,29 . A previous study found that when Permacol was used to bridge a fascial defect, the hernia recurrence rates were >80% 15 .…”

“…A consensus meeting involving a large expert panel defined CAWD as any defect presenting with two or more of the following criteria: large or multiple abdominal defects ≥10 cm in width; wound class III (contaminated) or IV (dirty); parastomal, lumbar or subcostal location; multiple previous repair; loss of domain; presence of fistula; open abdomen; and/or no primary closure possible without component separation technique 4,5 . Although CAWD repair represents a surgical challenge, the use of a mesh is currently mandatory 2 ; the exception is for cases where the CAWD shows a contaminated/infected field.…”