Delayed primary closure of contaminated abdominal wall defects with non-crosslinked porcine acellular dermal matrix compared with conventional staged repair: a retrospective study

Abstract

IntroductionSynthetic mesh has been used traditionally to repair abdominal wall defects, but its use is limited in the case of bacterial contamination. New biological materials are now being used successfully for delayed primary closure of contaminated abdominal wall defects. The costs of biological materials may prevent surgeons from using them. We compared the conventional staged repair of contaminated abdominal wall defects with a single-stage procedure using a non-crosslinked porcine acellular dermal matrix.MethodsA total of 14 cases with Grade 3 contaminated abdominal wall defects underwent delayed primary closure of the abdomen using a non-crosslinked porcine acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA). The results were compared with a group of 14 patients who had received conventional treatment for the repair of contaminated abdominal wall defects comprising a staged repair during two separate hospital admissions employing synthetic mesh. Treatment modalities, outcomes, and costs were compared.ResultsIn all cases treated with delayed primary closure employing non-crosslinked porcine acellular dermal matrix, there were no complications related to its use. Two patients died due to unrelated events. Although treatment costs were estimated to be similar in the two groups, the patients treated with porcine acellular dermal matrix spent less time as an inpatient than those receiving conventional two-stage repair.ConclusionsDelayed primary closure of contaminated abdominal wall defects using a non-crosslinked porcine acellular dermal matrix may be a suitable alternative to conventional staged repair. In our patients, it resulted in early restoration of abdominal wall function and shorter hospitalization. The costs for treating contaminated abdominal wall defects using porcine acellular dermal matrix during a single hospital admission were not higher than costs for conventional two-stage repair. Further randomized studies are needed to expand upon these findings.

Evaluation of polypropylene mesh coated with biological hydrogels for temporary closure of open abdomen

“…7 Mechanical property of PP mesh provides the strength of abdominal wall fascia to prevent abdominal retraction. However, PP mesh may cause acute and chronic inflammation, fistula formation, and chronic abdominal pain.…”

“…Polypropylene (PP) is one of the most commonly used non-degradable synthetic mesh materials for abdominal wall defects and hernia repair. 7 Mechanical property of PP mesh provides the strength of abdominal wall fascia to prevent abdominal retraction. However, PP mesh may cause acute and chronic inflammation, fistula formation, and chronic abdominal pain.…”

Remodeling of Noncrosslinked Acellular Dermal Matrices in a Rabbit Model of Ventral Hernia Repair

“…This conclusion was based on the poor host tissue incorporation shown by Strattice though adhesion formation was scarce. However, a recent retrospective clinical study [1] has shown that Strattice could be a suitable alternative to conventional staged repair. Among the benefits cited by the authors were faster patient recovery, early restoration of abdominal wall function and shorter hospital stay.…”

“…The wide range of properties boasted by bioprostheses has led to their rapidly expanding use, especially in settings of contamination or low-grade infection [1,2]. As a basic characteristic, these prosthetic materials slowly become degraded in the host until their complete elimination [3,4].…”

A novel surgical solution to impossible fascial closure due to contaminated abdominal cavities: A case report

“…Due to previous laparotomies, the abdominal wall fascia could not be approximated without tension and fascial edges still could not reach one another during closure [7] . Moreover, due to the contamination of the abdomen with secretions, it was not possible to insert a synthetic mesh for abdominal closure based on the high risk of infection (it is important to note that biological mesh is also very expensive and not routinely available to surgeons in lower socioeconomic nations) [8] , [9] . To address this issue, this new abdominal wall defect (which was more limited than the first one) was covered by ipsilateral skin flaps as a novel procedure (please refer to Fig.…”