Effect of surgical wound classification on biologic graft performance in complex hernia repair: An experimental study

A Cost-Utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair

“…Mesh-reinforced hernia repair is capable of restoring the functional characteristics of the abdominal wall, 38 and long-term level I data have solidified mesh-reinforced hernia repair as the standard of care. 4 However, traditional surgical teaching dictates that contamination is a contraindication to mesh use, because of the increased rate of wound infection, 39 decreased incorporation of mesh, decreased strength of repair, 15 greater risk of mesh removal, 40 and an overall increase in the risk of reoperation and recurrent hernia. 12,41 Biological mesh has emerged as a promising surgical tool with which to perform single-stage repairs in contaminated defects because of the theoretical resistance to infection.…”

“…4,49 When the decision is made to use mesh in cleancontaminated defects, many options are available. Acellular dermal matrix has distinct advantages, including contamination tolerance, 50 low risk for mesh infection and removal, 15,45,50 and overall reasonable rates of hernia recurrence. 51 The downside Plastic and Reconstructive Surgery • February 2016 of acellular dermal matrix in these defects is the significantly higher cost.…”

“…15 Studies not meeting inclusion criteria were excluded; specifically, studies describing contaminated or clean ventral hernia repair or those involving laparoscopic approaches were excluded. 10,11,[17][18][19][20][21][22][23][24][25][26] Outcome and patient characteristics were pooled and weighted by study size.…”

Remodeling Characteristics and Collagen Distribution in Biological Scaffold Materials Explanted From Human Subjects After Abdominal Soft Tissue Reconstruction

“…Of the 25 specimens for which surgical site contamination or infection was present at the time of mesh implantation, 9 specimens were procured from surgical sites with evidence of persistent contamination on clinical examination. For these 9 specimens, the persistence of contamination during the period of biologic mesh indwelling may have further biased the histologic results toward non-constructive remodeling 45 . Note, however, that despite data indicating high rates of repair failure and wound morbidity 46–48 , the off-label use of biologic meshes in clean-contaminated, contaminated, and infected surgical sites is representative of current clinical practice in the U.S.…”

Biomaterials: So Many Choices, So Little Time. What Are the Differences?

“…Rat models have shown that the degree of contamination will affect the bacterial clearance rate, wound complication rate, and strength of repair. 18 Other animal studies have shown poor cellular and revascularization of both human dermis and porcine intestinal meshes when infected with pseudomonas. Interestingly, the biomechanical properties of the porcine intestinal mesh were much more negatively affected than those of the human dermis.…”