Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14-Year Experience with More than 700 Patients

Abstract

Background Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs). Study Design We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs. Results We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m2, and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72–5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27–4.25; p = 0.006), but not HR (OR 1.06; 95% CI 0.57–1.98; p = 0.859). Conclusions SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination. Visual Abstract

Application of Acellular Dermal Matrix in Gynaecology—A Current Review

“…These treatments include, among others, burn treatments, hernia repair, breast reconstruction, etc. [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Moreover, there are several reports on the use of ADMs in gynaecological reconstructive surgery [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Comparison of Long-term Surgical Outcomes and Microsurgical Skills between Independent and Integrated Plastic Surgery Trainees

“…Regardless of prior experience with AWR, fellows were generally trained on the AWR techniques that were consistently performed at the authors' institution. [10][11][12] Patient selection was based on patient availability and did not follow any selection criteria. A trainee had to have complete autonomy in preoperative, intraoperative, and postoperative care and decision-making to be considered the operative surgeon for a case.…”

Advances on the modification and biomedical applications of acellular dermal matrices

“…After analyzing patients who had at least 36 months of postoperative follow-up, a report revealed that ADMs can provide durable long-term outcomes in complex abdominal wall reconstruction with hernia recurrence rates similar to those for synthetic meshes, and achieve lower infection and mesh explantation rates than those reported for synthetic meshes [92]. Moreover, relevant studies have shown that ADM can reduce complications for patients with multiple comorbidities and for those with abdominal wall reconstructions in contaminated wound environments [93,94]. In addition, based on a similar principle of ADM application in abdominal wall reconstruction, ADM has also exhibited good application outcomes in chest wall repair.…”