Long-Term Clinical Outcomes of an Antibiotic-Coated Non–Cross-linked Porcine Acellular Dermal Graft for Abdominal Wall Reconstruction for High-Risk and Contaminated Wounds

Abstract

Background Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin-/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds. Methods Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 and 2017 were included. Demographics, operative characteristics, and outcomes were collected. The primary outcome was hernia recurrence. The secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality. Results Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at the time of repair. All patients were from modified Ventral Hernia Working Group class 2 or 3. There were a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required reoperation or graft excision. Median clinical follow-up was 38.2 months with a mean of 35.2 +/− 18.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period with one planning for elective repair of an eventration. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/−12.7 months. Conclusion We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.

Highly biocompatible material for enhanced abdominal wall repair: a retrospective study with EGIS ® porcine dermal matrix

“…In our collection, postoperative complications rates resulted at acceptable levels, with none but surgical site infection below 5%. However, all fall within previously published literature, spanning 5.2–15%, leading us to consider our results well in line with existing data [ 18 , 19 ].…”

Prospective, multicenter study of antimicrobial-coated, noncrosslinked, acellular porcine dermal matrix (XenMatrix™ AB Surgical Graft) for hernia repair in all centers for disease control and prevention wound classes: 24-month follow-up cohort

“…Although biological tissue-derived materials are not currently indicated for use in contaminated or infected fields, these materials have occasionally been used in an “off label” fashion at the discretion of the operating surgeon. Two such studies reported the clinical results associated with the same AC-PDM utilized in the current study, but implanted in contaminated or infected fields 23 , 24 . In a third study, another type of noncrosslinked, uncoated PDM (Strattice™, LifeCell Corporation) was investigated in a clinical trial (RICH Trial) involving patients with contaminated or infected wounds 22 .…”

Membranous Extracellular Matrix-Based Scaffolds for Skin Wound Healing

“…To enhance the antibacterial property of ECM-based wound dressings, different antibacterial drugs, including rifampicin, ciprofloxacin, gentamycin, and minocycline, have been used as additives (Table 2) [13,[95][96][97]. Gentamicin loaded SIS, for instance, was proved to exert sufficient antimicrobial activity against a broad array of pathogens (E. coli, S. epidermidis, methicillin-resistant S. aureus, P. aeruginosa, S. marcescens, and S. aureus), and particularly, the antibacterial effects could be maintained for up to 7 days [98].…”