Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional Experience

BACKGROUND: Data on the use of biologic mesh in abdominal wall repair in complex cases remain sparse. Aim of this study was to evaluate a non-cross-linked porcine acellular dermal matrix for repair of complex contaminated abdominal wall defects. METHODS: Retrospective observational cohort study of consecutive patients undergoing abdominal wall repair with use of Strattice™ Reconstructive Tissue Matrix (LifeCell Corporation, Oxford, UK) between January 2011 and February 2015 at two National Intestinal Failure Units. RESULTS: Eighty patients were identified. Indications for abdominal wall repair included enterocutaneous fistula takedown (n = 50), infected synthetic mesh removal (n = 9), restoration of continuity or creation of a stoma with concomitant ventral hernia repair (n = 12), and others (n = 9). The median defect area was 143.0 cm(2) (interquartile range or IQR 70.0–256.0 cm(2)). All had a grade III or IV hernia. Component separation technique (CST) was performed in 54 patients (68%). Complete fascial closure was not possible despite CST and biologic mesh-assisted traction (bridged repair) in 20 patients (25%). In-hospital mortality was 1%. Thirty-six patients (45%) developed a wound infection. None required mesh removal. Of 76 patients with a median clinical follow-up of 7 months (IQR 4–15) available for analysis, 10 patients (13%) developed a hernia recurrence, of whom 3 had undergone bridged repairs. Seven patients developed a postoperative (recurrent) fistula (9%). CONCLUSION: Repair of challenging and contaminated abdominal wall defects can be done effectively with non-cross-linked biologic mesh and component separation technique without the need for mesh removal despite wound infections.