ABSTRACT
PURPOSE: There is a significant morbidity associated with abdominal wall reconstruction (AWR) with a need for overall improvement during the post-operative management. Scientific literature has proven the use of negative pressure therapy (NPT) in wound healing for orthopedic and cardiac surgery with limited data present on its role in AWR. The goal of this study was to examine whether primary wound events were different between patients who had primary closure with NPT versus patients who only had primary closure after AWR. METHODS: This retrospective study examined the rate of post-operative complications in all open-complex AWR that were done in a similar fashion between May 2008 and July 2011 at two large university teaching hospitals. Wound closure was stringent upon attending surgeon preference without randomization. RESULTS: There were a total of 61 patients who met inclusion criteria with an average age of 54 and 60 % were women. Thirty-two patients had primary closure and 29 patients had primary closure with NPT. The mean length of follow-up was 167 days for both groups. The type of wound closure had an effect on the rate of hernia recurrence and surgical site infections. The application of NPT leads to lower hernia recurrence rate of 25 versus 3% and the type of wound closure had a profound effect on the rate and type of SSI. CONCLUSIONS: The data presented in this study demonstrates a potential advantage for adjunctive NPT in patients undergoing AWR. There is an associated decreased incidence in the overall rate of SSI and hernia recurrence with the use of NPT in those patients undergoing AWR. These results show an advantage for adjunctive NPT.
Subject(s)
Abdominal Wall/surgery , Abdominal Wound Closure Techniques , Hernia, Ventral/surgery , Negative-Pressure Wound Therapy , Surgical Wound Infection/prevention & control , Female , Hernia, Ventral/etiology , Humans , Male , Middle Aged , Plastic Surgery Procedures/methods , Retrospective Studies , Surgical Mesh , Surgical Wound Infection/etiology , Suture Techniques , Wound HealingABSTRACT
PURPOSE: Ventral abdominal wall hernias are common and repair is frequently associated with complications and recurrence. Although non-crosslinked intact porcine-derived acellular dermal matrix (PADM) has been used successfully in the repair of complex ventral hernias, there is currently no consensus regarding the type of mesh and surgical techniques to use in these patients. This report provides added support for PADM use in complex ventral hernias. METHODS: In a consecutive series of adult patients (2008-2011), complex ventral abdominal wall hernias (primary and incisional) were repaired with PADM by a single surgeon. Patient comorbidities, repair procedures, and postoperative recovery, recurrence, and complications were noted. RESULTS: Forty-four patients (mean age, 57.5 years) underwent 45 single-stage ventral abdominal wall hernia repairs (3 primary; 42 incisional). Previously placed synthetic mesh was removed in 17 cases. In 40 cases, primary fascial closure was achieved; in 5 cases, PADM was used as a bridge. Vacuum-assisted closure (VAC) was used for 38/45 cases: 19 closed incisions, 16 cases using the "French fry" technique, and 3 cases with open incisions. Mean hospital stay was 8.2 days (range, 3-32) and mean follow-up was 17 months (range, 1-48). There were 4 (8.9 %) hernia recurrences, 3 requiring additional repair and 1 requiring PADM explantation. There were 3 (6.7 %) skin dehiscences, 4 (8.9 %) deep wound infections requiring drainage, and 5 (11.1 %) seromas (4 self-limited, 1 requiring drainage). CONCLUSIONS: Non-crosslinked intact PADM yielded favorable early outcomes when used to repair complex ventral abdominal wall hernias in high-risk patients.
