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Bovine Versus Porcine Acellular Dermal Matrix for Complex Abdominal Wall Reconstruction
Mark W. Clemens, MD, Jesse C. Selber, MD, David M. Adelman, MD, Donald P. Baumann, MD, Patrick B. Garvey, MD, Charles E. Butler, MD.
MD Anderson Cancer Center, Houston, TX, USA.
Abdominal wall reconstruction with bioprosthetic mesh, with or without component separation (CS), has been shown to reduce the incidence of mesh infection, fistula formation, and need for mesh explantation. Despite widespread use of bioprosthetic mesh, there are no studies that directly compare clinical outcomes of the two most commonly used acellular dermal matrices. In the present study, abdominal wall reconstruction outcomes are compared using either inlay bovine (BADM) and porcine (PADM) acellular dermal matrices.
A retrospective review of all consecutive patients who underwent abdominal wall reconstruction with or without CS, underlay bioprosthetic mesh and complete midline musculofascial closure from January 2008 to March 2011 at MD Anderson Cancer Center was performed. Patients with bridged repairs were excluded. Patient, defect, treatment and outcome data were prospectively collected and retrospectively analyzed. Indications for AWR were tumor extirpative defects and incisional hernias. Indications for bioprosthetic mesh included multiple previous abdominal surgeries, previous ventral hernia repair, contaminated wounds, and large fascial defects. We compared outcomes including medical, short-term, and long-term complications, infection, wound healing, seroma, bulge and hernia recurrence rates between BADM (Surgimend, TEI Bioscience) and PADM (Strattice, LifeCell Corporation) repairs.
A total of 234 patients were reviewed who underwent abdominal reconstruction with PADM or BADM; 123 patients underwent a non-bridged inlay reconstruction and were included in the study: 51 (41%) with BADM and 72 (59%) with PADM. Mean follow-up was 13.1 ± 7.7 months. Patient and defect characteristics were similar including BMI, age, comorbidities. Mean number of previous surgeries was 2.0 and average fascial defect size was 375cm2. Overall complication rate was 36.6% and was significantly lower in the BADM (25.5%) versus the PADM (44.4%) groups (p=0.04). Surgical complication rate was 29.2% versus 21.6%, respectively (p=.34) Similar rates were found for recurrent hernia (2% vs. 1.4%, p=.99), abdominal laxity/bulge (0% vs. 5.6%, p=0.14), skin dehiscence (9.8% vs. 6.9%, p=0.74), cellulitis (7.8% vs. 2.8%, p= 0.23), and seroma formation (3.9% vs. 2.8%, p=.99) in BADM and PADM groups, respectively.
Abdominal wall reconstruction for complex ventral hernia repairs using CS and inlay bioprosthetic mesh is associated with a relatively high overall surgical complication rate, predominantly due to infection, wound healing, and medical complications, however with use of bioprosthetic mesh, most surgical complications could be managed non-operatively as an outpatient without mesh removal. This is the only series to date that compares abdominal wall reconstruction outcomes with PADM versus BADM. BADM and PADM are associated with similar surgical complication rates, including hernia and bulge, and appear to result in equivalent outcomes in complex abdominal wall reconstruction. Further studies with longer follow up may help delineate differences in the two matrices, and guide selection of bioprosthetic mesh material.
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