Outcomes Of Abdominal Wall Reconstruction Using Acellular Dermal Matrix In High-risk CDC Class III And IV Defects
Abbas M. Hassan, MD, Malke Asaad, MD, Jun Liu, PhD, Charles E. Butler, MD.
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: Abdominal wall reconstruction (AWR) with synthetic mesh for patients with CDC class III and IV defects is generally considered contraindicated. Outcomes regarding using acellular dermal matrix (ADM) in this patient population are lacking. We hypothesized that AWR with ADM in this patient population results in acceptable outcomes.
METHODS: We conducted a retrospective cohort study of patients who underwent AWR using ADM in CDC class III and IV defects from March 2005 to June 2019. The primary outcome measure was hernia recurrence. Secondary outcomes were SSOs, and SSIs.
RESULTS: We identified 101 patients who met the study criteria. Patients had a mean age of 61.3±11.1 years, mean body mass index of 31.8±7.3 kg/m2, and mean follow-up time of 41.9±26.3 months. Patients had a hernia recurrence rate of 21%, SSOs rate of 54%, and SSIs rate of 24%. An independent predictor of hernia recurrence was panniculectomy (HR, 3.38; 95% CI, 1.33-8.56; p=0.010). Component separation was an independent protective factor (HR, 0.20; 95% CI, 0.07-0.56; p=0.002). Independent predictors of SSOs were rectus muscle violation (OR, 2.70; 95% CI, 1.16-6.30; p=0.021) and greater mesh length (OR, 1.42; 95% CI, 1.05-1.92; p=0.021). Independent predictors of SSIs were tobacco use (OR, 13.7; 95% CI, 2.95-72.55; p=0.002), rectus muscle violation (OR, 4.63; 95% CI, 1.33-16.09; p=0.016), and greater mesh length (OR, 1.73; 95% CI, 1.18-2.53; p=0.005).
CONCLUSION: AWR with ADM in CDC III and IV defect results in acceptable outcomes. Despite the level of contamination, safe and durable outcomes are achievable in single-stage AWR.
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