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Bovine versus Porcine Acellular Dermal Matrix for Complex Abdominal Wall Reconstruction

Clemens, Mark W. M.D.; Selber, Jesse C. M.D.; Liu, Jun M.S.; Adelman, David M. M.D., Ph.D.; Baumann, Donald P. M.D.; Garvey, Patrick B. M.D.; Butler, Charles E. M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182729e58
Reconstructive: Trunk: Original Articles
Video Discussion
Abstract

Background: Abdominal wall reconstruction with bioprosthetic mesh is associated with lower rates of mesh infection, fistula formation, and mesh explantation than reconstruction with synthetic mesh. The authors directly compared commonly used bioprosthetic meshes in terms of clinical outcomes and complications.

Methods: A database of consecutive patients who underwent abdominal wall reconstruction with porcine or bovine acellular dermal matrix and midline musculofascial closure at their institution between January of 2008 and March of 2011 was reviewed. Surgical outcomes were compared.

Results: One hundred twenty patients were identified who underwent a nonbridged, inlay abdominal wall reconstruction with porcine [69 patients (57.5 percent)] or bovine acellular dermal matrix (51 patients (42.5 percent)]. The mean follow-up time was 21.0 ± 9.9 months. The overall complication rate was 36.6 percent; the porcine matrix group had a significantly higher complication rate (44.9 percent) than the bovine matrix group (25.5 percent; p = 0.04) and statistically equivalent surgical complications (29.2 percent versus 21.6 percent; p = 0.34). There were no significant differences in rates of recurrent hernia (2.9 percent versus 3.9 percent; p = 0.99) or bulge (7.2 percent versus 0 percent; p = 0.07). However, the rate of intraoperative adverse events in the porcine matrix group [seven events (10.1 percent)] was significantly higher than that in the bovine matrix group (0 percent; p = 0.02).

Conclusions: In patients who undergo complex abdominal wall reconstruction, both bovine and porcine acellular dermal matrix are associated with similar rates of postoperative surgical complications and appear to result in similar outcomes. Porcine acellular dermal matrix may be prone to intraoperative device failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

In Brief

VIDEO DISCUSSION BY JEFFREY JANIS, M.D., IS AVAILABLE ONLINE FOR THIS ARTICLE.

Author Information

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication February 28, 2012; accepted July 2, 2012.

Presented at the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012.

Disclosure: Dr. Selber and Dr. Adelman are consultants for TEI Biosciences. Dr. Butler has served as a consultant for LifeCell Corporation. None of the other authors has any financial incentives or conflicts of interest associated with this article. This study received no external funds for support.

Jesse C. Selber, M.D.; Department of Plastic Surgery, Unit 1488, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, jcselber@mdanderson.org

©2013American Society of Plastic Surgeons