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Initial Experience With Biologic Polymer Scaffold (Poly-4-hydroxybuturate) in Complex Abdominal Wall Reconstruction

Buell, Joseph F. MD, MBA, FACS*; Sigmon, David MD; Ducoin, Christopher MD; Shapiro, Max MD; Teja, Nikhil MD; Wynter, Emmett BS; Hanisee, Mary K. MD§; Parker, Geoffrey PhD; Kandil, Emad MD, MBA; Darden, Michael PhD||

doi: 10.1097/SLA.0000000000001916
ORIGINAL ARTICLES

Objective: To evaluate the use of the new absorbable polymer scaffold poly-4-hydroxybutyrate (P4HB) in complex abdominal wall reconstruction.

Background: Complex abdominal wall reconstruction has witnessed tremendous success in the last decade after the introduction of cadaveric biologic scaffolds. However, the use of cadaveric biologic mesh has been expensive and plagued by complications such as seroma, infection, and recurrent hernia. Despite widespread application of cadaveric biologic mesh, little data exist on the superiority of these materials in the setting of high-risk wounds in patients. P4HB, an absorbable polymer scaffold, may present a new alternative to these cadaveric biologic grafts.

Methods: A retrospective analysis of our initial experience with the absorbable polymer scaffold P4HB compared with a consecutive contiguous group treated with porcine cadaveric mesh for complex abdominal wall reconstructions. Our analysis was performed using SAS 9.3 and Stata 12.

Results: The P4HB group (n = 31) experienced shorter drain time (10.0 vs 14.3 d; P < 0.002), fewer complications (22.6% vs 40.5%; P < 0.046), and reherniation (6.5% vs 23.8%; P < 0.049) than the porcine cadaveric mesh group (n = 42). Multivariate analysis for infection identified: porcine cadaveric mesh odds ratio 2.82, length of stay odds ratio 1.11; complications: drinker odds ratio 6.52, porcine cadaveric mesh odds ratio 4.03, African American odds ratio 3.08, length of stay odds ratio 1.11; and hernia recurrence: porcine cadaveric mesh odds ratio 5.18, drinker odds ratio 3.62, African American odds ratio 0.24. Cost analysis identified that P4HB had a $7328.91 financial advantage in initial hospitalization and $2241.17 in the 90-day postdischarge global period resulting in $9570.07 per case advantage over porcine cadaveric mesh.

Conclusions: In our early clinical experience with the absorbable polymer matrix scaffold P4HB, it seemed to provide superior clinical performance and value-based benefit compared with porcine cadaveric biologic mesh.

*Tulane Abdominal Transplant Institute, Tulane University School of Medicine, New Orleans, LA

Tulane University School of Medicine, New Orleans, LA

Department of Surgery, Tulane University School of Medicine, New Orleans, LA

§Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA

A. B. Freeman School of Business, Tulane University, New Orleans, LA

||Department of Economics, Tulane University, New Orleans, LA.

Reprints: Joseph F. Buell, MD, MBA, FACS, Director, Tulane Transplant Institute, Tulane University School of Medicine, 1415 Tulane Avenue, #HC-05, New Orleans, LA 70112-2632. E-mail: jbuell1@tulane.edu.

The authors report no conflicts of interest.

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