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Complex Abdominal Wall Reconstruction: An Outcomes Review

Henry, Cathy R. MD*; Bradburn, Eric DO, FACS; Moyer, Kurtis E. MD, FACS

doi: 10.1097/SAP.0b013e31828a49f9
Clinical Articles
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Background Complex abdominal wall reconstruction (AWR) remains challenging. Techniques for repair are numerous and include primary fascial approximation, separation of components (SOC), and use of various biologic and synthetic meshes. Given the vast expanse of available techniques and lack of consistent algorithms, an analysis of outcomes in AWR is presented.

Methods A retrospective review was performed of complex AWRs performed by 2 surgeons at a single institution from July 2008 to October of 2011. Outcome differences for hernia repairs specifically addressing SOC with an acellular dermis inlay (retrorectus), underlay, or overlay mesh, as well as interposition biologic mesh placement were included.

Results A total of 66 patients were identified. The average body mass index in this population was 35.5 kg/m2. The average age was 53.7 years, with 62% females and 38% males. The overall rate of tobacco use history was 48%. Twenty-eight percent were diabetic. The overall hernia recurrence rate was 16%. Patients having SOC with inlay (retrorectus) mesh had a hernia recurrence rate of 9%. Hernia recurrence in those with SOC and biologic mesh reinforcement as an underlay or onlay was 12%; in those without mesh reinforcement, 22%; and for those with a biologic mesh interposition, 40%.

Conclusions The results of this review show that hernia recurrence rates are decreased with primary fascial repair. Further reduction occurs when biologic mesh reinforcement is used. The lowest recurrence rates were seen in the group with SOC and a porcine biologic mesh inlay. Abdominal wall reconstruction is challenging and with continued outcomes review a refined algorithm can be achieved.

Clinical Question/Level of Evidence Therapeutic: III

From the *Division of Plastic Surgery, College of Medicine, The Penn State University, Hershey, PA; †Trauma Surgery, and ‡Section of Plastic and Reconstructive Surgery, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA.

Received January 11, 2013, and accepted for publication, after revision, January 26, 2013.

Presented at the 29th Annual Meeting of the Northeastern Society of Plastic Surgeons.

Conflicts of interest and sources of funding: none declared.

Reprints: Kurtis E. Moyer, MD, FACS, Section of Plastic and Reconstructive Surgery, Carilion Clinic, Virginia Tech Carilion School of Medicine, 3 Riverside Circle, Suite 400, Roanoke, VA 24016. E-mail: kemoyer@carilionclinic.org.

© 2013 by Lippincott Williams & Wilkins