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A Comparison of Acellular Dermal Matrices in Abdominal Wall Reconstruction

Maxwell, Daniel W., DO; Hart, Alexandra M., MD; Keifer, Orion P. Jr, MD, PhD; Halani, Sameer H., MD, MSCR; Losken, Albert, MD

doi: 10.1097/SAP.0000000000001692
Reconstructive Surgery

Background There is a growing literature of evidence that the use of acellular dermal matrices (ADMs) in abdominal wall reconstruction (AWR) for high-risk patients provides superior complication profiles when compared with standard synthetic mesh. Here we compare Fortiva, Strattice, and Alloderm ADMs in AWR.

Methods In a prospectively maintained database, all patients undergoing AWR between January 2003 and November 2016 were reviewed. Hernia recurrence and surgical site occurrence (SSO) were our primary and secondary endpoints. Kaplan-Meier survival curves and logistic regression models were used to evaluate risks for hernia recurrence and SSO.

Results A total of 229 patients underwent AWR with 1 of 3 ADMs. Median follow-up time was 20.9 months (1–60 months). Cumulative recurrence rates for each mesh were 6.9%, 11.2%, and 22.0% (P = 0.04), for Fortiva, Strattice, and Alloderm groups. Surgical site occurrence for each mesh was 56.9%, 49.0%, and 49.2%, respectively. Seroma was significantly lower in the Fortiva group (1.4%; P = 0.02). Independent risk factors hernia recurrence included body mass index of 30 kg/m2 or higher and hypertension. Adjusted risk factors included oncologic resection for hernia recurrence (odds ratio, 5.3; confidence interval, 1.1–97.7; P = 0.11) and a wound class of contaminated or dirty/infected for SSO (odds ratio, 3.6; confidence interval, 1.0–16.6; P = 0.07).

Conclusions Acellular dermal matrices provide a durable repair with low overall rate of recurrence and complications in AWR. The recurrence and complication profiles differ between brands. With proper patient selection and consideration, ADMs can be used confidently for a variety of indications and wound classifications.

From the Department of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, GA.

Received June 5, 2018, and accepted for publication, after revision September 20, 2018.

Conflicts of interest and sources of funding: A.L. is a speaker for RTI. The authors have no further disclosures to make and have not received funding from entities including National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, Research Councils United Kingdom, and others.

Reprints: Albert Losken, MD, Department of Plastic and Reconstructive Surgery, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322. E-mail:

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