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Acellular Dermal Matrices in Abdominal Wall Reconstruction: A Systematic Review of the Current Evidence

Janis, Jeffrey E. M.D.; O'Neill, Anne C. M.B.B.Ch., Ph.D.; Ahmad, Jamil M.D.; Zhong, Toni M.D.; Hofer, Stefan O. P. M.D., Ph.D.

doi: 10.1097/PRS.0b013e3182605cfc
Reconstructive: Original Articles
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Background: Reconstruction of the anterior abdominal wall is a complex procedure that can be complicated by contamination, loss of domain, previous scarring or radiotherapy, and reduced availability of local tissues. With the introduction of acellular dermal matrices to clinical use, it was hoped that many of the problems associated with previous synthetic materials could be overcome. With their enhanced biocompatibility, acellular dermal matrices are believed to integrate with surrounding tissues while demonstrating resistance to infection, extrusion, erosion, and adhesion formation.

Methods: The MEDLINE database was reviewed, including all publications as of December 31, 2011, using the search terms “dermal matrix” or “human dermis” or “porcine dermis” or “bovine dermis,” applying the limits “human” and “English language.” Prospective and retrospective clinical articles were identified.

Results: A total of 40 eligible articles were identified and included in this review. Thirty-five of the studies were level IV; the remaining studies were level III. Acellular dermal matrix was used to reconstruct the abdominal wall in a wide range of clinical settings, including trauma, tumor resection, sepsis, and hernia repairs. The operative methods varied widely among clinical studies. While the heterogeneity of the patient populations and techniques limited interpretation of the data, concerns were identified regarding high rates of hernia recurrence with acellular dermal matrix use.

Conclusion: High-quality data derived from level I, II, and III studies are necessary to determine the indications for acellular dermal matrix use and the optimal surgical techniques to maximize outcomes in abdominal wall reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Dallas, Texas; and Toronto, Ontario, Canada

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; and the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network.

Received for publication February 28, 2012; accepted March 7, 2012.

Disclosure:Dr. Janis serves as a consultant for LifeCell Corporation. Dr. Zhong has received funding from the Plastic Surgery Foundation for one-stage breast reconstruction using dermal matrix/implant versus two-stage expander/implant procedure (AlloDerm randomized clinical trials). Drs. O'Neill, Ahmad, and Hofer do not have any financial interest with any of the products or devices mentioned in this article.

Jeffrey E. Janis, M.D.; Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, jeffrey.janis@utsouthwestern.edu

©2012American Society of Plastic Surgeons