Use of human acellular dermal matrix for hernia repair: Friend or foe?

Background. Surgeons continue to search for the ideal prosthetic material to repair complex abdominal wall hernias. Recently, anew biologic material was introduced into thesurgeon's arsenal. The purpose of this study is to review a single institution's experience with the use of human acellular dermal matrix (HADM [AlIoDerwm]) for repair of hernias. Methods. This was a retrospective review of all patients who received, HADM for repair of an abdominal wall hernia. Patient demographics, comorbidities, wound contamination, operative technique, complications, and hernia recurrence were analyzed. Results. Between May 2004 and October 2007, HADM was implanted in a total of 46 patients undergoing repair of a ventral hernia.. The average age was 54 years (range, 26-7 7), with an average American Society of Anesthesiologists classification of 2.5 (range, 1-4). Indications for use of HADM included complex ventral hernia repair (n = 34), mesh infection/enterocutaneous fistula (n = 10), and pen'tonitis (n = 2). The incidences of comorbidities were hypertension in 4 7 %, diabetes mellitus in 16%, and coronary arteo) disease in L/ %. The majority (8 7 %; n = 40) of the procedures were performed on an elective basis. Seventeen procedures were performed in contaminated wounds. The HADM was placed as reinforcement to the hernia repair in 26 patients and as a "bridge" between the fascial edges in 20 patients. The average follow-up was 12.1 months. Wound complications were, frequent I at 54 %. There were 6 recurrent hernias and 8 patients with eventration of the bioprosthesis so that the recurrent hernia rate was 30%. Alone of the recurrences were, associated with a postoperative wound infection. The majority (88 %) of patients who developed. eventration of the HADM had a repair using the bioprosthesis to "bridge" an abdominal wall defext. Hernia recurrence and eventration were not associated with use of HADM in a conlaminated/infecled wound. Conclusions. HADM is a suitable prosthesis far repair of complex and routine abdominal-wall defects This bioprosthesis can incorporate into contaminated tissue without becoming infected. Eventiation occur when HADM is utilized as a fascial replacement rather than as a reinforcement.