Abdominal wall repair using human acellular dermis

Background: The surgical repair of abdominal wall defects that cannot be closed primarily in contaminated fields is a difficult problem. The use of nonabsorbable synthetic materials usually is contraindicated in this setting because of the risk for colonization and chronic infection of the mesh. In this study we sought to determine the safety and efficacy of implanted human acellular dermal graft for abdominal wall reconstruction. Methods: The records of all patients (n = 20) who underwent a repair of an abdominal wall defect with human acellular dermal graft at a Veteran Affairs hospital were reviewed retrospectively. Patient demographics, complications, and hernia recurrence were recorded. Results: There were 15 perioperative complications in 11 patients: 6 graft dehiscences, 1 evisceration, 2 postoperative intra-abdominal bleeds, 5 bacterial graft infections, and 1 death. Patients with heart disease, American Society of Anesthesiologists classification of 4, and/or dirty wounds were more likely to have perioperative complications. The median follow-up period was 9.4 months (range, 2-16 mo), during which 6 hernia recurrences were noted. Conclusions: Human acellular dermis use is safe in abdominal wall reconstructions in contaminated surgical wounds.