Outcomes Of Abdominal Wall Reconstruction Using Acellular Dermal Matrix In High-risk CDC Class III And IV Defects

Abbas M Hassan, MD; Malke Asaad, MD; Anaeze C Offodile II, MD, MPH, FACS; Charles E Butler, MD, FACSDepartment of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.

Background



>400,000 operations

performed annually in the US alone.



Costs >$3 billion



AWR in the presence of bacterial contamination is challenging

Conclusion



Patients with class IV defects have a higher risk of SSOs, but not HR or SSIs



Safe and durable long-term outcomes are achievable in single-stage AWR using xenogeneic mesh for CDC class III/IV defects despite the high level of defect contamination

Contamination Level

Acellular Dermal Matrix (ADM)

Rapid revascularization

Fibroblast stimulation

Cellular

infiltration

Soft tissue

incorporation

Knowledge gap

Optimal mesh selection in class III/IV defects is controversial

Outcomes using ADM are lacking

Objective

Evaluate the long-term outcomes of AWR using Porcine ADM and bovine ADM in patients with CDC class III and IV defects

Methods

Retrospective cohort study

March 2005 to June 2019

The University of Texas MD Anderson Cancer Center

AWR of Class III and IV patients

Primary outcome: Hernia recurrence (HR)

Secondary outcomes: Surgical site occurrences (SSOs) and surgical site infections (SSIs)

Results

725 Patients

CDC Wound Classification

101

Class III/IV

322

Class II

302

Class I



Patients with class III/IV had HR rate of 21%, SSO rate of 49%, and SSI rate of 24

Class IV defects were predictive of SSOs (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.11–7.42; P = 0.029) but not HR (HR, 1.60; 95% CI, 0.59–4.34; P = 0.355) or SSIs (OR, 2.62; 95% CI, 0.85–8.10; P = 0.094).

Figure 1. Kaplan–Meier curve for hernia recurrence

Limitations

Single-institution retrospective design confounding/bias

Lack of synthetic mesh control

No patient-reported outcomes

Evaluated only the two most common ADMs

References

Contacts for authors