Parag Bhanot

Plastic and Aesthetic Research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery.

Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates.

Summary: It is well accepted that the use of mesh has facilitated and improved outcomes following repair of the complex abdominal hernias. Current mesh options include biologic, synthetic, and resorbable materials. The use of biologic materials for the repair and reinforcement of abdominal wall hernia has generated significant discussion. There are a variety of biologic mesh materials that are currently available that are derived from various sources including human, porcine, or bovine. All are processed for heterogeneous use, include variable amounts of collagen and elastin, and may or may not be crosslinked. The mechanism of action for biologic mesh is the incorporation, revascularization, and recellularization into the surrounding soft tissue. The presumed benefit is that the added soft-tissue support will reduce the incidence of surgical-site occurrences including recurrence. This article will review the salient studies that have incorporated biologic materials for the repair of complex abdominal hernia.

Infection of synthetic mesh after abdominal wall hernia repair is a complex problem. The purpose of this study was to determine whether a staged approach to abdominal wall reconstruction (AWR) using a porcine acellular dermal matrix (PADM) is beneficial in the setting of infected synthetic mesh. The authors performed a retrospective review of 27 patients who underwent immediate, staged complex AWR using PADM from 2007 to 2012. After a component separation, primary fascial closure was achieved in 21/27 (78%) patients, whereas 6/22 (22%) received a bridged hernia repair with PADM. Wound-related complications developed in 7/27 (26%) patients including wound dehiscence 6/27 (22%), surgical site infection 5/27 (19%), and hematoma 1/27 (4%). The hernia recurrence rate observed by 32 months was 19%. A bridged hernia repair and the development of a postoperative infection were associated with hernia recurrence, P<0.05. A 2-stage approach to AWR with PADM can provide a safe and effective solution for patients with infected synthetic mesh.

Laparoscopic technique to repair ventral hernia offers advantages over conventional open surgery such as shorter recovery time, decreased pain, and lower recurrence rates. There are a myriad of meshes available for laparoscopic repair of ventral hernias. This study evaluated the outcomes of laparoscopic repair of ventral hernias with Proceed mesh (Ethicon, Somerville, NJ, USA) in a single academic institution. An institutional review board-approved retrospective review was performed for 100 consecutive patients with ventral hernia who underwent a laparoscopic approach at our institution from August 2006 to February 2009. All patients were operated on by a single surgeon using a standard technique with transabdominal suture fixation and tacks. The study included 100 consecutive patients (57 female and 43 male patients). The mean age was 55 years (range, 16-78 years), and the mean body mass index was 33.3 kg/m(2) (range, 19.6-68.9 kg/m(2)). Of the repairs, 27% were performed for a recurrent hernia. The mean and median size of the defect were 128 cm(2) and 119.5 cm(2) (range, 4-500 cm(2)), respectively. To ensure appropriate mesh overlap, the mean size of mesh was 253 cm(2) (range, 36-700 cm(2)). There were 4 conversions. The mean operative time was 117 minutes (range, 35-286 minutes). The mean length of stay was 1.9 days. There were no major abdominal complications. With a mean follow-up period of 50 months (range, 38-68 months), we have not recorded any recurrences. No mesh-related complications have been documented. The laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications. At 50 months of follow-up, the recurrence rate is 0%. There were no mesh-related complications.

The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m²). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1–24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.