Porcine acellular dermal matrix (PADM) vascularises after exposure in open necrotic wounds seen after complex hernia repair

Abstract

Biological alternatives to synthetic meshes are increasingly utilised in complex abdominal wall reconstruction. There is a lack of evidence demonstrating that non-cross-linked porcine acellular dermal matrix vascularizes and integrates with human tissue in suboptimal wound conditions. We aimed to evaluate these properties in Strattice™ (Life Cell Inc., Branchburg, NJ) following ventral hernia repair. A retrospective review of patients with high-risk ventral hernia repair utilising Strattice™ as an onlay after open component separation was conducted. Patients with postoperative wound exploration and exposure of the onlay were included in this review. One patient underwent punch biopsy for histological analysis. Eleven patients with wound complications necessitating postoperative debridement and exposure of Strattice™ onlay were identified. The onlay was partially debrided in two cases, and one case required complete excision. Vascularisation was clinically evident in 10 of 11 cases (91%) as demonstrated by the presence of granulation tissue and/or the ability to support a skin graft. Histological analysis of one onlay 3 months postoperatively showed neovascularisation and collagen remodelling with minimal inflammatory response. Strattice™ demonstrated resistance to rejection, ability to undergo vascularisation and incorporation into host tissues in sub-optimal wound conditions following ventral hernia repair.

Keywords: Abdominal wall; Components separation; Hernia; Porcine acellular dermal matrix; Strattice.

Figure 1

Wound dehiscence with wound cellulitis, underlying fat necrosis and exposed mesh.

Figure 2

Wound following excision of necrotic tissue and removal of mesh demonstrating healthy tissue. Exposed bowel is directly beneath the blue towel.

Figure 3

Primary closure of the muscle following lysis of adhesions and bilateral components separation.

Figure 4

Reinforcement of the muscle with a 20 × 20 cm² piece of firm non‐cross‐linked PADM mesh onlay and an infra‐umbilical panniculectomy via a fleur‐ de‐lis incision.

Figure 5

At the discontinuation of negative pressure wound therapy, healthy granulation tissue was noted throughout the base of the wound.

Figure 6

Definitive closure was accomplished by a split‐thickness skin graft.

Figure 7

Haematoxylin‐ and eosin‐stained biopsy of Strattice within the wound. Extensive vascular integration is seen throughout the entire thickness of the mesh.