Dermal Matrices: Do We Always Know What Is Going On?

Abstract

The use of dermal matrices in abdominal wall reconstruction has gained increased attention over time, particularly in contaminated fields. One of their advantages is the greater capacity to resist infection. We report a case of a 36-year-old man, with congenital bladder exstrophy and neobladder reconstruction during childhood. He presented to us with an abdominal hernia associated with a vesicocutaneous fistula. We used a bovine-derived dermal matrix (SurgiMend®, TEI Biosciences, MA, USA) for reinforcement of the abdominal repair considering its laboratory-proven mechanical superiority regarding strength. The early postoperative period was complicated by an infection that led to mesh disintegration and the need for surgical revision. We believe that matrix digestion by bacterial enzymes culminated in rapid breakdown of the product. Further investigations are warranted to determine optimal selection criteria and indications of bioprosthesis in contaminated wounds. Surgeons should be cautious when selecting a biologic mesh in these cases, favoring meshes with a better integration profile.

Keywords: bioprosthesis; bladder exstrophy; contaminated wounds; surgimend®; vesicocutaneous fistula.

Figure 1. Chronic wound of the abdominal wall

Abdominal wall with multiple previous scars and a chronic wound just above the base of the penis

Figure 2. Intraoperative photograph after placing the dermal matrix

Figure 3. Intraoperative image of mesh disintegration

Mesh degradation at the 12th postoperative day.