2008 Annual Meeting Abstracts
Abdominal Wall Reconstruction Using an Acellular Porcine Dermal Implant
Russell Babbitt, III, MD, Genevieve B. Broderick, MD, Nelson L. Jenkins, MD, Timothy Emhoff, MD, Janice F. Lalikos, MD, Richard A. Perugini, MD, Raymond M. Dunn, MD.
University of Massachusetts Medical School, Worcester, MA, USA.
Objective: This study reviews our results using an acellular porcine dermal implant (Permacol™) for abdominal wall reconstruction.
Design: Retrospective review. Post-operative follow-up: <1 month-18 months(mean 8 months).
Setting: Hospitalized and ambulatory care.
Patients: Twenty consecutive patients of five surgeons who underwent abdominal wall reconstruction using Permacol between June 2006 and March 2008.
Interventions: Separation of components was performed to achieve primary fascial closure with Permacol onlay in thirteen patients. Interposition hernia repair was performed in four patients. In three patients abdominal defects following TRAM breast reconstruction were buttressed with Permacol.
Main Outcome Measures: Assessment of reconstructive outcome and post-operative complications based on clinical exam and imaging.
Results: With Permacol interposition, one patient developed infection necessitating debridement. A delayed repair was performed with synthetic mesh. Two patients developed abdominal wall cellulitis and fascial dehiscence.
Permacol onlay was complicated by enterocutaneous fistula which developed post-operatively in a patient who had a single enterotomy repaired after injury during lysis of adhesions. This healed with conservative management. Seven seromas were treated with drainage. Two patients had debridement of necrotic superficial tissue.
Except for the patients who developed infection and dehiscense, all patients have stable hernia repairs without recurrence. Eleven patients had CT scans of the abdomen 3-11 months post-operatively. Imaging results suggest the abdominal wall remains stable without recurrent hernia after fascial closure and Permacol onlay.
Conclusions: For two years, we have utilized Permacol for complex abdominal wall reconstruction and massive ventral hernia repair with a low rate of recurrent hernia. Permacol, when used as an onlay, may provide a stronger biologic closure than separation of parts alone, with much less long-term infectious risk than a synthetic onlay.