medigraphic.com
ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2016, Number 1

<< Back Next >>

Cir Plast 2016; 26 (1)

Grade 4 complex incisional hernia repair with components separation reinforced either with biologic mesh or rectus muscle plication

Espinosa-de-los-Monteros A, Avendaño-Peza H, Gómez-Arcive Z, Arista-de la Torre L

Language: Spanish
References: 16
Page: 27-35
PDF size: 2221.96 Kb.


ABSTRACT

The presence of abdominal wall infection in patients with large or lateral incisional hernias represents a special clinical scenario because of the limitations which exist in the use of synthetic prosthetic materials. The purpose of this study is to evaluate postoperative outcomes in these patients undergoing the components separation technique reinforced with either biologic mesh or rectus muscle plication. Over a five years period abdominal wall reconstruction with components separation was performed in seven patients within an infected surgical field. Pathogenic microorganisms were identified by sample cultures in all cases and antibiotics were administered accordingly. Three patients underwent muscle closure reinforcement with biologic mesh, and four patients with rectus muscle plication. The differences between groups were analyzed with Fischer’s exact test or Mann-Whitney’s’ U depending on the type of variable studied. Post-surgery morbidity in the form of wound dehiscence associated with the surgical procedure was 29%. One-year recurrence-free survival was 100% in patients whose reinforcement method was biologic mesh and 75% in those who had rectus muscle plication. We conclude that, in the presence of an infectious process, large or lateral incisional hernia closure with the components separation and reinforcement technique material represents a method that provides stable reconstruction.


REFERENCES

  1. Breuing K, Butler CE, Ferzoco S et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010; 148: 544-558.

  2. Slater NJ, Montgomery A, Berrevoet F et al. Criteria for definition of a complex abdominal wall hernia. Hernia. 2014; 18: 7-17.

  3. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990; 86: 519-526.

  4. Butler CE, Campbell KT. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg. 2011; 128: 698-709.

  5. Espinosa-de-los-Monteros A, Dominguez I, Zamora-Valdes D, Castillo T, Fernandez-Diaz OF, Luna-Torres HA. Closure of midline contaminated and recurrent incisional hernias with components separation technique reinforced with plication of the rectus muscles. Hernia. 2013; 17: 75-79.

  6. Khamnuan P, Congruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy. 2015; 8: 1-7.

  7. Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM. Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg. 2012; 255: 176-180.

  8. Yegiyants S, Tam M, Lee DJ, Abbas MA. Outcomes of component separation for contaminated complex abdominal wall defects. Hernia. 2012; 16: 41-45.

  9. Novitsky YW, Rosen MJ. The biology of biologics: basic science and clinical concepts. Plast Reconstr Surg. 2012; 130: 9S-17S.

  10. Jacobsen G, Easter D. Allograft vs xenograft: practical considerations in biologic scaffolds. Página de la Escuela de Medicina de la Universidad de California en San Diego. [Internet] Disponible en: https://cme.ucsd.edu/biologicscaffolds/

  11. Ngo MD, Aberman HM, Hawes ML, Choi B, Gertzmann AA. Evaluation of human acellular dermis versus porcine acellular dermis in an in vivo model for incisional hernia repair. Cell Tissue Bank. 2011; 12: 135-145.

  12. Bellows CF, Wheatley BM, Moroz K, Rosales SC, Morici LA. The effect of bacterial infection on the biomechanical properties of biological mesh in a rat model. PLoS One. 2011; 6: e21228.

  13. Bellows CF, Wheatley BM, Moroz K, Rosales SC, Morici LA. Histologic and biomechanical evaluation of biologic meshes following colonization with Pseudomonas aeruginosa. J Surg Res. 2012; 175: e35-e42.

  14. Espinosa-de-los-Monteros A, de-la-Torre JI, Marrero I, Andrades P, Davis MR, vascones LO. Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg. 2007; 58: 264-267.

  15. Ghazi B, Deigni O, Yezhelyev M, Losken A. Current options in the management of complex abdominal wall defects. Ann Plast Surg. 2011; 66: 488-592.

  16. Patel KM, Bhanot P. Complications of acellular dermal matrices in abdominal wall reconstruction. Plast Reconstr Surg. 2012; 130: 216S-224S.




2020     |     www.medigraphic.com