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Indications and Outcomes following Complex Abdominal Reconstruction with Component Separation Combined with Strattice Reinforcement
Ketan M. Patel, M.D., Frank Albino, M.D., Maurice Y. Nahabedian, M.D., Parag Bhanot, M.D..
Georgetown University Hospital, Washington, DC, USA.
Component separation is an effective technique for complex abdominal wall reconstruction (AWR). Reinforcement of the repair with mesh can add durability. Strattice, a non-crosslinked porcine acellular dermis (PADM), can be used to reinforce midline abdominal repairs when combined with component separation. Our study evaluates the indications and outcomes following component separation combined with Strattice reinforcement.
The authors performed a retrospective review of all patients who underwent complex AWR at the authors’ institution from 2007-2010. Only patients who underwent component separation with underlay Strattice reinforcement for midline hernia repair were identified. Primary fascial closure was achieved in all patients. Patient demographics, indications, peri-operative details, post-operative care, and long-term outcomes were reviewed.
37 patients were identified who met the criteria for component separation combined with Strattice reinforcement during the study period. The average patient age was 58 years with a BMI 34.7. Average follow-up was 383 days (range 102-925 days). Patient co-morbidities include coronary artery disease (51.3%), diabetes (35.1%), and COPD (13.5%). Indications for repair included recurrent/complex hernia (81.1%), previous/active infected mesh (29.7%), and enterocutaneous fistula (2.7%). Patient symptoms included cosmetic concerns (43.2%), pain with activity (37.8%), activity limitations (29.7%), pain at rest (21.6%), and open/draining wounds (10.8%). Hernias were classified as grade 2 (81.1%), grade 3 (8.1%), and grade 4 (10.8%). Bilateral component separation was performed in 94.6%. Concomitant panniculectomy was performed in 18.9%. Average hospital stay was 7 days. Complications occurred in 24.3% of patients: infection/wound dehiscence (10.8%), superficial skin necrosis (10.8%), and seroma (8.1%). Strattice exposure occurred in 10.8% of patients with eventual healing occurring in all patients with operating room debridements and/or dressing changes. No patients required explantation. There were no bulges or hernia recurrences during the follow-up period.
Strattice is an effective adjunct to abdominal wall reconstruction when used as underlay reinforcement during component separation for a wide variety of indications. Complication rates remain low in complex patients. In addition, Strattice appears to add durability to midline reconstructions with no recurrences during our follow-up period.
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