Evaluation of a Porcine Dermal Collagen (Permacol) Implant for Abdominal Wall Reconstruction in a Pediatric Multitrauma Patient

The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol) implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient. 1. Introduction Abdominal wall defects caused by trauma, incisional hernias, or tumor resection present a formidable challenge for surgeons, as the size of such defects and the presence of contamination of the surgical field can complicate the surgical procedure. The treatment of small incisional hernias commonly consists of simply suturing opposing fascial edges. However, as the defect increases in size, recurrence rates may rise by up to 50% [1–4]. Thus, in cases of large defects, most surgeons agree that the defect should be repaired in a tension free manner using a prosthetic mesh material [5]. Although these meshes increase abdominal wall strength [6], they are associated with serious complications such as fistula formation, adhesions, skin erosion, and increased susceptibility to infections [7]. Therefore, the use of synthetic meshes in contaminated fields, which are common in trauma, has high rates of morbidity and is strongly discouraged [8]. Recently, the focus on treatment has shifted toward bioprosthetic meshes that provide strength and promote host tissue incorporation and infection resistance, all of which combine to make them particularly well suited to use in contaminated fields. Permacol is a relatively new acellular porcine dermal matrix for use in abdominal wall reconstruction. Structurally similar to the human dermis, it is purported to be equally nonallergenic and nontoxic. In addition, the chance of suffering a foreign body reaction is much lower with Permacol than with conventional prosthetic meshes. We present here our case experience with a Permacol mesh in the reconstruction of the abdominal wall of an eight-year-old patient suffering from multiple injuries. 2. Case Report This case involves an eight-year-old boy from a Palestinian refugee camp who was badly wounded during an explosion