Use and Indications of Human Acellular Dermis in Ventral Hernia Repair at a Community Hospital

Background. To evaluate the use, indications, and short-term outcomes for human acellular dermis. Methods. We retrospectively reviewed patients having human acellular dermis placed for ventral hernia repair from January 2008 through October 2009. Demographic information, operative details, and outcomes of patients with and without recurrences were compared; a P value <0.05 was considered significant. Results. 115 patients met inclusion criteria. The average age was 60 years (range, 24–89). The technique of repair included primary repair with overlay of mesh in 76%, bridge repair in 13%, and underlay in 11%. Average cost of mesh per operation was $3,709 (range $191–10,630). Open repairs were performed in 90% of patients with addition of component separation in 12%. At an average of 13 months, 58 patients were available for followup (50%), with a 47% recurrence rate. The morbidity rate was 48% and the mortality rate was 2%. Technique of repair was the only significant risk factor for recurrence with bridge repairs associated with a higher rate of recurrence ( ). Conclusions. The use of biologic grafts for ventral hernia repair is becoming more popular especially in clean cases. Although followup is limited, there remains a high recurrence rate associated with the use of human acellular dermis. 1. Introduction Inguinal and ventral hernia repairs are some of the most common surgical procedures performed worldwide. Good evidence supports the concept of a tension-free repair in most cases with the use of mesh in inguinal and ventral hernia repairs [1–4]. Synthetic meshes, such as polypropylene, polyester, and expanded polytetrafluoroethylene (ePTFE) have been widely used and studied; however, concerns regarding infection have somewhat limited their use and efficacy. The introduction of biologic grafts in 1999 revolutionized hernia repair and allowed surgeons to place these materials in infected fields. The theoretical advantage of these products for use in infected fields relates to their inherent properties of a regenerative matrix; however, robust scientific evidence supporting this is lacking [5]. Despite this, and largely due to early promising results, biologic grafts have been widely accepted by the surgical community as an alternative to synthetic products in contaminated and potentially infected fields. Increasing interest in the field of biologic mesh has resulted in a dramatic increase in the number and types of biologic products available, with over $400 million spent on biologic grafts in the United States in 2007 [5]. This rapid increase in